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CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;
CONTRACTOR INFORMATION:
BUILD[NGA2&S35 SALEM AV
JIM KRAUSE ROOFING
Pr:"MIT
OWNER'S NA tALUCKY
2310 DIANA AVE
APPLICATION SDI31
,IIONE:
SANITARY NO. 05 C gtfA
ARC] 111CCVIiNGINEER:
BUILDING PERMIT INFO
(408)779-0704
HI.DG ELECT PLUMB MECII
IUI IJ 1—I IJ
LICENSED COM RACFOR'S DECLARATION
Job Description
1 arrcby o irm that I ;an licensed order...... on, of Chapter 9 femnmemeng
,.Illvsi 3 ofthc luL,ien.a.sw.toldlS'mlsunw CnJcL. hnA ley llcennc
[riskier
iaensrSection900(
is in Fall Come sadc
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nam%TC.nd.aelat
AR OECLAHA'110N
I tee.stnry pmns,hall be usedas Ponca recoWn
SHAKES TO SHAKES /
Licensed l'mfasianal
ON
fr nl?CeContractor's
Oat
e
1 hereby .]lien that 1 :un cacm.n from the
Iran exempt
Anyc Law for my
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onC :
following reason. (.cairn 703 Business.nd Professions Cale: Any city or roomy
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which )cquire, a pumil m camlfrct, pilel, rrnfprrvu, demolh %n, or repair
r000m Cnaca,menneie
pere
nt amtiva File signed
.nn its ceiresce, also rcquitae the applicant for
Sy. FL Floor Area
Valuation
diothisbcens Con r m Low (Chapter v
ill
Diikiann
fc.npacmrsucensvhwor,Co
th reuumm00)of Di vision Bothe Bu,hie,and cam)
aolrthe is
$1.35
and Inc basis forme at e,emantto Any t
or that io is eenl:Semon and ins. Ansi
III
r Ilenrn sabisn< the applicant m a ci.dl Penaltye
ar 1 s by any applicant ct%the
er 31.5 b applicant
AP
Occupancy Type
e d a,
onmt Imre than live ltuoaen dollars (ss(en.
ann
.U"6
5.00
❑L as awmer of the property, (it my employees with wages,[V4jsjt�l
as their sole compensation,
s c _
Required Inspections
will do Inc wok, and the wucmre i, nal Iamaded or ufl'crcd Ila ,sale (Sec. 7044,
Iwsines and Profession% Code: The Contractoras Liecc Law does not apply m an
ownerof prapeny Who bunds or improves division, and who does such work himself
,it through Civ own employee,. poo dcd Incl ,r& illprznve nen , arc and inanded or
o0ircd for sale. If, however. the building or improvanenl is sold within one year of
rmpletinn, the owner border will have the btoden of �proving that III not build or
305 — FRAME
aprove tar purpasvot sane.).
307 — INSULATION
❑ I, as owner of the ptopeey. am exclusivelycontracting with licensed contractors to
mamcl the ..ojeel (See.m 'nW4. Bu,i;;c,s Ilyd Pmfasions Core:) The Cota e,oWs
601 — ROOF TEAR OFF
t an owner of Property who builds or Impmve% ervan.
License Law does napply it)m
and who contracts for such forms with a contractor(s) licensed pursuant to me
602 — ROOF PLYWOOD NAIL
Contractor' Lic... e l.nw.
❑ I am exempt under Sec. .B&PC frnt, ream.
603 — ROOF BATTENS
Owner Daae
604 — ROOF IN—PROGRESS
WORKER'S COMI'IiNSN'ION DECLARATION
I hereby ahnn urcEr permlty of psemy.nc of the following deelarmians:
,
❑ 1 have and will a tinam a Cenllicare of Consent In %d&ins re for Worker's
Commnsation, as provided for by Section 390(l of the Lahr Civic, for the
performance of the work for which this permit is issued.
Ahave and will maintain Workers Compen%arear In.wmnce, as required by Section
AW of the Labra Code, far the performance of the work fur which this permit is
t
issued. My ke', C n tin Ineumncc carrier and Policy I other aarrc:
-
Camer: P.licy Nw:"_ ✓-0d—e /3
FROM
CIiR"1'ligCAT1ONOltixTioNINS FROM WORKERS
��oOD
COMPENSAOONION
(Thi, w raion nccd nal he nau.leted if the prnrdis future hundred dollar%
(61110) of le".)
���
I many that In nh pclli,rnrenac .l rbc wort, for wh'r,h this permit Is issued, I
shall nal employ any pelma in any manner wo as m become subject to the worker
O kT•
Compemmian Laws of California, Dam
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N`
Appliaml
P.
NOTICE TO APPLICANT: If. after making this Certifiers of Ess lap.... y.. %Could
brcamc subject to the Workers Compensation pmvidons of the Lahr code, you must
lo"hwnh enmply w lh such provisions or this permit shall be dermal revoked.
(y
CONSTRUCT ION LENDING AGENCY
V�
I hcrchy alllnn diad mare is a aon,wunior landing limey tin Inc perhor fee
.f die work far which this ..it is issued (Sec. 300. Civ. C.)
-
Lendds Nandi
lender'%Address
I veedy that I have read this application and state that tne:dswe information is
.mel. 1 agree 1. ,imply who all it, amt .oarty oldr-o''es and sone rows rchteag
.
to building construction, and hereby rutnome ocpre,emmfives of this city to enter upon
the a sveynontionN pr.peny for imlroctnor purposes.
(We) rgrec to %ave, indent riry and keep Carries, ore city ofC.peWn r outlast
rabilitie,. jadgmems, cast, mall v%psnws which may to any way .cane rgairwt said
City In cnnscyucnee lM1e gmmmg of mi% perms.5`2C,
APPLICANT''RS'NI)SAND'ILLCOMPLYWI'I'HALLNON/�'(OIN'
Date 7 -u0
SOURCE ATIO S.
IgSnedb y'
rh �ij�y��
—T
Re -roof
Signature rl Applo, Contractor Dai"—
AZARDOUS MATERIALS DISCLOSURE
Will me annliwmt nr home handing twcuprnt .store or handle Corridors mateam
Type of Roof
aw delinN by dile Cupertino Municipal Calc Chapter 9.12. mW the Hear, and Safety
Cala section 25532(.)?
oyes Llbi
All roofs shall be inspected prior to any roofing material being installed.
wmme applicant a. moors building te,ttp.nt use vgriptnem or Ifwhich
If a roof is installed without first obtaining an inspection, I agree to remove
coil bue:vd a,s err onnarimants if, defined by the lin, Area Air Quality Management
District
all new materials for inspection. Applicant understands and will comply with
°Ya,
all non -point source regulations.
1 have read the hara does material% requirements under Chapter 6.95 of the
California Health & Safety(Code, Section, 25505, 25533 and 25534. 1 understand that
Ifnhe CuilJing Anc.uun cuncntly have a mnun61hat it is my rewpon%Ibiliny r, notify the
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occupant of the requirements which must he met prior ut issuance of a Cenificme at
r
(kntp
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Signature of pelican[ Date
All roof coverings to be Class sB" or better
1)
Owne.m emu met ng nt 1)ate
OFFICE