01070155 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19938 TWILIGHT CT 01070155
OWN R'S
Hb�RNG-LI 07/31/2001
PHONE: SANITARY NO. CONTROL NO.
M es O ARCHITEC(ENGINEF,R: ` BUILDING PERMIT INFO
X u,- B G ELECT PLUMB MECH
y .z 1 L_-I I� 1.—]
u=Ni i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions cf CTapter 9(commencing REROOF . P
rrmFso with Senion7")mfpDiision3of�lhe Businessand Pmtensions Ccdc.undmylicense
<yEd ain cen Coro=anae 3 SPRAY INSULATED ROOFING ON SUBSTRATE.
z 2 Licenser Class u[..
3 N
Data Comracto
C u O Q ARCHITECr'S DECLARATION
I undersand my plans shall be used as public records
so
�so
a a O Licensed Prufesxional
es F5 OWNER-BUILDER DECLARATION
at w I hereby a1Rm that I in emmpt from the Commetor's License Ww for tae
r z< following reason.(Section 7031.5,Business and Professions Cale:Any city or courtly.
E x o which requires a permit to construct.alter,improve,demolish.or repair any structure
3 c .,prior.to Itsis,uspre.also requires the applicam for.such Permit m rile a signed statement - 1 26;00
-
thatheislicenseepursmnttotheprovi.sionsof the Contractor's License Law(Chapter 9 Sq, Ft. Floor Area- Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code) t _ .( sem•1• s„ t !,
or that he is exempt therefrom and the basis for the allegca exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penally 1
Iof not mom than five hundred dollar.x500). APN Number I sL",,,f- Occupancy Type
or',as owner of he property,.my, empmyees with wages as their sale comp=asaaon, 305 - FRAME ! .
-wdrnn he work,Profession,
structure i..no,mteneLi or Low for are Isec:1044; 307 - INSULAT I�uired Inspections 1'`' .r'._•U, -
'will io antl Profand h Care:ure I, n,sten edorLicense Law does not apply m 4' ^
owner of property Who builds or improves thereon,and who does such work himself 601 - ROOF TEAR OFF t
or through his own employers. n,,Wed that such Improvem its arc not intended nr . ._
offered for sale,If.however.the building .__. _-._ ......... .. _._...._ P, .. .. .. ..- -
m mprovettcntt rola within 602 - ROOF PLYWOOD--NAIL',
iohipinion the owner bn leer writ have the burden of Prov n8 that he did not buil)or
mprove rte pnrp,a=nr salol. 603 - ROOF BATTENS 1
----- -..__. --- -- -- --- '--- --... - —PROGRESS-
LI -
s ofthe property, exclusively ly t i g with licensed contractors to 4"_._ _
construct the project(5 701 Business and professions Code:)The C t mr's , ( s
License Law does not apply to an owner of prolsorty,whoWilds p thereon
and.whot commets.forh pritects with a conumplorm)licensed.pursuant m.the _ .__- - .. .. .._..__ _ ._. - ------
Contractor',
Cot t License La
❑I smemntp order See ., ., ,B&PC losdulreason
Owner •` Date -as
WORKER'
WORKIiR'S COMPENSATION DECLARATION
1 hereby alfir under pcio diy of perjury ane of the following declarations. Q/
❑ 1 bavc and dlmaintain'a Cenificum of Consent to self-insure for Worker's
Cmnprnxminn, as provided fur by Section 37W of the LMr Cods, for the
redo/soused of the work for which this peril is Is.med.
�I have and will'o.inmio Workers CmnMnmiionrinsunince,an required by Section
37W of tae Laanr Cotte.for the perftirmanceof dic work for which this peril is
issued,My Workers Co(ixtdallion Insurance carrier and Policy number are: -
Carder
art 1Pol cv No
CER IFICATION.OF EXEMPTION FROM WORKERS Fv, - 'k s '1•
COMPENSATION INSURANCE
^ '' yl(This v'lion nerd'not be'cnmplemd iftbepermitis forenehundreddollurs
ISIW)m less.)
1 ein fy th i n the n in any manner
s a k for which Ni ct lis ts: 4t1
Confirmation
nnl employ any person n any man r as to become subject to tae.Workers
Comicant'ion Wws nl Calillimin.Ore
ApplNOTICETOAPPLICANf ❑ Ter k g b.C of of Esempt on you should ` ` -
O Obdcomc subject to the Worker r Compen.otos Prov s ens of the W Mfr CWe you must
forthwith complywith such Provisions orthis Permit shall bedeem=dmwkm.
'V] -- ----- •CONSTRUCTION LENDING'AGENCY.• " ^'1
C > "I tmrtby affim,that is a construction lending spent;for e perfdniu m, t. ,.'I ..
r�:r
fare work for which this peril is ksoed(Sed3007,Civ.C.)
Q CeMci s Name '
=); LBnder's Address "
C.7_Q . 1 certify that I have read this application and state that the above information is
t& F
to
1 gratocomply he all city J county I' nc J,: 1suser upon
0 C.1 th bake g construction,pr and hereby i ihm¢e rep r i Oc ofthis ry t enter upon
: E-9s7 the M t P.P pertyt p=a purposes.
p. a two) B t indemnify Jk keep oar smcCly fC penlno against e� o tq lialudg t. t J pe h a Y anY y [m gainst se d
Z City in cnnsoque fin nl the grana tg of this permit. _APPLICANTllNDERST ' SA " LCOMPLYWITHALCNO'.POINT Issued by: Date , .
at ULA V/Lr e
si awre of Applica HAZARDOUS
'.,,';,Date Re-roofs
H\Zorfupa MATERIALS DISCLOSURE r.
W ilm=hppr2 I ft i lenspur. tre .a tWhen d'rmmene Type of Roof ...
v
Core.Section
d by the Cpen nn Mun[ .� Chapter9l and Healthand Safety - r .t .tiro . 1
ca
S t n2551 ' e
tote. -All roofs shall be inspected prior_to.any_roofing"materialbeing installed.
•t,:,QVilltheapPlimmorfuwabuilding«cupomusccquipmentordc,im,whi,h If a roof is ins[alledlwith'out first obtaining an inspectiol','Ilhgree to remove
emI t harardoux air contaminants as defined by the Bay Arca Air Quality Management
Dia&e C3,N/ all new.materials for inspection., Applicant.understands and will comply with .
'01yes �:- - - all non-point source regulations:.
has read 0<homNiau<materials mquiremeius under Chaptci 6.95 of the 1
California Health&Safety Calc.Sections'3505,25533 and 25534.l understand that _
RhePIdnb.J nt a h x Ih my .po.hfry to notfy the
[ am of th u mem mu I be t to i.. one f C nit to of
Signature of Applicant Date
o= P 9 P
r�- r mnraee gent Date All roof coverings to be Class `B" or better'
,..,,, ,,,,,,,,,, ;,,;,, '. ,•: . .. .: _,.: ... f - __ .OFFICE.