01070060 OF
PERTINO
CI eat Dwc DIVIISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18740 NEWSOME AVE. T N T ROOFING CO 01070060
M IPSENANYEENCHAIR 219 SHOWERS DR 07�13N/2001
PHONE: (415) 308-3335 SANITARY NO. CONTROLNO.
0,-,. ARCHITECDENGINEER: BUILDING PERMIT INFO
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- BLDG ELECT PLUMB MECH
a i� LUj L_1 f� L=1
0 m z LICENSED COM'Rd under b DECLARATION Job Description
ItiW70afcr Diatlam ail.fre under provisions of Chapmr9(commencing REROOF.
�H F u wilt Section]000)poQf Division 3 of Me Busirrcxs vrM Professions Code,and my license
p�zJ IS Infull
Licen Cromwri -e 9 Llc.0 B Z T/O TAR & GRAVEL, INSTALL THE SAME.
w Dae ` Common,-
3 u.vt-i ARCHITECT'S DECLARATION
u O; 1 understand my plans shall k owed as public records
p O Licensed Professional r' II /� C
a.
a z
OWNER�BUILDER DECLARATION r ,V A {-ww
to I hereby affirm that I am exarnp,from the Contrabor'x Licemc Law fnr the
folinveing,cuc„...(SaJn..]0315. fu.ines and Nntcwia...Coda:Any chyr county
_2 C which require.a pnmit re conama.alms such Permit
t or repair any suucmre J U L 2 3
poor mslicensed e.pa eso rtto methevisions of for suchpetict Licensle ae arv(ummem - --- -
thaluisci.,witpursuann.00pmnuision the CommctakLicense fewon,Co e) S Ft.,Flo 9 .y-Area-„ Valuation
(eommhe is vem,seNofir,an seethii bails u theraBnedseena Profession,si Cale) ;.-Q•�� -{ I: ,; •.r- is •.S-,Q:...� �,-%
of that io is 31.5 b therefrom seethe basis further subjects
the
a)icant t.Any violation
of Section 7031.5 v anyapplicantamfor apcmtit subjects the epPlicwttoacivil Penalty iILDINP
of not mare roan me M1anaeea nonan 5x5..1. APN Number Occupancy Type
01......a,.f the property..,my employees with wagesus theirsole embiRmtum., 3055 - FRAME
will do she work:and the structure is not intended or offered-mr dale(See:70,14: 307 - INSULAT IR juired Inspections- - t
Business and'Prefesslons Cale: The Caot mmemr's License Law does napply m an
owner of property Who builds or improves thereon•and who does such work himself 601 - ROOF TEAR OFF
or through his own employees.provided that such improvements arc not ontendede ymer or _ __
'completion sthe:wner-Wild.melhav the burden
rola-he did not Wild of 602 ROOF PLYWOOD NAIL. - ... _.
completion,for the owner-Wild),will have the huNcn of proving that he did not build or F 1
tnprm)r.r pa,pn+e.r=al).). 603 - ROOF BATTENS
ra ..._ . ._. _. ,- - --604- - ROOF IN=PROGRESS .. --- •-...............
a.
" ewe'oat -tire,ofthatpmpcny.a xusiness and tmcssir wit Code:)The
..
cornwn the does
reject(Ser.]BIA,same
and property wh ns Code:)The ver mention.
e mr's
io
-- License Lawdoesnotapply man.wmrth acontrwhobuildsseor improves,In the
e _Cimmus.c.mmct+forsuch protects with a contractors)Iiccn.+M.pursuum.to rite .. . . .. .- . ..___. .. _.. .. .1.... ._. ... .__ ._..._ _ ..... .... .... .... ...
C I am exempt
License Sea '-I
� ❑lam cumPs urMcrSa:'- " • ' _• ' ' � (B&PCfor his Interco
tTvitir '- Date
WORKER'S COMPENSATION DECLARATION
. . ..
