01090063 CITY OF CUPERTINO
BUILDING DIVISION PERMIT' 'E CONTRACTOR INFORMATION:
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BUILDINGADDRESS: PERMIT N(1
7565 BOLLINGER RD EXTERIOR SOLUTIONS 01090063
OWNER'S NAME: APPLICATION SUB DATE
WONG STANLEY H AND BARBARA P 1771 SMITH AVE 09/17/200.1
PHONE: SANITARY NO, CONTROL NO.
(408) 358-1233
❑is z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
F'w O BLDG ELECT PLUMB MECH
Fit O I-J 1_I IJ
an w z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby i fHon thio 1 am licensed under provisions of Chapter 9(commencing
„F5 with Section 7")ofDlsl%ton3oftInUmbriessand Promasion%Code,andmylicense
REROOF.
` ism fun forte and eifec
ce w a Licenx 1,aa �_t_ Lies 7 3 REMOVE SHAKE, INSTALL 30 LB. FELT &
1e. Date-/�_ e Cemmelor "- — 7/16" ISB & CELOTEX PRESIDENTIAL.
ARCHITECT'S DECLARATION
:RS 1 understand my plum shall be used as public records
Y
i p O Licensed Professional
OWNER-BUILDER DECLARATION
w 1 hereby.(Seco that 1 am exempt from the Contractor's License Law for the
t z< following uiman.(section 1031.5,Business and Professions Code:Any city or roomy
I O
which requires a perent to construct,alcor,improve demolish,wrepair any%wm
cm
.pm --pr ort i ' also re4 'lea the ppl tf nonsuch pemi0 ffi l signed immanent,
in the %1 ath ep frimmtom p sio rat conimctnr L Law(cn pt r9 S Fi Floor Area, -- s $i ation
ne m ngwthSci 700BofDvis 3 of the Busincap W Hpfessions Code) �.-two , , A `-,1q,'S>< - .. .e s ,Yi.,yaS,.LS 1ft v" y81�
or ih t h _- mpi th mf7om'umi the basis for the alleged exemption.Any violation
s-ofSection 7031:5 by any applicantfor a permt subjects the applicant to a civil penalty ! ,itr
turret mir
- -aenndreddollars(a50o) 35SdMI tb®f0 i i Occupancy Type
j °l.as owner ofthe property,or my employees with wages as their sole compensation, _
will do the work('and the stracture is not intended or offered for aide 7004,"
9 A, ss a'Proreons Code The Commctor's License Law docs not apply to ad 305 - FRAME Required Inspections "11'
mcdor of property Who Wilds or imp vas thereon,and who does such work himself
or th o h his own employees pro dee that such improvements are not intended or 307 - INSULATION 1 _
.come le 1 If,h thebuilding vetheb nen ofprotrssald awrthmnot care or'' 601 - ROOF TEAR OFF '
mcompletion,the owner builder will have the hoiden or proving that he die not build or `"
prove for purpose of sale.). _ 602 - ROOF PLYWOOD NAIL
..O.I, %owner f,ha coined, in exclusively.. .... . ..- ..603-
_- oaawat he act(sec lona.Business ad contracting obi,cove)The conimcmr's 6 0 3' - ROOF BATTENS
604 ROOF IN-PROGRESS"
License Law date cts,f apply to an owner of property who builds or improves thereon,
,
.,and who contracts,License
such projens.with o contiacmrt%).licenvd.pursuam m the
01 m agar I Inde L
❑loco exempt tinders ' B&Re fortms mason
er. t -
WORKER'S COMPENSATION DECLARATION Pa(ILA L.ED
I hereby affirm under perialty off, 1.my'one of(he follnwingdc,IrmtiW,:'
° I have'and'sill mainiain'dCenificaie'af consent I.self-inmre for Worker's OCT 15 2001
Compensatiom�as provided for by Section 37M of the Labor Code:for the
_ perrormhnceorthc work for which this pennitis Issued
°Ih dwilliilhnuunWok 'k Co p C 1 a requireJbySection BUILDING
` 3700 of the Labor Coda,for the performance of the work for which his permit is
issued MyWrkr'C mpensoton ln.um ter' dPal y'number,rea y-
e, ! i ERTIFICATION OF EX 7 k k, . .`. ..
r 1 EMPTION FR -
C t li / .iAL t.5ty P Y O'All _ S Y se ( "t< 6 '� sF t i
-r COM NSATIN INSIIRANCB r ,r r t .,._. _.,..._ . ...� ..._ ... _ -.------..---
No
1
11 (Th 6i on rival not be cont let f th permh is for rte hundred dollars a s tl* ``-+n (" r W
) (SIO% 1 .7
(
..`Compeosat on Lews f California aaioa,er so to be'cone subject to the'is issued:
1 n f th t in the rfoima re (the ik fp wb-
ad ch th s t Is u tl I r
' P Y YPe Y j ,.µif i ) �i�A..
.Applicant
-'
i'Not ICE TO APPLICANT If,after
mak ghsCrtfieto ofF pr y
should
0neem subject to the Wok C cope t p Loh Code: must
C) forthwith comply with h p this hallbetl deemed reached.,
i
i
1
F
o am that
AGENCY
-t' 1 hereby arnrm ih,t th s u constroction leading agcy f 1 the performance .-
(thew kf whmh th pe it sd d(Se,1p91 Crv.C) 1 I
WQ Lenders Name ,.m...._ .. .. ._. . ._... _. _ . ..
11
�Izl Ledr Adds "._
V Q y l I cert fy ihm I have read this apps mon and state ihauhe above information is
correct.I agree to comply with all city and county ordinances and state laws relating
0..V to building conswdion:and hereby'a tic iiis repreaeri.6is of thin city to enter upon
the bo m foned p petty r Inspection p rpo
ei
(W)cl to ae indemnify and kap harmle sdo,6iy of Cupeninoagainst
r'Ln liabilities judgments costs and expenses which mayin any vciy accrue again,amd
V z
City in consequence of the graddiagortho,permit
kPLICAo IDERSTANDSANDWILL COMPLY,W,ITHALLNON- OINT`
0 CATIONd ' Issued by:
Date
APPI!c ' jl Datat Re-roofs„HAZARDOUS MATERIALS DISCLOSURE
,,. W 11 the application 6r fikine building occupant store,or handle barnrd os mate el Type of Roof- - v .,
,.
as diffirsed by the Cupertino Munmipal Code CT pt r 9 12:and the Health and Safety -
.. ,.,'.'.: ... .g .. g . ....
Code Section 25532(a)
fr 1 - •. ,
°Ye, °lv by ra` 'Ir gemen spected-prior,to.any.roafin .matenal.bem installed.,-.-
c; �, - All.roofs shall be m
�, W II the applicant future building pari intuitional devices which, If a roof is installed'without first obtaining an'inspectlori;'I'agree'to remove
D t h b - A,I Quality Maria- t _ PApplicant._ _ .. .
vii i ,. ._ _
N
P � g „ d will,comply with
a new materials or inspection. an
„ all nop- Dior source re ulatjons. ..:
I
have read the hazard us m te`nal mgmremact0onda,Chr,Ba�fi.9' ' iiia
fth Budd n tae automation th t t d 25530 I understand tate
Calif H lth&Safety Code.Seci ons 25505 25533 en
y report bltyi �u�ytho
i eatebr \ _. g s B or'b-16 G/
Oc relaPoco of th`rrzedi e t h ch must be met Pn r to Date
g o c n m y ave y
P
iy g PP All roof coverings to be Clas
I nature of A hcant
Date ii
; .
IZ
OFFICE ..._.... - , .., __._ ..... ._.__..... .... ....
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