02110113 (2) CITY OF CUPER'rINO -»
,a BUILDING DIVISION PERMIT GONTRAC�`T RINFORMATION
BD1Lpygap,DRB0LLINGER RD WAGNER ROOFING CONTRACTOR PEP`NO02110113
OVOT(D DON GREGORIO AND ELENA 12242 SARATOGA-SUNNYVALjyPLICAT1111SUB1D51(l2002
Ah
IFZONE. 408 777-8331 SANITARY NO./ / CONTROL NO.
ARCHITECGENGINEEK BUII.DING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
fop JACENSED CONTRACTOR'S DECLARATION
ac I hemhy motion Thal I am Iiccnxd under provisions of Chapter 9(commencing Job Description
�« with Smcaimn7000)nfDlvi.isn3Ortha,BusineasandPrpressinnscnde.andmyBeen..cis REROOF
Fny mfull forte trod cflccl., `, 2?S Y �u �aWLS LtiD
2 O'�? f."wosc CleS.a e- N ( IYS�
OZ- n Dam f/ Cmmmctm
ARCHITLCTS DECLARATI.
� pQ lundcrsmnd my plans xhall be uxJ a.puNic rccnNs NOV '2 7 2002
SOaD
=LLO_L0 Licensed Professional
Fj OWNER-BUILDER DECLARATION
ce Qy I hereby aflirm thdl 1 am eaempl Irnm the Contractors License Law for the ��'�®'��
at 0 O following reason.(section 7031.,Business and Proussionx Code:Any city of county $7533
=6� which requires a permit to conalrucl,alter,improse,demolish.nr repair any svuaum
FZQ prlornit, amce
nn .oleo requires the applicant lorsuch pcomitto file a signed statement
TFC that he is licensed pursuant m the provisions of the Contractor'.License Law Chapter 9 3Tg9H2I0("A@m Valuation
w1S (commencing wi is Section 700d)of Division 3 of the Business and Professions Chile)or
a.3- that he is exempt Ihemfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mart than Eve hundred do])..(5500). PN N Occupancy Type
01,as owner f the property,or my employees with wage.s as their sole compensation. 307 - INSULATION
will do Ne work,and the structure is not intended or offered for sale(Sec.7W,Business
and Professions CWe:The Contractors License law docs not apply to an owner of 602 - ROOF P nWrI J Jn5
pmpeny who builds or improves thereon,and who does such workrc hndlelfor through his 603 - ROOF BATTENS 1`0A 11
own employees,provided that such improvements anot intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner
Wilder will have the burden of proving that he did not mild or improve for purpose of 604 — ROOF IN—PROGRESS
sale.).
0 1,as owner of Ne properly,am exclusively contracting with licensed contractors to
construct Ne project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of properly who Milds or improves tomnn,and
who contracts for such projects with a conuacmr(s)licensed pursuant o me Contractor's
License law.
0 l am exempt under Sec. ,B&P C for this reason
Owner 41 Date
WORKER'S COMPENSATION DECLARATION
i. 1 hereby affirm under penally of perjury one of the following declarations:
ily I have and will maintain a Cenlficam of Consent so self-insure for Workers Compere
sation,as provided for by Section 37(to of the labor Code,for the performance of the
work for which his permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3708 of Ne labor Code,for the performance Of the work for which this permit is issued,
My Worker' pe aliyylosuranep carrier and Policy number am:
Cartier: T/a�J.E_f/ Policy No.:_/%�V ' 6 —
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flTissection need not M completed if the permit is formic hundred dollars(9I0)
al less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any mannereo as to become subject to the Workers'Compensation
Laws of California.Dmt
Applicant C
NOTICE TO APPLICANT:11,of making this Cenificam of Exemption.you should
Mcome subject to the Worker's Compensation provisions of the TaMr CWe,you must
OO forthwith comply with such provisions orris permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[+ I hereby u0irmthat there is a construction lending agency lir the performance of
the work lin which this pefmd is issued(Sec.3097.Civ.C.)
�W Q Lender's Name
r7 Z lenders Address
U 0 1 acidify that 1 have read this application and scale that the above iniu
kmtim
an is
(y F cortex.I agree to comply with all city and county ordinances and cute laws relating to
U building cOmswction,and hereby nuthoris mpmxnmtives of this city m enter upon the
r ahovetmjudgments,property
st for inspection whichm.
Ow)agree to save,indemnify and keep harmless the City of Cupertino against
U h
liabilities.cnqence ofthe
coarsing of this omit. may in any way e¢me against said City
U Z APPLICANT
ND granting Of this AND
Issued by. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N NPO T
SOURC REGU ,TIONS. /���
nature of ApplicanUContrxmf are C-roofs
I IAZARDOQ AIS DISCLOSU Type of Roof
Will the appiicans or tutu rJing occupant store or anJlc havaNnux material
a.defined by the Cupenimi Municipal Code.Chapter 9.12,and the Health and Safely
code.Scelmn 2553200 ❑Nn All roofs shall be inspected prior to any roofing material being installed.
❑Yc.
Will the applicant ter Imam milding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
m it harardous air contamiwnu ss defined by the Bay Area Air Quali LY Management all new materials for inspection.
Distfiet7 P
❑Yes No
I have read thc haul mmerials requimmems under Chapmf 6.95 of the Califn,
iia Health&Safety Cak,Secdmns23505,25533 wd 25534.1 understand Nat if tM building
dins mol cmrzcmly have s mnof I thm it I Issuance
of
Certificate
erti ic notify the rccupanl of the �� /
rtquimmen men stMml fmisspaneemracmurnmmr0. airy Sig re of App cant Dal
Owr&&authanizolagent D6 All roof coverin [o be Class "B" or cuter
10300 TbM Aveaft .
�sda0.CA OM4, U
CUPEIiTINO " °` (4M)M-3=
Building Department
snb)eebRegooft POHq jo�So CUy of Cupartisto NOV 19 iooz
1. Prior to permit .3' moat BY:
and wdtten app
roVva
pplW
and atarsufactures apedganan tO 00mply with 1997 UHC Stan
2 ,New roof shall not retoofi>,sg.
widwft SM aPPrOval shalt � AP s•A °� B on on
3 �� bss ;g9 M°P�when rite=o flng is
'L )reoelve Eniall d fsommtthe any ittstallal,
1) �and/or tear off approval.
'tB sus are s
3) FhW approval
approvaL
a) Spark arreger,b&W W .
5. if Pbnw is
6. Any rOOftS wIdch is applied withoutfirst � �,w�
rt Tdre the removal of an
Sproper City hOPe�an be P rial dm t.the sheathing so that the
II1P0&TANTs
1. Flat sofa mart have a alum of'K"Per foot slope and demonstrate that
!lure is no ponding,
2 AnECB.O.report 19 reTzlred to be on
job aide at lite time of inspeclian,
r We undaasdssd tlse above Polley an MmOBAS '
Hanuowness Nama a and ndti wsapip wird this polity.
—�� Ht�S
Address -757?
' �00�8 hasty Name: k/R$svYiC �,�N C..vls .tivc. ,
Applicants Sgs bxm ........Joe ..............
s
Antontwd
(chief Huihding oakfal)
NlJA2