1 hereby affirm under penalty
' of lierjury ane of the ful lowirtg declatations
° 1 have and will maintain f Certificate Section o!Conant tt mLotharrt rot Worker's
Comrmanc o as provided far by sista3]00 of the Labor Calc, for the
perlonnance of the work for wbicM1 this pennit,iz ismed;,
❑1 have and willin
mamin Worker',Compensationus Insurance, rcyuiuJ by Seniors
37M of the Ltba Cafe,for the performanm of the work for which this p.I,is
issued.My Wadme,Compensate.
ps t .Insurance career and Policy number ars:
Cn _S7E1I�F`At[2 Polby Nn '7O OT�I� - ., >•, _--.•..
CERTIFICATION OF EXEMPT ION FROM WORKERS't 31 t. tj I4i.•+ . ,
COMPENSATION INSURANCE•.• a •__`_.. _ __.._._. _.._........... .. .._ _.__ __". _.... __ __...___..._.."-
i his section need not he•completed if the permit is for We hundred dollars
(SIM)or lcss,l.
1 certify that In thei Lance this wait for which s perm t is timed , t \
rt
shall not employ any poonn m any Hunner so as to become subject to the Workers 'I`
Camiume, into Laws of Califpmia.One e .
..Applicant ' ..
NOTICETOctte APPLICANT term
Worker Cruipensatijh isovisios of of Exemption.ynoumulst
hecnnm subject m the Wucker'.s Conip,or his previsions of the Labor Cale,you must
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forthwith comply with such provisions or this permit shall be deemed re,oked. I
UO " 'CONSTRUC ION LENDING AGENCY t
1 y
hereb Tann Lha 0cm is v conxuunion lending ,it funds:pmmn
edoce
_aI'iM1 kfhich this its iswad(Se 3097,Cis,,C)
L"Ic
SIN
one
=)-zL,leer.Addre.s- ..
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V •I„ I certify that I have read this application and state that the above Ii formunion is
F., correct.1 agree to comply with 011 city and county ordinances and state laws reining
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u,nothing o,nsmiction.andhereby put..orize eep rdve.(if this city to ntcupon
the a bo _ t neap pany n+pen Purposes,-
rpo ,
. ,y (N ) gree I.sae ndem fy and keep h 1 sthe City of Calcine ogler -
Vl liabilities.tjudgments.costs d expense Inch. Y ary Y e Bain: said
d z City in consequence of the granting of this permit
APPLIC NT UN DERST'AN ND WILL COA YWITH ALT.NON 01
sou9 cuLAnol9 f , y�� Issued by: Dale
Signature of APPli !6—��� '
'actor Re-roofs
AZARDOUS MATERIALS DISCLOSURE
_ Will heopplearn or future b Jaing caps tIn.or handle n efarm,material Type of Roof .. .. ... ..... .. . ..-
av defined by the Cupertino Municipal CChapter 9.12,truth,Health and Safety
Cale,Section 35532' I .: ,, t ( f' ,a' �h ;• . . '.',a f t .
❑Yrs .All roofs-shall be inspected-prior to any roofing.material being.installed._
Will the ayplieam for m�dding mcuprw use equlp,ent aaevlues which If a roof is installed-without first obtaining an inspection, [ ag"�ee'to'ielnove _
�r emit haeardous air cnmaminunts as defined by the Buy Area Air Quality Management
Diadae all new materials for inspection. Applicant understands and will comply with
° Ie all non-point source regulations.
1 have read the to mrJuus matadals res,irements under Chapter 6.95 of the
California Heahh A Safety Code.Sections 25505.25533 and 25534.1 undersmnd F \ _
if the building Jon not currently have a tenant, mit limy respnnsibillgm notify the NJ.��f � �3
tz<upam ol,ihc rtqui - nix which must be t prior to izxuance of o sitifcata of O/'/,'a",
F Oce ancy. ,
aq•`3 Signature plicant _ - - _ _ Date
-. jwnapra n,rte agent to All roof coverings to be Class "B" or better
... .. . .. . . _ . .f. OFFICE ..
1