00080111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
nuu.DINc,AIT047 TUSCANY PL AL' S UNDERDOG ROOFIPORkIIIN0,00080111
OWNER'SNA fi:IPALA ALAN J AND MARY K 465 MARSHALL AVE APPl.lcnnorPA8'/r),fiE/2000
. PHONE: (408) 289-1.313 1Asf IARY NO CONTROL,NO.
C n> ARCHITECI'IENCINEER: BUILDING PER.MI'1INFO
1.O pOp BI.DO ELECT' PLUMB NIECII
S�� LICENSED a)NTRncroR's DI:cLnxnnnry Job Description
. 1 hercbr mB,m that 1 ant feenacd atmer prosisfons nr chapter 9 aommencag
j,H f-tO�i with Stt'tinn](OMb..f Division 3 the Husinna nnJ Prnfe%vionv CnJe,unA my license REROOF
in ran Ens and effcD [J B
w S Licenu - r- Lida� L �6.8`
LL N Dale� ' Y-� CLECILA[Af ,_�'K -
\HCI{I I'I C'1 SDI CI AN V IO,
f_-O; 1 Jnr J pl h II h sed p hl' As
Wy .
OWNER-9
Es.M=' UILDER DCCIARATIOry
l7i 1 he by affind thin I out cawnpu from it C I Bur's L cane Law fnr the
,F]7y< f Ilow 6 uu,,.Sati t 7031.5.If . e. III,]it f na Cnla Any i y n,soanty
i O which requires a pemtit m construct,alley.impmm,tenni sh,ar raped,any stm ane
at=om pnorm its mmuce,aho requires the applicant bar such pdrmitto fie asigned statement
a•3— dn,Ihelahsenscapm.nammtheprm,,on,at EleCorn d,nrshecnsaLaw(Chapter9 SyFt
. , Floor Area al6;[ik610
Ed round,with Section]10X1)of Divi%ion Sof the Business and Pral .....a,Cute)
or that he is exempt therefrom and the huNs for the alleged exemption.Any%iodation
III Secant 90315 by;my applieaal Inca pcamor aahicnta the telliran ton civil penahy
of not mom than live hundred dollars($500f AP1�d+�e�rinhgpJ3,a_„ 0Qf Occupancy Type
01,asowner,, the property,many cmpluyces"m wage us their sole I aped'atiun,
will do the work,and the ahuaurc is not intended nr oRired fnr rule(Sec.]Oda,
Business and Proessinns Curb: Me Contractor's License Law docs not apply to an 305 — FRARtHuired Inspections
r of pmpeny Who hnllds nr improves there....,and who does such wink himself
or through his own employee.,provided that such impnecmems are not intended or 307 — INSULATION
ofined for sale.If,however the building or Improvement is sold within one yew of
nmpkcnn,the owner-hndder will have the burden of Proving that he did not build or 601 — ROOF TEAR OFF
6npmvc fair parpn.cofsale'), 602 — ROOF PLYWOOD NAIL
❑I.as Burnout'fit,property.ant eadu%isdy contaid,with licensed comenanrsm 603 — ROOF BATTENS
names the project(Sec.7044,Huv and I'rolms%i n OndeU'H
tu Co.Comrac �v
License Law does not apply to an ounce of pmperty who builds or improves brown.
and who contacts for such projects with a c..mmDm(s)fceawd pursuant to —the 604 ROOF IN—PROGRESS
Com who'.,Licence Law.
01 am exempt under Sec. .B&P C far this maim
Owner Dam
WORKER'S COMPENSATION DECLARATION
I l emhy affair under Penalty al Pa d,y Ana of Iha full—iag decbuminna:
❑ 1 have and will maintain a Cendicam of Convent H,self-inowe for Worker'%
Cnmpcasadon, as provided ha by ,Sao a 3700 al' the Lubar Code, For the
perfmmance of the work fin.0ich thin permit is kwed.
I
and will maintain Watkcr'a cnntPuasmin I Inwmn't, uv requi ed by Sccnion
]t of the Lahtr Cade,for the pe111c namid of lha work ill'which dais permit is
issued.MY sYorIt Ct peonmug�Inau�ce carne,and Policy nnmher are
Cartier_s"�'G-��IT^ Ift
�ohcy No.: I_ OO_Zoo-•
CGRTIPICAI'ION OF EXEMPTION FIR WORKERS
COMPENSATION NSURANCE_
phis inion aced nm be completed if the permit is for one hundred dollar,
IS 100)or leas.)
I cervi fy that in the performance of the work fnr which this permit is issued.1
shall nm woploy any Persmt Ia ally manner an cN u,become subject It,the Worm,
Compensation else...of Calntmtm.Date
Applicant
NOTICF.'n)AppIACAN'r:It,Ana making chi.Ccnifcmc o(1'xmnmion,You chola
become subjectthe workers Cosa
mpen ... provisionsof the Inbm Code.you moat
Q O o Form.ith comply with such prm'isium or this permit.hall eaJccmcJ rcmkcd.
z .
F r_ CONSTRUCTION LENDING leading
AGENCY
a >
]thereby alli,h than team is a condi(Sec. IeoJing agency for ac perfomsancc
Liz I. he wank far whicM1 this parntit is isnueJ)sec,1119].Civ.C.1
rat
05 C lender's Name
� z LcnJcL.Address
U 0 1%colt,dea 1line III application and sale that the..hove Information is
fa. P mora.1 agree to comply with all city and county ordinances and state laws relating
Q U tnhuildinmm
g cnmtior.; Iherchy aahmlao rep .w
teeatnee of this city to enter upon
B7 the aMwcmaninncd pmparty lin'inspection m ,aw,.
y (We)agree m save,indemnify and keep harmless the City of Careful,against
V1 haluditics,judgamms,costa and expenses which may in any way accrue against said
U Z city in conwt,dowe in the gmntin,ti hi, rnut. //
APPLICANT UNDERSTAN SANDw .L COMPLY WITH AL NON INT Issued by: �' Date 9 U J
SOURCE REGULATIONS. S/l�0
Signature of Applicant/Contractor Dec Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the."'Imamn,alum holding uenpent slam Brhaadlc harardm,s mmenal Type ofRoof
or
defined by the Cupertino ldunicipxl Crede.Chapter 9.12,and the Health and Safety
Cade.S,aaw 25532(x)?
❑Yc, El No All roofs shall be inspected prior to any roofing material being installed.
Will the tmpfcant or future building occupant use eaaipment or devices which 11'a roof is installed without first obtaining an inspection, 1 agree to remove
• Deal haenrdnu.c air coin:m,inan..a,datincd by the Bal Arc,Air Quality M:uwgaaent .
nnslr`ovea El No all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have raced the buCode mown%2 rcquircmans under Chnptcr 6 95eeda n(the
ii the irnili Health!t, Crvde,Scct a I'1.th25533 ands,,,I 2553a.lundcmund shat
II the but m ai,req not currently have a,just
b,L that it Ix ury raepnce of icy m notify as
occupant of the rcquirentents which Bras(M mel prior m insuanm nl'o Ceniticam of
Occupancy' Signature of Applicant Date
Owaeroramhonced agont Date All roof coverings to be Class "Rs' or better