01040062 CITY OF CUPERTINO
BUILDINc61VISU)N PERMIT CONTRACTOR-INFORMATION:
BUILDING ADDRESS'. - e - PER MIT NO.
1
L711040062
OWNER'S NAME: q .APPLICATION SUB DATE' -
04/13/2001
PHONE - t - SANITARY NO. -CONTROL NOr
iter O O ARCHITECT/IiNGINEER: - - BUILDING PERMIT INFO
s m BLDG - ELECT PLUMB MF.CH
Ru
f=1
z z y' 1 hereby ofLICENSED
m in ramli CONTRACTOR'S
uu der 1 U ions Chap Chapter 9(commencing lob Description .'
5=F. with Section 70001 of Division Sof the Businessand lMdnoin., 9.and myliccnse •'' •] ,_ -
6 S= is in full tome an tf �t 9 ,
mck!u a°°nsecl°' __ Lie'a_(_�p REMOVE 'SHAKES INSTALL-.1/2" . CDX
- 3�1u- Date_ �� comme,m go AL.E� & . 3@4 CERTIRINETTED -SHINGLE. t
A CI1I'1'IiCI"S DECLARAION
I understand my plum shall be used as public records
o LicensedProessional J N 2 4 2002
QWNI3R-UUILOIik DECLARATION
e
to- I thereby arum thin I am exnupt from the Cer mcusr's Lire"sc Law few the r
Z a following reason.(Section 7031.5,Business and IioBcsions Cale:Any city Or county
5_2 .Mfr requires a permit to construct.aper,impose.dcmnrsn.of repair any stmao
i
3= priarhr it issuance.also require,the h,plicwtlor such perminn fileasiead stem:nen t
Ural he is licensed pursuanuolhe provisions of the Contractors License lye(Chapter 9Sq. FL Floor Area - Valuation -
(mmmencing with Sechm
li7 W)of Division 3 of the Bromeu ail Profession,Cale)
or that he is exempt therefrom and the basis for the at lege)exemption:Any violation -
of Section 7031.5 by any applicant for a permit wbjects the applioirt to a civil ptaal,y ` -
ofnot more,hanfive handled dollaa(55()(1): - APN Number Occupancy$• -Br50
01,as owner of the property,or my employees with wages as their sole compensation. '
'will do,he work,and the structure is not intended or oRertJ for sale(Sec.71
Business and rrorasipna Cade:The Contractor's License law does not apply m and Inspections r
owner of property Who builds or improve.tberton,and who doe.sen work himself 316020 c&e or through his own employees.provided that such improvements arc not intended fir
offered for sale.If,however,the building or improvement is sold within fine year of
completion,the mvner-bullder will have he burden nfpmving that he did not build or 305 FRAME
. improve for pugv.e of axle.), - ` -
Oi,as owner of the Fropeny,amexrmsivcry mmmrting with licensed rmnonorsm 307 — INSULATION .
corewcl the project(Sec,71M4,Bwiness and Professions CWeO The Contractor's 601 — ROOF TEAR OFF • '
License Law does and apply m an owner of property who builds or improc%thereon.
and who charmer,for such pinjcets with a conrmclodid licensed pursuant to the 602 —. ROOF RI_VWOQD NAIL
Commcmrs License Law. -
0lurnaserniunder Sec. ' ;B&PCfor mi,heaven .. 603 — ROOF, BATTENS -
Owner Dune - 604 — ROOF IN—PROCTRESS -
WORKER'S COMPENSATION DECLARATION
I hereby alfimt under penalty of perjury one of in,EOlowthg Jcclumtions: -
❑ 1 have and n will himmnin CeNm
Era of Consent m sell=inure for Worker's _
Compcnmtin as provided for by Section 3701 nl rhe'IaWr CWe, for the
performance i he ark faT is h h this Fannie I,issued.
I h' d will oiri m it k L 1 sat I : required by Section ,t t
'm of the Labor CWe for,the pc liar runes.of the work tear which this per i i is
issued.M�yN'�"rkeu Ct pa ��fs vs.s1,�jrm}'!m�ua`q:�rpg anA l'nll�ty m�.nhcr rc�j�l1
Carr :^,..kstf�6h S•" ryN\No �Ot2.�38]01 •i .
- CBRfIFICAI[ONOI'LXIiMPS'IONIgts1MWOIiKIi14S' -
COMPENSA'fION INSURANCE -
' o a l ,
r-
(This salon need not bearnpletedtlife larnit is Fitorelmtieddollo,
($100)ortes)
I 'ri,day that if he pato taecot the wok lo, Irl tl Iam't W,I - t
shell nor employ any"rom in anynaIam,,
m m beet se t b,lecr li r the Wn kers' -
Con,m,Ilua Law-a Calilorria.Data s It J
Not ICE 10 APPLICANT:It,uRernmking the Carp IIlam it Nempt on.youshould [
berehJ eh theN A Compensation p 'li Isot the Lal rCape.yor meq
z..
O
m - n
forthwith ply with 1 1 r i s or the pe t quill ho Men ed revoked - -
CON59'NUC'I'ION hENDI NG AGENCY
- a � Iheeor wOhtlinl - ihn land;,:goncy for the pa lnnnunw - ..
-,,I the work for which this per it is:.nucJed(Sri.3017 Ci,C') I` ' -
Lra ,
Lender's Name
z . Lenders Address - � ,. " •
V 1 ordify the I have read this applirulina and stem that the mine information is
emmea.I ma F,comply ihat)1.1, J „art, 1 W slam l w,retain],
.Q C.7 r buildingr 't ori mad l byre th e p s fit r ftp lyt ate I m
WQ rhe move mentioned p pe ty to,inspectionp rp
t„, 6 (we)agwe to tda tilt' n l keep harmless the City I Cii,pediao agairsh
y
liabilities judgm c r and asperse,which nuey in any way carom eye na and
C.1 City incors,4rear,at the grommg f la, annit.
APPLICAM UNDFRSTANI S AND WILL COMPLY WITH AtL N)N POINT --�' r
- soukce � ulATlolgs. �_�— _Issued bytl�e Dale
S: a of Applicant/Comromnr Dam 'Re-roofs - -
HAPARIy0U5 M 1 S DISCLOSI)kli -
WUlrheepplicamarumtebuil gnatpmgm6orhandle haranlnusrmtlerial .type of Roof
as defined by the Cupertino Municipal CWe,Chapter 9,12,and the llcalth and Safety
CWe,Seed..25532hm? All roofs shall be inspected prior to any roofing material being.installed. `.
Will me applicant or future building havolanl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove'
emit formal m,,onmmhrants a defyeJ by the Bay Am.Air Quality Mawgamem -
Di...ct? ./ - _ , all new materials for inspection. Applicant understands and will comply with
❑lies :r. pNh all.non-point source'regulatibns.
I have read the harartous materials requirements under Chapter 695 of the -
CalifomiaHealtheFSaf”y CWe,Sections 25505,25533 mid Z1534.l uademmmillion """ ��,
Him,building does nor currently If...wnangthanis myrespomihili,ylonmllythe `' y �7 '
occupant of the requinancids which mus,be met prior to issuance of a Certificate of X I
Occupancy! <iguiWuore of Applicant Date—
at
ate—
aamariaea a fit - nate All roof coverings to be Class "B" or better'.
OFFICE ',