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CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BGB.DINGADDR7452 STANFORD PL
R E ROOFING
PERNIll 00100100
owNER•s sAnnsLINE LARRY I_
OAKLAND PL
APPI.ICAnON Siff t*%E13/::000
It NE:
(408)925-9995
SANITARY NO. CONTROL NO.
ARCIII'rECr/HNGINEER:
[WELDING PERMIT NFO
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I41.IJ ELECT PLONIB
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LICENSE 1) CONI 'RAMOR•S DECLARATION
.lob Descr, [1011
I hereby al'limt Thal 1 inn ECemad wider prosilonv nl'Chaffer 9 (c"fun creing
ac
withSection](X*)nfDivisinn3oftneBunineoandPndession,Code,-ondmyliecox
REMOVE EXISTIP G, INSTALL FELL'
is in full lince and ellen.
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Liccme Class Lic. p
Contractor
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ARCH I rECrS DECLARA I' ION
I L dermad my plum ,hall he used a, puhbe recur,
Licensed Pn,fcwi...I
OwNEILBUILDER DECLARATION
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1 hereby of ri t rhnt I am esanpt from the Commcmr's ]License Law far the
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ShIDnwing
o
rc n. (S,,I 70115, Ilucine,v' and P-Acs,iun, Cud, Any city or county
cte
h, construct, alter, improve. demolish, or repair any ,Imlu
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ca
xtick myuirc, a permil
print to its issuance, also reclaims the applicant for such pools to file a signed nammant
Sy. Ft. Floor Area
valutt�le�1�E5
— 'hat he is licensed purstain to the pirro focus of the Contractor , License 1,w lChupaei 9
(enmmenci ng with Section 9IX0) of Division 3 of the business and Professions Cale)
_
nr do, In, is c,u mal fherefont and the basis In the al legal esmnpinn. Any violation
of Secti a 9031.5 by any until leant for a permit subjects the applicant to u civil penalty
APNjbee,019.00
Occupancy Type
ofa,„moo, Iran Ise handreddana"($500).
—
❑ L m "wnend dhc pluaLd,, L, nay entployce, with wag,, as dheit s.le enmrcmminn.
—
Ired Inspections
will do the work, and the structure is not intended or offered Inr ,ale (Svc. 70L.
*The does
Business and Professions Code Contmcmr's License Law not apply n) ao
owner nt popery who huild, or Intpnnus theater, .,,it wlnl does .,it work hint,cl
or through his own employees. pounded that such impoventena are not intended or
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ollkred I'or sale. U. haw,eO. the adding in itnprovcmmat i, ,old whhin ono year of
the owner -builder will have the burden of aftom, shat he did not build or
iompletion,
mprove Bot pmpose of sale.(.
.
❑ I, as owner of the popsy, let escm,ively contracting with Bec.ud to mmmon 1.
•.
jeeL (Sees 701 business and Pmibs.ion, Code:) The Contractor '%
instruct the pom
construct
a Law d:x, not apply to an nwaerar prolenY won holds at improve, there"..
and woo c ... wcu for such project, wkh a c an¢I"ris) licensee Pontoon( u, Iha
Contmcme, Licensc Law.
❑ l an ocenum under lice. , B ,F P C for this reason
,
Owner r>m
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WORKER'S COMPENSATION DIiCLARAIION
1 hereby affirm under penalty of perjury one of the following declarudnn.s
have and will muimuin a Colilicule "I Consent n, -it-in,mre for Worker
a, provided fur by Section LOW of the Labor Code, for the
onnan,, of the wed rim whialt tris permit is issued
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nave amt wit maintain worker, Cmopeit i houraneu, a, rcyuined by Section
'
137M01compenodion.
of Ne Labe Code. loin the perfnrmmle of the wed fnr which thin permit i,
Lt.er h1y Cympcn,: 'on Insnr;utco cagyr I, Icy ny
is Policy l//\ kL—
CEEI{(r//µ1
ION
CERIIFI-A'1'IO GI PXChIPITON PILON wORKh:ItS
CG PENSAI'[ON INSURANCE
This section need no be completed if the permit is for one hundred dollars
is I IXII nr leas.)
I Cutfy 11141 in the perlenn.lncc of the work for which this permit is issued. I
%hal nm ample, any per,,,a in a.y manner.w a, ,, become emhjen t" Om Wn Let,'
Cause,....am Law, of Califorram. Date
Applicant
NOTICE 10 APPLICANN: If, after making this Cenifcah, of Escalation. you should
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acconmwfro au he W..ou',C"mpenmfion povirom of the Labor Cam, you oust
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forthwith comply wilt such provisions or this permit shall be deemed rooked.
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C'ONSTRUCT'ION LENDING AGENCY
I hereby upon that there i, a construction lending agency for the perfimnanee
of the work fnr which no, permit I, tss.cd (Sec. 3097. Civ. C.1
a
Le.Jcr', Nam,
lender's Address
1 renify clad I have read thin up,l ,u ioa mal state taut the above iatornwtier i,
e.
correct. I agate to comply with all city and county ordinances and stale laws elating
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hereby L In ofthis city a, carer main
,median,d a, re
r” huild'ug tv.a;m
Wthe
shove mentioned Pmperly for inspection purpose.
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(We)egrnato save. Indomnily and keep harmless the City of Cupertino against
in any way accrue author saidii,
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liahilkie,, jud uncau, cunt, and e,pen,es which (nay
consequence of the grunting of this permit.
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AI PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
ISsuedb Date
y'
SOURCE REGULATIONS
Re -roofs
Situaturc"f Applicam CAthocmr Dae
IIAZARDOtJS MKfERLALS DISCLOSURE
Will the applems, ar much, building ac.,,nl nre or handle harmnato material
Type- of,
its delined by the Caperton Municipal Cale, Chapter 9.12, and the Health and Safety
Cadc.❑ YL, 25532(a):' O No
Alloofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occapatn use eyuipmem ordeviees which
If a roof is installed without first obtaining an inspection, 1 agree to rens-ve
it hanudom, r... cttnamine as as defined by dhe Buy Arca Air Quarry Management
DNtr1eC
all n � for inspection. Applicant understands and will comply with
E2 Y1, 0 N
no - sour r "
f the
I M1.oc rend the M1:vnNou, mamriah rcyuimmcnu underCW",
1arm.11,mlh
dt Safety Cale, Secton, 25505.25533 an 255thus
— IL I �yhe
haildingdte, not correctly nave. coons, that it is my e,amthe
%7-000occupam
atom h,,iden a u, which fund rte mr prior h, I%vanee of
Occupancy.
Cs Date
All roof coverings to be Class "B" or better
awlera Dasa
mmnariaed aga,t
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