No preview available
04010083 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT tC'ONTRACTORIINFORMATION BUILDING ADDRESS: BECKS ROOFING PER MIT No 04010083 OWNER'S NAME: PERMIT ISSUE DATE RODRIGUES LEROY J (;1 91 ori4n PT,nq ng 01 12.0 12 004 ONE: SANITARY NO. CONTROL NO. 408 36 — ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i00 Lm that I LICENSEDCONTRACTORS under DECLARATION rte 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Desc 6� wiNScClkm?0M)of Division of il.mausxandP kasios[pde,g� cenuis ANALE® _"e. mmnr CL _ �/ !!// (/� REMOVE ROOF/NO PLYWOOD ,y= Lkcnu r Lic. Dm Contractor 30LB FELT/30YR ELK JAN 2 6 2004 e ARCHnELTS A% RATION y 9 j 1 understand my plans shall he used as pu tic records eau fie. Licensed PmreaslnnB1 `res OWNER-BUILDER DECLARATION BUILDING ' <5 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 Following....(Section 703 1.5,Business and Profetsimu COM:Any city Cor county K$�i which mquims A permit m eonLruct,alter,improve,demolish.or repair any structure poor it)its issuance,also reclaim the applicant For such Permit o file a signed AMemcm WpmyF� that he is licensed pursuant to the pmvisinnsof the Conlmct.rA License lsw(Chapret 9 Sq. Ft. Floor Area ValuaC r)00 (commencing with Section 70W)of Division 3 of the Busincuand Profcssians Code)or Q $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section?031.5 by any applicant for a permit subjects me applicant o a civil penalty of APN Number Occupancy Type nal mere Nang hundred dollars(SSM). P Y YP ❑1.az owner of the propcny,or my employees with wagex az their sole compenudon. 321532028 . 00 will do the week,and me cwaam is not intended or offered for sale(See.704,L Business And Professions Code:The Conuacuu'a License La.does Out apply to an owner of Required Inspections property whobuilds or impenws thereon,and who doessuch work himself or through his own employees,provided that such improwmena arc not intemled oroRued forsole.If. however,the building or improve em is said within ane year ofcompiniun,One owner. builder will have the burden of praying that he did not Wild or improw for puryme of .1e.1. 0 1,as owner of the propcny,am exclusively contraning with licensed contractors to construct the pmjca(Sec.?D6a,Business and Pmressions Code:)The Contractor's Li Cetera Law docs not apply m as owner ofproperty,who builds or improves thereon.and who contracts for such projects with a eom eaetor(s)licensed porauam to the Contracloo" License law. 0 1 Am exempt under Sec. ,B&P C for this reason Owmr Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of penury one of Ne following declarations: I have and will maintain aCenificate of Consent to self-insure for Workeh Compcm action,As provided for by Section 37W of the Lutur Code.for the perp ormmue of Ne work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,az required by Section 3TW of the labor Code,for the performance or he work for which this permit is issued. My Werk�Iup.. d Policyln��u(y(�—jyys/�(�M ' ilieg 0�OM WORKERS'SURANCE CITLsaceliuo reed nal becompleted if the Permit is foronc hundred dollars(SIM) or lcsaJ 1 Certify Nal in the pefformancc of the work for which this limit is issued,1 shall nm employ any person in any manner se az lis become subject o the Workeri Compensation Lim of C.Ith.h.Data Applicant NOTICE TO APPLICANT:Ir.after making this Ccnifcate or Exemption,you should become subject to the Workers Compensation previsions of the Lallor Cade,you mull .J O forthwith Comply with such provisions or this Permit shall be deemed revoked. 'Zy CONSTRUCTION LENDING AGENCY [-v (hereby affirm that there is a constmctam lending agency for the performance of a Nc work fur which this permit is issued(Sec.5097,Cr,.C.) W Q Lenders Name a Lemin's Address Z) Z U Q 1 cenify that 1 have rcod thio application and sure that me above infonmadun is CMCCL 1 ague m comply with all city and county ordinances and Aute laws relating to 0U building conswction,and hereby authorize mpreunutives of this city to enter upon the orrection UJ alnvom.jiulgroproperty ford c.,.purmwhich may (WO agree to taw.indemnify and keep harmless the City of Cupertino against, H h liabilitteme ce or th,coati and Of this snail, may in enY way seems against Mid City U z in consequence of Ne gmming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 6� Date SOURC6RE ATIONg, l— alurco Applican onus or L/ Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam er fuure Wilding occupant score m handle harerduus material As defined by me Cupertino Municipal Code.Chapter 9.12,and the Hca1N and Safety Calc.Section 25533(x)? All roofs shall be inspected prior to any roofing material being installed. I Yea Nu Will Nc applicant 01 mull buildingottupanl use cquipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hay Mous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. istriel? n 0y. a e, I have read the horsed smaurialsrequirements under Chapur6.95afNeCalifor- AN HcaIN&Safety Coda.SCNens}55)5.25533 and 25536.1 undersand this tithe building O does not came 1p haw a IenN at it is my msponsihility to Amity the aeopanl of me no,i ata (h use he IEIt 'aruiIf 0 ssaance fc Cor Foal. Signature lifApplicant � � Dale ` I tae aulhamcd agent Date All roof coverings to be Class "B"or better CITY OF CUPERTINO 563 REROOF CUPERTINO PERMIT APPLICATION FORM APN# f Date �L Building Address: Owner's Narpe: Phone #: Z;7 �Z Contractor: ©O� Phone#: License#:/ Contact: C Phone l Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof 0' Asphalt Shingles P Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# Sh To be Removed ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic : ❑ (� Job Description: . _4117dA t� A59 O .� Residential ❑ Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with PI g Dep . 'f there are an res ctions: LJ of Pro' Type of C struction: Occupancy C 1� r Qty. if A li e Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 72-