00100045 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURF'_SS: PERMIT NO. -
I G SER ICE 00100045
OWNER'S NAM('- - - APPILICAi ION SUB DNIE
-SHIRLEY Ao tAVE1.0/05/2000
HONE: EIREEI_ SANITARY No. CONTROL.NO.
>. AHCIIITECT/ENCW EIiR: 140121 294-7EI -9
BUILDING PF,RMITINFO
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6 1.1c1- i CDN'fancraa's D11c1.nRAl'1oN Job Description
I thereby ofiant that I nim licensed order Provisions of alp",9lcmmnencing
wHw with Section 7NX))of[;Woo.3ought,Busivcw.nd Professions Codcandmy license
xza i"i«� I nreF ^�e�=t39 Lie_eL�6SZ SHAKES TO FIBERGLASS SHINGLES
XO Date_ eontmetnr- n _�Psa
u:3 n.N ARCHITECT'S DIiCLARAnoI
C o I I malconun l my plans shall he used a,puhlic records
tau i p O Liccmml Pn,fc..opal
OWNIiR-BUILDIIR UECI.ARATION
so 1 ncreby ato 'Ill,m, ,a,I or exempt fnnn the Comou'lo"s License Law It,,,the
IZ'Q fallowinglemon.(Section 7031.5.Business and 11 Iceinns Code:Any city of county
sF O which requires o permit,o construct.alar,improve,demolish.or repair any swaure
C priorits i...ance.also receives the,pplicam,or such Pcom drcmnnfile.signed,mod
a 3� m that the is ficenewd Pursuant it)the provisions,of the Contractors Limme Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of the Husmess and Professions Code)
or that he is exempt mamtrnm and the halls for the alleged eman,tion.Any liulation 7
of Sel 7031.5 by any.ppli...I for n permit-subjects the applicant to;l civil penalty
lir not mare man me hlal,drcd dollar,(S500), APN Number Occupancy Type
❑I.us owner nnhe propeny.nrmy employees with wags as meirsdc vol,co,gons.
win do,bc walk.and Ibe slmclum Is not intended or offered for sale flee 7494,i
Hoomss and Professions Gyle:The Contractor's License Law does not apply m an Required Inspections
If property Who build,or improves thereon.and who does such work hinvelf
nor through his ownemploy«..Included that.u0h impm,'ement..re.e,intended or 305 — FRAME
offered for sale.If,however,the building or improvement is sold within line year of
completion,the nwmer.htdlder will have the burden lir pawing that the did not build lir 307 — INSULATION
npowe it.....Tom nfs:de.), -
❑1,asoncrnfinperc
epoy.I ,'choolycnmraefn,with ht,,nsrdrnmelm
astI, 601 — ROOF TEAR OFF
O.Ime,me It it,,(sa.7044.Im,no,,end Proldision,Code,)'Ilie Conuaelor1 602 — ROOF PI_YtJOOD NAIL -
License Law docs Bol apply to an owner if property who builds or imp......thereon.
:rad who cormact,for such projects with a.mnmctons)licensed puamen to the 603 — ROOF BATTENS
Contractors Limnse Law.
o l am exempt under See. .R d P C for this mason 604 — ROOF IN—PROGRESS
Owner Date
WORRIER'S COMPENSATION DECLARATION
1 hereby atfr n ander pcnahy of perjury one of the ollowing declarv,inns:
�] I have and win muinlain t Certificate of Consent Io self-insure lin Worker's O
Compensation, is provided far by Section 3701 of the L,hnr Cole, far the
Normmance of the work for which his permit is issued. 40/
❑I have and will maintain Worker's Compensdam Insurance,as required by Section - �^
37M of the Ltdor Code for the perfunnume of the work for which,his permit is V v�
issued,MY WWorrkker',Compen.va,ion Insurance drier aml Policy nut nerr doe:
Can icr:1 PIR_ � Tolley Nu.:�OOOII[TI
CTIC IIICAIION OP CX EMPI'ION FROM WORKERS'
COMPHNSATION INSURANCH
('rills action need not be complcied if the peril Is fix one hundred dollars
ISIIt less.
C cenify,hot in the ptrlonmand,of,he work for which this Permit is issued.1
.hull not employ any Person in any manner so as to become sublet in the Workers'
Compensation Lowe of Cali forma.Date
Applicant
NOI'ICI3'I'0 A PPI,ICA N'1':if,ilia making Ih is CanlEeote n(ExemP,im 1,you should
nacmne wbjecl m the Worker's Compcnsetiun pn t-III.in[he Ulster Cish.yon must
Q 2 lonbwi,h comply will,slash pmwi,nns.1 in,Ti shin the deemed revoked.
fCONS'rRUC ION LENDING AGENCY
1 hereby affirm mut there is a construction leading agency for the performance
of the work for which this Permit ie issued(Sec.3097,Co.C.)
0. Q IenJ Name
7 .z Leader I Address
U 1sonny,hl11 c mad,1 . ppl Iion and stale thinthe Mwe inkonintion is
R. F null agree i I ly 1111,111 Ey' 1 ty ordinances J a t ,, ling ol
Q U I,building i by 0 ti fab 'lyl ler pun
Q.... the ho g 1 Property f p u purpose'.
E" y (W)agree 1. n indemnify keepdth I in the C, fC pen against
(A
handles,used,mina c lit. and pc.e,"Ifill Yin and Y against
U Z City in Cnn,1`UNIe of the griming D thio L mm.
APPLICANT UNDI STANDS WILL COMPLY WITH ALL NONi`OI N'r Issued b to
SOURC
IT y'
n ler I Apprcant/Cnmmctor Dale Re-roofs
I IN'/,ARIIUUS MAI'CRIALS DISCLOSURE
Will,he applicont lir l atue hunding,veupm l cum of handic h:varloos ntalerial .Type of Roof
us
defined by the Cupertino Municipal Cole.Chepler 9,12,and the Health and Safety
Coda SectiO Ym 25532(01:'
❑No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding nceupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nil hamrdou,air contaminants as defined by the Bay Aro Air Quality Management
,trete sea ❑Na all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I hoe mad me l,vla'dom nmmri.L rcgoion ens under Chapter 6.95 ul Ibe
1-�ncr
lmou llealth.9 Stiety Code.Seclinn,255115,255.13 and 25534.1 understand(hat q
he building Docs not fumndy based Icnunl,lbm It in my resgmsiM1li,y n,notify,he
upaent of the requirements which most he met prior m issuance of a Ctrome lid of
cupa /i Signature of Applicant Date
nraamnri,.edngent Date
All roof coverings to be Class"B"or better
OFFICE