01100065 (2) CITY OF CUPERTINO
BUILDING DMSION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10345 EL PRADO WY CALIFORNIA SECURITY ROOF NG 01100065
.OWNER'S NAME APPLICATION SUB DATE
ROSS KEISER 90 UMBARGER RD 10/10/2001
HONE SANITARY NO. CONTROLNO.
! (408) 363-6400
OO ARCHITECTIENGINEER: BUILDING PERMIT INFO
Z BLDG ELECT PLUMB MF.CH
I_-I O I—1 L7
S H 1 benbLICENSED CONTRACTOR'S DECLARATION Job Description
i Z-0 y offuh that 1 am Ifcanseciwider,m visi.n of Chaper 9(cammenciog
_tw .wihseedan7g0)afDmisi.n3.rh<Busin�eaanaProre"mnaeueaanahyncrn RE—ROOF
int is in run(..a.Ja 3/3
Oee U Licerue Cls" Lic,g
EES
Date /o/gyri i cmuncmr
i 40 .I'i ARCHITECT'S DECLARXET519
1 understood my plana shall W used u public records
1 E p O Licensed Professional
"ICR OWNER-BUILDER DECLARATION
0 9 effum that 1 am exempt from the Convactor's License law for the
- n.(Section 7031.5,Boniness and Pref tendons Code:MY city or cowry
Z r w or to a issue p"n it m construct.eller,Impm pair any swcee $15000
C follow n6 easo
ve demolish,or repair
3$ .•p teaala equ reglhc ep beam faeuch perm uofleengiied WlerMnn
th5l hats lremselpuduenitotheprovls m tdIhe Cwmx1m`1Limma Low(Chaper9 3 S��F�.)~'10}1r f�Cg F}4•+ i ' Valuation
(commcsiu g Ih Sa ami 7000).f lurniou 3 of the B rime. pt4 Ptyfrions Code) C111-IN 1 (I 3 flo 4o w_ ;All 0,",
1
or Nal he rs exempt therefrom eM Ne bas s f.r Ne alldged eAAdmduon. y vtohnoa
of Section 7031.5 by any applicant nor a permit wbjmu the applicant to a civil penalty
of nor me to
mn eve hundred dollars($500). 3 05A PN[4t/(lll2e� Occupancy Type
r tttarin, 1
❑Cas owner of the property,or my employees with wages"their sole andcompensation,
will do the work, d the structure is not intended or oHeea for sole(Sec.7044," 3091u
Business �In$ fictions"' f
mid'Professions Code:The Contractor's License law does not apply to an 6 01 - ROOF TE q VL^L' P
owner of property Who milds or improves thereon,and who does such work himself
_o1 throuh his own employees.provided nut such improvements am not intended or. 602 - ROOF_ PLYWOOD ..NAIL
p .
Rered for sale.If,however,the Wilding� -t is sold wiihin one y em of -- ---- -
completion,Ne owner-builder will have the Wdcn of proving Must he did not your
w 603 - ROOF BATTENS
Inflows for purpose of We.). s
__-- ._. _ 604.-.- ROOF_IN-PROGRESS:.
❑i,"Owner of,the pm,P,9y an exclusively contracting with licensed contractors 1.
co inn thePset(Sec 7044 B nest and Pref ons Code)The Contractor's
i•In I\;P
Li La doe nm apply 1 an owernof property no W Id r mp c.Merton, `
.and h vac".for such meRctamth ronwnm(s).1 me pormut to.Me. _ _ .. _ -__ _ _ _ _. _ J
omrectLima.
