00070120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM IT NO.
R E ROOFING 00070120
OWNER'S NAME: )(PLICATION SUIT DATC
OAKLAND PL 07/20/22000
HONE: SANITARY NO. CONI ROI,NO.
(408) 925-9995
o z z ARCHITECIENGINEER: BUILDING PERMIT'INFO
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cENseucoN'reneroesDl:cLARA[ON Job Description
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F=�Jwith Snloo 7(1W)al Divistrm3nnnB Btaincxs and PrufasamsCWc.nnJ DIY liccnw -
., "In fall mr"nmlcll"'. REMOVE 1 LAYER WOOD SHAKES INSTALL NEW
0g`U ""` SDECLA PLY AND 30# ANN FELT (2 LAYERS) AND EAE
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ARCI LT'I DECLARATION
tYg arra tnmin+yrlansxl+tmnBasanaspan°crecn", CONCRETE TILE ICBO ER-46605 SPEC SHEET£
so`o Liecowd Professional r
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OWNER-BUIL,trDLCI. IOy \•9\='�` 1 fruits,mdrnl lwl 1 nth BUILD Bata thC e mnractor,Liaeme 1-aw mr n,e
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following pic,tiou 7031.5.Br,iats,and l r l Odic:Any city rural,
which requiresI n t It p tem l.h pa y fracture
ce prom t d 1. 4 theapplicant f h oe tt fl signed statement
Iha,U is liorr,dlpr, n ,hrnvd+,. f the c nn,License e. Chain,,9 Sq. Ft. Floor Area Valuation
(mmmcnong with Section 710111 or Division 3 a1 the Imomra,and Pmlci•vlon,Code)
or that he i,exempt thcmfmm and the basis for the alleged exemption.Are violation
of Section 7031.5 by any applicant for a permit subject%the applicant to a civil Penalty
it m I.Ihun rise hundred dollar,S.100). APN Number Occupancy Type
01.a,owner mane properly.or sly employees with wages as theirsola compensation. $15873
will do the work,and the mulure is not intended ar affcred for wlc(Sec.701
Ilndtwd,and Pmfex%ion%Coag:The Contractor%License I.aw does not apply in a, Required Inspections
owner nl projvrly Who build,or lmpmvcx thcmon,lost who docs such work hinioll'
or through his own employee,.provided chat such improvements are not intended Lt 3421.7081. 00 _
offered burials.If,however,the building or improvement is cold within one year of
ampletina the owncr-builder,will have the harden of proving that he did hat build nr
a,pnwe rm pnrpn,I ot°air.)' - 305 — FRAME
O L an owner ofthe property,am exclusively contracting with licensed contractors It, — INSULATION
naet the project(Sec.70,14,Business and Profession,C'ade:)The contractors
In
.,Gro,Law doesmol apply u,as owner or Prnpurty who built.I,,intpa)ve,iheeon.
and uho coamacls IDI,aah paiv,i ata,a camta..r(,)Bccnded pursuant m the 601 — ROOF TEAR OFF
ommn«Os,License Law,
.nsrrcfor this reason 602 — ROOF PLYWOOD NAIL
owner D,ae 603 — ROOF BATTENS
WORKER'S COMPCNSA'1'[ON DECLARATION 604 — .ROOF IN—PROGRESS
I herchy ullina under penalty or pointyun,, furl 111 ingylccl las
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10 1 have and will maintain a cialficate of C en tenItt
Comiscation, as provided for by Section 3700 of the LaWr Code, for the
perform;mcc of the wokfor which this permit ix issued)UN AilAl
0l have and will mainiain Worker.Compensation Insurance,us b
3780 nl the LLM,r Crude,for the performance of the work fm which this permit is
I,wcA,My Workor'x Compenmtinn In,urance currier and Pdiey nw Wr nrc:
Carrier: PoliayNo.: BUILDING
C12RTIFICATION OF EXESTPr1ON FROM WORKERS' -
COMPENSNION INSURANCE
(Tlli,section need not he completed if the permit is Ra one hundred dallun
(51()(11 ur lc,,,)
1,trill,mut in tee rerrm,ne,ae nl he-a,rnr which Ih'rs "no,i.ixaed,I
nail not employ any pe,,a.in any nmlmer.o a, ,,become suhlect u,the Workers
Compemmion Wws of Culifomia.Date -
Appliltm
NOTDUE*10APPLICANI':11;afarnwkiva thlx curlrkaeof Eacnr a.your,houIII
M1ccame starect to the Worked Compensntion pr,rvi slop oilhc Lame Code,yna oma
Q forthwith comply with such provisions or this Permit%hall he deemed rooked.
FQ C" CONSIRUCTION LENDING AGENCY
y, l hereby omnL mm Dam i,n aomwct;m+lending agley for tire pBrrormance
,fine work for which this Permit i,i,lucd(SD.3097,Civ,C.)
0. Q Lender'..Name
7 z L.I&I..Address .
U O 1 certify that 1 have rend tlds application and late that the above information
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i,. [. corn.1 agree to comply with all city and county ordinances and door laws relating
O U In banding ean'tirtI.amt hcrebyu daaj,cR,o,unhnixu,anhis city to enter ala,.
mI abm B.mcmim,ed prnpeny in indpeation purpo....
a (we)agree at indemnify and keep hanale,d tine Co,of Crisco...again„
Vl iidea judgments,cos,and expenses which may in any way acerae ngain,t,aid
City
U iry in of the of his conal.
APPLICANT'
UDNDSAND WILL COMPLY WITH ALLNON-POINT Issued by: w DilO 20
_ �
SOURCE REGULATIONS.
Signature of ArNiaantiCo,mall Date Re-roofs
HAZARDOUS MNI TRIALS DISCLOSURE ,
Will the applicant m mote bund...ove.pant smm m handle hat mous mitatial Type of Roof
a,dented by the Cupertino Municipal Code.Charter 9.12,and the Health and Safety
Code,S,,orm 2553200
OYe. 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nit h:vuNous air cnmmr,i Lan,as defined by the liuy Area Air QualityC
r,IrleH' new materials for inspection.,Applicant understands and will comply with
O Ye.% 0 N opo 'our' g ns.
I have rend the hn.idnux materials requirement.under Chapt L �S
Culllornin Hwlm Ne Sufcty Clalc.Scnian,25505,25531,and 2553J. w /f riflhe Wilding does nm eermalc have:ucienlmutit i,my (�eupam of the requirement%which mu.a be met prior to issuance of a
occapanc, at re of Ap t Date
Owner or unthuAaed agent Date All roof coverings to be Class "B" or better