01080035 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
,I BUILDING ADDRESS. PERMIT NO.
l� 21230 HOMESTEAD RD APT E ALL SEASONS ROOFING SERV CES01080035
i
OWNER'S NAME: APPLICATION SUB DATE
AVERY CONSTRUCTION 2640 PACER LN 08/07/2001
PHONE: SANITARY NO. CONTROL NO,
4089724455
D z ZARCHITECT/ENGINEER: BUILDING PERMIT INFO
�v O O BLDG ELECT PLUMB MECH
la U I_.] 1__.J 1_ 1 L-1
w i LICENSED CONTRACTOR'S DECLARATION Job Description
OO Z—C1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
pmFw with Section 7000)of Division 3ofthe Business and Professions Code,and mylicense TEAR-OFF TORCH DOWN
6m I; is in full force and eff q p r
�mpea Lre...Clan '_3� 07f
w3 U, Damn Contractor
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
N
X O O Licensed Professional
K
e' o z OWNER-BUILDERexempt
DECLARATION
w—m 1 hereby am.,Rthat 1 am exempt from the Cession o License Law for the
�Z Q following mason,(Section 7031.5.Business and improve.
de Professions Code:Any city or county' $3000
e'—❑ which requires n permit m construct,the aalterpplicant
improve,demolish, f,repair any structure
a 3= p to t. . seance r q a parciu l can[foc Comme re,t[ is .gnw(statement - --hot hI' sed pt n7000pfDivision3o the
L LawonsCo e) .yep L}'+. F nor ApjCa Valuation
or m gwnh5 t taha and the sisaofthe Bust o tit Professions Coder 3L b•OoD�b •'VU •+"
or that he is exempt tbercfrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty y�
of not mere than live hundred ratios,(s500). 305 APN b'� Occupancy Type
°1,as owner of the property,or my employees with wages m their sole compensation, '
will do the,work,and the structure is not intended or offered for sale(Sec.70.14, F.
Business and Professions Code:The Contractor's License Law does not apply to an 601 - ROOF TEA&FgV*#,Inspections
ownew of props Who builds or improves thereon,and who does such work himself
or through his own employees.provided Our such improvements are not intended or 602 —..ROOF PLYWOOD NAIL
,offered for sale.If:however,tlm building or improvement is sold within one year of
-compinion,the owror-builder will have the burden of prating that he did or(mild or 603 - ROOF BATTENS
improve for purpose cisme.)' 604 - ROOF
- . . - .. . .. _._.. IN-PROGRESS
111,as owner of the property,am exclusivelyri g h 1 contractors m .
_.. ...... _ -..
..
License the project Sec.]14Q Basin d eProfessionsCode:1 Th C then n nA L EM
License Law does not apply roan Deane f property y n builds ice p (Here
Ifs i
f and who contracts for such projecns.with connactmis)licensed Pursuant to the ... .. ...... _. _... .. _. .. ._... .. .. .
' C mrazmis License Law. -
OulamexemptunderSec. ' „B&P,Cfar thismanom DEC 1 1 2001is
Owner. Date
"t WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: 13UILDING
° I hove and will maintain'a Cerdfcam of Conan
nt rad self-insure for Warkcr's V Vl
Cnmpensrtion, as provided for by Section 3700 of the Labor Code, for the
pe umancoce of the work for which this permit is issued.111 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the,performance of the work for which this permit is
i d My Wo is Coope i ori Ins 'lir and Policy umber arc
Carz cr f V .. P'Iicy No,Val oa 4eLl ort' / � .. _ .._ .. -:,.. ... .... .. . .
C IFICAT]ON OF EXEMPTION FROM WORKERS' - -
.; COMPENSATION INSURANCE' -' . - _ .... _. _. .. .__..
' (This section nee.1 not he completed If the permit is for one hundred dollars I' -
p ,
(E HMI)or less.)
f certify that in the p in any manner
me work for which this permit a issued.ker 1 t
�&hallCmu not employ wany s;f Cali in any manr¢r so m to become subject
m the Workers'
Applicantp� tion Laws of California.Date
- _ .. ... . ... . _..... -. . ._
Ncome subject
Workers
this Cisions fof Lobar Coca.y umuist
'become subject h the such pr Colons or I,provisions the Lobar Code,you must
Z O forthwith comply with such provisions or tM1is permit shall be deemed revolved.
FCONSTRUCTION LENDING AGENCY '
]bomb y ff that construction is a cn: ci n lending agency for the perfornmnce
W ► mf herk for which th permit is issued(S .3097,Civ.C.) .
C6 to Le d r.Name.:.. . . ._ .. _ ......
Z),,Z I add a_
_ V'O I deityy dirt I have¢adthsoppl vv on. dsomeohm the above' o...nadun is
W r F correct.I agree to comply,with all city and county mJimances and state laws relating
OPV to building construction,and hereby authorize representatives of this city to enter torn
>,'w the above-mentioned property for inspection purposes.
E.46 (We)agree to s.an,indemmy and keep liturnficts the City of Cupertino against
In liabilities,judgments,costs and expenses which may in any way accrue against said
V•^ City in cunsequence of Ihe'ghming of this Pe 't.,: .�/(/�
_ APPLICANT UNDERSTAND$AND /I tlMPLY WITH ALL NON-POINT Issued b Dale CJ `
SOURCE'REGULATIONS. - Y'
Signacurebf ApplicnMConnhdor, ' .. Date Re-roofs
..
HAZARDOUS A ERIALS DISCLOSURE -
WWII the uppl c rat o f wre b e occupant nos or handle haiardrus austral Type of Roof _. .,. _ .._ .. _.
as defined by the Cuperi nm Manic Code.Chapter 9.12,and the Health and Safety
Code.Section 255321 )
°Ye'` ° - All roofs shall be inspected.prior.to.any.roofing material being.installed..
..Wil Ithe applicant or future Mimi as,occupant use equipment or devices which If a roof is installed without first obtaining an'inspection;'I agree to remove
emit hazardous err nasturtiums as defied by the Bay Area Air Quolhy Management
DLaant] .. all new materials for inspection. Applicant understands and will comply with
ore. CNr all non-point source regulations..
I have mail'he hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,M533 and 25534.1 understand that
..little building does not currently hmea commit.that it ism ox,rusibilitym notify the -
decupam of the requir
Occupancy. is 'must be mu prior m issuance of a Ce'
nifeme'of
'
j � Signature,of Applicant _ Date
Ownauthorized a n - - - Das All roof coverings to be Class"B"or better
: .
:. . . . , .. .. OFFICE .. . . .. .... .... . . .. .....