C ! ma V L u
i ❑lame amq riders B&P C for this mae.n -. _
Owner U Data . 1••,
'WORKEN'S COMPENSATION DECLARATION /
I"
I hereby affirm under penalty of perjury orie oflhe following declarations:
_ 7 I have and will maintain e`Cenificom of'Consent'lo self-inure for Worker, �6
ompensalion, as provided for by Section 3700 of the labor Code, for the
performance of the work for which this permit is issued.,,,,
❑1 hnv the will maintain Worker a Cohpchatinn IeMnnca"r1dell M by Rnion
37W of y labor Code:Compensation
Insurance .f ere work(m'which this prmit u
iuunt:MYWorkcfs Comps tion lnsisiwce cam _end Poliry�number
Clmerl�> �r wHid•4F Policy No.. /. - -.p e, \ 's:;. i tti'a� '�a' ) y -Y.♦.: may', �1'1..(rn,• ___.._._..._
CERTUICATIONOFE%EMPIONFR MWORI(FJtISs (�•,''7`• -
t COMPENSATION INSURANCE,,, w.. ..
tin.. .c•, -n'
(This Senion need sial be completed if the permit is for one hundred dollar '1• "
($tw)or Icu)
f 1 I certy,,that u the pert mut Ne ark for which N perrmt a issued 1 ... -. .. - t 1 \' f 1 ! •_.._ . . ... ..._ . . .
ahhll not employ on osubjectl -
P Y Y a any manner,sa ox to become t Wo kers
'Comps noon fC IIT Ie:Dmei /ti,7
-APPbcmm �
'NOTICE TO LICANT If after Me
t ism sof Exemption,you should
Q 0 become subject h the Words Compenalion p i ons.f the Labor Coda you must
fon usith comply with such provisions or this permit Nell be Manned rtwkcd. '
y. - .. _ _ _. . . . _ --•di ..._.
I i',i' " •""•'
CONSTRUCTION'LENDING AGENCY' ' '�
�.� =whichw_na - ewhich....NN.a.st.'permit
eml.ii.s is
s'ic.ssoun.d�(S.ee_...3.l,0e..n9d7.i.nC{iv C...)
.rh..
p' Lorder'sNue...
s "
Lindens Address• •'r -_. _v. _ -. _ ._.... ...__ _. .. ..
T..,
.1 anify that 1 here reed Ws application Bird mme Ihn the above infonn"iw is
Tec
TO correct:I agree to comply with all city old county ordinanc"and sae laws elating
to Wilding construction,and heeby'sudorile representatives of this city toenterupon
- Ne eWve-m<mioned property for inspection purposes.,, ,
Fpr (We)agsee to nave;irdehnifyrod keep haimini the City'of Coperdo6igeinal
(A liabilities,judgments,costs M expenses which may in any way amm against,aid
f.7 Cly consequence of Ne gm n g of In e
'AP LICA NDBRSTr1NDS AND WILLCOMPLx WITH ALC NOIJ-POfNT "
so�i cuLATwNs. I. .•i+.'' o-m Issued by: i Date
Sig ameor ApplicanOConimct r' ,' '\ ,Date"'.., Re-roofs
i s 'HAZARDOUS MATERIALS DISCLOSURE
WiII the Opplicant ter falUR W(ding ocLUpwt start Or haMl h"eNws inetedd Type -
as defied by the Cupaninolva ,pal Cade Chepn 911 r d Me HeWh wd Saf ry sof Roof-, _. .. ,
Code Seetion.155321e)7 k \�i l'I(Itsh
❑Y",• y Sflllk- No'I: t 4r 11L1;ys ft hla4 '
t t • .dr . - All.roofs shall be inspected.prior to.any..roofing material.being installed.
x
Will the applieani Ofu[ueW;iMn'goewpsm use equipment or devices which If a roof is iiisEalled Without first obtainingins ctiori;'I'a ee'toteimve
emit hezeidous sir con1e111irW""defined by thManagementBey Area Air Quality Management
an Pe
District? _ all new materials for inspection. Applicant understands and will comply with
- ❑Ye ,, P, y .❑Ni,] ;1', •t t -.'', , all non-point source regulations:'L
ha a ked the Wxmdous memnals equ re cats under Chapter h95'of the
I
CelJomu ll' tb&Safety Code.Sectio"15505 25533 end 25534 I nderstaad that
if Mebuilding doer note retlyheveatrnant Nal its my responsibility to notify the --'-
o' prom of theegoism ms which must be'el pdor'e issoonce of a Carnificals of
Occupsm
Signature of Applicant - Date
a
o eor a i .n:eaag'��7`"�?� �P. Data,.. Al] roof coverings to be Class "B"or better
OFFICE-