02040137 CITY IDF c DIVISIONNO CONTRACTORv 11 INFORMATION:-.
PERMIT
BUILDING ADDRESS: PERMIT NO.
10370 LINDSAY AV SAHLIT ROOFING 02040137
OWNER'S NAME: APPLICATION SUB DATE
KEATING JERROLD K AND LOUISE F 10481 DAVISON AVE 04/24/2002
1 PHONE: SANITARY NO. CONTROL NO.
(408) 255-5094
E O O ARCHITECT/ENGINEER: RIDING PERMIT INFO
H
BLDG ELECT PLUMB MECH
HZto L J ILL]
h= LICENSED CONTRACTOR'S DECLARATION
1 hereby affirthat land licensed ander provisions of Chapcer 9lcommeacing Job Description
�_�� m with Semion]000)of Divisian3of the Business and Professions Code,and my license REROOF
in full force n IT
"!A p
i z�u License Clns - Lic.X "I TO
i LL O N
Data�� Cantrac u i,
Ablrcrl T'SDEC ARATION
_1 1 u plans shn ed uhlic records
3�af
3 6 p 0 Lice d as.Iarm
ca OWNER-BUILDER DECLARATION
mIhereby affirm mat I am exempt from the Contractor's License Law for the
n
S o
following match.(Sectiont ]031 5,Busltesvandmpr Profess ons Code Any city stmetury
wh h requires p rte t t ti t t aIle improve,demolish, repair any stivdure $12400
a. .pro tons ace also requiresPreapplicantfn such pc Permittofile a.Law
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that rte wit pu_ I,om0 Previsions s finContractor'eu a � on,C de) �. 3,gp�-g .p,. 1.At.1 - - Valuation
(commencingwith Sem ]m'b ofDivision3 [m Bushes dP f Code
or Ihat he is exempt therefmm and the best,for the alleged exemption.Any v olauon '
-of Semm�]n3I s
of not more man five ahu ndorreg donnrammr(asspoaon)n.i,snnjems me apph=ant m a siva pmlalty - .. Occupancy Type30cIWME
❑I,as owner of the property,or my employees with wages as their sole compeneatlon,
will do the work,and the structureis not intended or offered for sale(Sec.70al D weal
Business and Profession,Code:The Conwc,or•s License Law does no,apply man' 601 - ROOF TER`IAIdWIhIspection&""
owner of properly Who builds m improves Hereon,and who does such work himself
orthrough rms own employees.provided in,or oomine el in he
ino or .602 _ ROOF PLYWOOD NAIL
offeredr rule If,ho tfie nmld n6 nmP ov , Id -ithin-one Year of
completion,the owner ha Ider will have the burden of proving that he did not build or 6 0 3 - ROOF BATTENS ''
fmprommrparposeofsale.). 604 - ROOF IN-PROGRESS
Dip with licensed cnntmcmrs Io ..___.. ._.. .... ._._
ownerofine pmpeny,am B.,inivelya Professions
..p•-
cicense the project(Sec ]to. Business end Professions Coder The Contractor'sth ..,
License Law does not apply man owner with
property who b,i Ids se Improves thereon, "
.r
and who contracts for,such.projecs with e.comracmr(s).bcensW pursuant.m.me. _ ... ....... _.._ ._..-.__.. . . .,._ .i._ .__. _.._.__ __. -------
Contractor's
IrunaxeLicense Law.
❑I exempt under Sec .,.a. ,B&PC for this rwsoo
0,water r,t . Oat ...
WORKERS COMPENSATION DECLARATION 1MINALS®
I hereby affirum under penalty of permar,on I a tiflom following declamations: - A fin/ p
° 1 h a , .` t C y tical f C' .aorto If' f Worker's -"�'• ( 9 2002
Co p t .-pr ided I by Set 3]0U f the Labor Cotlee r for the
pert a[d wokf who ,h spermnis mbd.
°Ihave d wid mitionainor ker Compensatimi Insurance, eq' dSea on B�'`�I1Y
3700 of th L bo Cod f m prf f the work fo 1 h this
perm i s
issued.My Worker's C pe t o ra 1 suer and Pol y be e:
Cvmq, "RRTIF Inds Policy No.: :., a vArT T.1'o.tl.4.-,.@d Efo d '41i'7�'1 v,a p, �jf. f,
,t{{. CERTIFICA710N OF,EXEMPTION FROM WORKERS'.' s. 5�
' r COMPENSATION INSURANCE' - "
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(This section need tut be'complamd if the .it is for one hundred dollars " "- ,' d, ,•„t�,i; --
(t100 or less.) ..
I .,, matin the b forma f th k( a ch permit o Issue1
snail not em to an comesuiteet m the Workers
D , .f n y anti p aq t ,tom
Comps s f of C_ahyf mm..UAte 5'-
.:APPI cam. ANT
NOTICE TO CANT If r,rmaA g th s C
Q O become subject tothe Worker's Compep ov sions ofthe Labor
ab r t Code,yoyou
shmo ili
forth rah co ply with such provisions or thisDenied shall bed to mad revoked.
s 1 1
...
I
�oCONSTRUCf10NLENDINCAGENCY ”. S
_ I hereby trnn that th re is a construcu n lend g agency for the performance
t
W .'tea of the work for which this permit sued IS 3097 C C) s
..Lend Nam _.
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5-Z
Leader'.Aidt f
V 0 1 cerity,that I have mad this application and ,to that the b einformation is
Lr Ey..
correct.1 agree to comply with all city and county ordinances and stem laws relating
C.p m budding construction;and hereby authorize representatives ofdsis city to enter upon.
the
Qibbo(We)rigreatirspropeIrtnytl ftuarn inlysand
puhrpancales,
feartanC ty rls
Cot) iah I c ludgm 6,costs and expenses which
may in any ay fern gainst sold
V city ml 9 cote of'he g ant S of this p5g�t
Appiih'A TUN h�F�9 qNb�'fJYJ�[yAPLY WITH ALL NON-POINT`S -
U _ , Is TI ', • . Issued by: Date
157glre(e ollApplicant/Contmctor. ''✓J ""' r -',Dine- i;.' Re-roofs
i; ,HAZARDOUS MATERIALS DISCLOSURE
W II the appbcam o future brilduili oc pant stole or handle hand atonal ,Typo Of ROOF
as defined by m Cupertino Municipal C d Chep, 9 12 and theHealth and Safety ., yyf
Code 5 m 25532m)n 1 twit f Rpi.. <4, r
°Y " ,i Al]roofs shall be inspected pnor,to any roofing material being installed,
IWIII m applicant future b Idin cepa t se equipment r de sea which, If a roof Is installed:without first obtainingan'ins ectlon I a roe t( remove
chair h b contain hart as de by th Bay A ea A Quality M nagement P g
District, _ all new materials for action: Ap l It understands and will comply with
❑vas rvn i,. , all"non-points a regal' S. ,
^ms,un h
'sad the hazardou ' i Is requ
is is
L_:'�' l havLing y t yfede Chapt 6.95;o25534 1 understand that
pam of thus nal Rendnha e m bot ,tap tar to isisponsb I'ty ro notify the "--'fo H ah&Saf ty C d 5 t ns 25505 25533 endui t i uoccur
a of C ri fate of m ra d Si nature of Applicant ate
agent t: Came
All roof coverings to be Class B oi';better
s
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OFFICE
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