01090080 CITY OF CUPERTINO I ` - _-0
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS: PERMIT NO.
20198 CAMARDA CT PRO ROOFING 01090080
OWNER'S NAME: APPLICATION SUB DATE
YUM SU I AND YOUNG J TRUSTEE & 100 BLOSSOM WAY 09/20/2001
PHONE: SANITARY NO. CONTROL NO.
(831) 440-9100
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
s m BLDG ELECT - PLUMB MECH
Qu
yea L'.0 O U L_1
LICENSE-Z! Ihereby affin I]am]],tensednndeRproviamasof hapter9(commencing Job Description
IATION
yt with Section 7000)ofDivision33oafttheButmenisand ro cions de, dmylicenu REROOF.
Ss t rnn force arta err,�r( f- INSTALL 4 0 YR. COMP.
c 6 Liecrec C s ` 2 U1.1
e aO�u Dam v ,DECLAr
ea.0 ARCHITECT'S DECIA
O� 1 understand my plans shall be used as public records
iaf
i p O Licensed Professional
6=, OWNER-BUILDER DECLARATION
1 hereby affirm thin 1 am exempt from the C scions o e:A, Lew for the
t 8 following reason (Section 0031 5,Business and Professions Cade Any dly or county
O which require'a permi'm construct, Iter improve,demolish,or repair any structure
c. m •-pn , ¢ innaalcor 9uve provisions
of me Contractors
icameL
— thin hd I Gained pursuant[o the prop ns of the the Business
L Gene Law Chapter 9 5' t �"looL ea
(commencing exempts (o Joon) frn Division a the.Bnhm .aaahal i loo) A.,(?'a`_ 1a � 9, i,sl- _.',.+mss.,re C -Valuation:,.�.' 3? ;
or that he is exempt therefrom and the bass for the els the eztmpnion Any violation
of Section 703 LS by any applicant for a permit subjects the applicant to a civil penalty'
of not more than fiverandreddollarxa5w). um er Occupancy Type
°I,as owner of the pmparty,or my employees with wages as their sole compensation, f
'%ill'do the work;and the stmwre is not intended or offered for side(Sec.7044,
' c
Business and Professions Code:The Contractor's License Law does not apply,o an 307 - INSULAT ft4Dired Inspections'
owner ofp parry Who bdda or improves thereon,and who clues such workhimself 601 - ROOF TEAR OFF
or through h' ply provided that such improvements are not intended or
offered( 1 ]f h thebuild improvement is sale within one .... I. ._. _ .. ... .._. ._. . .__ ..
gunmen of Pr year or 602 - ROOF PLYWOOD NAIL']
io'pl tion,the owner builder will have the burden of proving that he did not build or '
mprove for propose a Is ale.). 603 - ROOF BATTENS y
❑Los ownerof the p openy, exclusively contractingwthli nee convacmrsm 604 - ROOF IN-PROGRESS ,
construct he paged(S ]044 H nes d Professions Code)Th C t czar s A C
License Law does not apply i n owner f property who builds n improves thereon, P I N A LED "
�aaa/ 1, _
and who omamos for such.projects with..contractor(s).l licensed u muam[o the :
I;. Co v set rs L cense Law ... .�..... .... . . .. . . _ ......._... .
exempt under Sec B&PCfor this reason Fav„ j 2001 Ownm i' U
"WORKER'S COMPENSATION DECLARATION
I hereby affirm under penatry or Qerjury one oflhe following declarations: BUILDING
° 1 have'and will mountain a Certificate of Consent'to self insure for Workers
Compensation, as Provided for by Section 3700 of the Labor Code,-for the
performance of the work for which this permit is issued. .
°1 have'and will maintain Worker's ComPeralfifimahaviounce,as regoned by Section
3]00 of the Labor Code for the gaeurmence of the work for which,his permit is
"ell.„My N'rke C rope l 1, see c d P Icy numbe r:..
�. COMPENSATION INSURANCE
ertat IPJCATION OF FRO Y
„ -
0 ,I _
r a , '�' 111 $4 1..,5 ...
M WORKER
{ 4 . '
lilt's sectiohundred
- r, ._.. . . . .......... . .... ... ..
CERT t.
n ncid tint he oomplemA f the permit is for one h ntlred dollen
($100)or less.)
i. I cemfY,tha,in the performance o(the ark for which fis panni,is iss d 1
shall not empl y any ny man so a m hecom s b)ect to;the W rk ri
Co ge rd ori La Caor
NOTICET APPLICANT If afmrmakrg the Cendicale of Exemption,you should $•n -:r ;'
becosubject to the Worker's Compensation pro ision's of[h lab Code,you must
Q Om
fonhw ith comply with such provisions of this permit shall lis deemed revoked. S
,Z _ ... .. .. .. ......._
F-� "CONSTRUCTION LENDING AGENCY -
a, 1 M1 by R th t there construction]coding ag Y f m performance
oftn
we
k f which th perm,' tied(Se J09J Civ.C)
Leader'.N ..: .: .. . . . ..
.Z _.... _.,. .. .� ..:_. ,....
LeadeetAilifire,ii
C.) .I cemfy that,I have read this application and state that the above information is '
IT 1; coact.I'agrte,o comply with all city and,county ordinances and slam laws relating
gyp[) to building cruswetian,and hereby autfiori eiepresentativas of this city to emerupon
the abeve-mentioned property for inspection purposes.., _.
(We)agree to xf,,J indemnify and keep hm
adcss the Ciiy of Cupertino against
F+. h
liabilities judgments, t d expenses h h may in•any wit,arcane against said
V City in consequence of the grafting of this p rain
APPL ANT NDERSTANDS AND WILL COMPLY WTfH ALL NON POMT
so UI.ATIONS Issued by: Date
Sig am fApplicam/Contreclnrv;. r, t:."I Date:
HAZARDOUS MATERIALS DISCLOSURE '” Re-TOOT$
CJ ,handl healt team 1
Wu th .pphes t fid.bti long ace p r r Type of Roof- .. ... ,
az d E ed by theCupertinoMunicipal Code Chapter 9 12 and the Health and Safety
ode Sat -25532fe) 4 'sA4a si f s' -%`J:1 0. ,f`♦ }t� p ;,� f1 e: - '.: : rl '. i
°YC5 Q" + at- _.. All roofs shall be inspected prior to any roofingr material being Installed.
f— Will the applicant orfuture buildingoccupant use equipment ordevices which If a roof is installed without first obtaining aninspectid' I'agree�to'iemove
y Management inspection. Applicant .. .. _
A Q al i ,
Y Y r -'• all non-materialsall new t source re uluons. A hcant tinderstands and will comply with
amt anarlin,air contaminants as defined e a Area
❑Yes DNC
P g
1 h e read the hazardous team els rrq menu under Chaps 6.95 of the
California Health&Safety Code;Sections M505,25533 and 25534 I understand that
if the building does not currently have-am t that it ismyresponsibility to notify the
dcca Yupan f th requirentt wh ch must be me,pno to iss nce of a Certificate of III
' SI nature of Applicant Date
Otrautho : , . � .:.
ng SP✓��G o„y All roof coverings to be Class"B”or better
ICE
_ . . J OFF ,,.,(,