01010072CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS;
22625 SALEM AV
JIM KRAUSE ROOFING
PERMIT NO.
01010072
(IWNIiR'S NAME:
2310 DIANA AVE
APPLICATION SUB DATE
01/18/2001,
CHAO ROBERT Y AND JEAN
H
Ill
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SANITARY NO. CON'rRol, NO.
(408)779-0704
ARCHI TF.0 7IiNGINEER:
BUILDING PERMIT INFO
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BLDG . HLECIPLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
,lob Descr Ion
I heraby affirm than I an, licensed .reIs, provision, rel Chaptar 9lennon encing
with Section 70NE of [)is xinn Sof the Ra,irn,, and Pn,les,uns Code, and my license
It murra ana�e39 55L
Licence
; ., ,,
T/0 SHAKES, RESHEET 1/e CDX AND 0# I
Claes 5/
Date /�a� cnntmCanr_
ADD 40 YR GAF COME' SHINGLES
ARCIIII EC f'S UECI.ARATI(I,
1 understand my plans shall be used a, public record
Licensed l'mlussinnuI
OWNER-BUILDER DECLARATION
I hcrchy upirm Ihet 1 ren exempt from the Conracen's License Law for the
following remnn. ISn'ano 7031.5. Business load 11 1 ..was Code: Any city or county
which requires a permit to Consumer. after. improve, demolish or repair any structure
prior taus icxnance, ad,n requires thmipplicurn on'such permit m filen signed tlate I
Sq. Ft. Floor Area
Valuation
that be is licensed Puhsum,t talk prevision, ohne Contractors Liamc Law(Clwpter 9
(commencing with Section 7000) Of Dimon 3 of the Baines, and Prnfeuinns Code)
n that he is csempn thcrclrvm and the basis lie Ibc allepcJ esemptian, Any ciolurinn
al Section 70335 by any applicant for a pem,it subjects the applicant to a Civil penally
APN Number
Occupy
III rel acme nrvn live hundred doElo,1($500).
❑ 1, as owner orthe pmpeny or my employee, sold, wage, e, their sole a,mpcamion.
I.
3421208 itec�l ed Inspections
will do the wad.. and the ,wnure is not intended o, mitred for sale (Sec 7B44.
Business and Profession, CWe:'fne Contractor's License Law docs nor appy In an
otoncrol'p,,,ryny Who ndddl or improve, Ihemm, and of Joel such work hln,xelf
or through his own coodoyms. provided that such impnrcenxnls are not intended or
nntred (resale. B; howe,cr. he bldlding o, Inpmcemerht i, sired within one Bear oI
'W
— FRAME
pili0 M1 IJ Ilh rel burden fp bthtl JJ Ilor
.305
i an Pn I p R r ')
301 — INSUROOF ATION
❑La nn property, exclusivelycontracting 'Idlicensed n r :rn
TEAR
E01 — ROOF TEAR OFF
eConstruct In project (See,7(o a B I f Core:) m t tor',
d I spirt fproperty ao builds 1'o to „"
602 — ROOF PLYWOOD NRIL
andLt
and who ermrmn> for ,act Pm¢su sono a conlranurl,) noosed pursuant ro Inc
are License
— ROOF BATTENS
❑1amesr, nodes Sec. .BNI'C for this na,a
01.,a Sec
E03
604 — ROOF IN—PROGRESS
j
Ovo Due
WORKER'S C'OMPENSAI']ON DECLARATION
v
0/
1 hereby out!. order I,anay of pc jury Co. of rhe following deck rutinnl:
: I has and will naintain n Certificme of Consent to xclt'-insure far Worker's
Compensation, as provided list by Section 3700 of the UlNr Code. for the
Nrlbl man,, nldw wort in, whim hi, ,,,Pont is koa,d,
. I have I d will maintain Worker's Cnmpensatiun Insurance. as noin:J by Sec,ion
1-11Ed If use Labe Code. for the ),edonmun:e ret the work for which this Novi, is
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issued. May Worker , Cnmpcnv ton Insurance Courtier oral Polley numMrr
re;
]'.It, No. �e$S—Ori—OV
CI'.R I'01CATION OP EXEM I'fION FROM WORKERS'
COMPENSATION INSURANCE
(This scurin I rand oat he can... cd If the Inrn.it i, fur nnc hundred dollars
(SIN), lar let.)
1 Certify tout in Ire performance of one work for which Infix Permit Is Issued. 1
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shall not employ any person in any manner so m to hecome subject to the Wnderi
Cnnquns;aiun Law, at CuEhonm. Dine
Applicant
NOTICE 10 APPLICANT: IL alter nuking lea Cetilianrc of Exemption, you should
nmm,e sit bjca as the Worker's Conhpeaarion previsions of the Labor Code, you Cars,
comply with such provisions or this permit shall W deemed accused.
CONSTRUCTION LENDING AGENCY
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I hereby affirm feat there i.s s construction lending agency for the perromianco,
of the x.rk for which Eris permit I,. issued (Sec. 3097, Civ. C.)
lander', Name
Lenders Address
I ereify In:e 1 have real this applicution and store that Ibc akoe informmion is
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sect. 1 agree m comply with all city and comfy undinunecs and s(laws ,eluting
Corr
building consnmction. and hereby authorize representatives of this city to enter upon
the nbuco-mc oncawd nopeny for inlpccfinn Puquuus.
(We) ague to save, indemnify and kap hurdles, the City of Cupertino.,.ince
liuhill' '. Ildgncnl,, cont, zone Cv,cnsc, which may in any wary, accme again,, said
Ci m orequcna of Ise grinning of this permit. ��"
,'PLICANTUNDE ANDS AND L COMPLY Win I ALL N(%+_Ny`Ir
'DURCE u 'IDs,. �/8//�
Issued by: Date
Re-roofs
signirmre�pplicen✓ nnmca„ Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or turner building o,ccup ons sone or handle Wzadaos anterial
Type of Roof
ns Jdined by Ise Cupertino Mm,ici,ed Coolc. Coupler 9.12, and the lRaI o land Sat,ty
Code.e o 25533W)!
Yc ff—
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant:,r future wildingmeupa.Iuse egnip.aat cle.iee,which
If a roof is installed without first obtaining an inspection. I agree to remove
em it nuardons air C Cral.nanl, a delined by the Buy Area Air Qnnlhy M:magerncnt
hrrieaall
new materials for inspection. Applicant understands and will comply with
O Yen
all non-point source regulations. '
I have mad the hazardnu, matenul, acquirements under Chapter 6.95 of the
Calitbmiu ILech a, Sufery Codc. Sections 25505. 25,133 lord 8534. I adcnumd n hn
the Wilding does not Currently love a accent. neat it is toy responsibility n, coolly flue
T"J ��^ / Q
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,oenpa�m�oao�Jf Inc ,cots which now W ter poor m iswancu cera Ccnilisam of
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Use up�k{ /
Signature of AppVant Date
�/�
t`—�a,d C
All roof coverings to be Class `B” or better
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owner
nr atm„rice
OFFICE