01060105 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22432 BALUSTROL CT EXTERIOR SOLUTIONS 01060105
OWNER'S NAME: APPLICATION SUB DATE
COLLINGS EARL L AND DALE A 1771 SMITH AVE 06/19/2001
z'
.'HONE: SANITARY NO. CONTROL NO.
' -. (408) 358-1233
❑ Z ARCHITECnENGINEER:
Lu O O BUILDING PERMIT INFO
& BLDG ELECT PLUMB MECH
m<n E J L".- I__i CI
y Z LICENSED CONTRACTOR'S DECLARATION Job Description
ZO�y o 1 hereby Affirm such 1 am licensed under provisions of Chapter 9(commencing
rxlca with Section 7000)ofDivniun3ofthe Businessand PmfessionsCode,and mylicense REROOF.29SQS . REMOVE SHAKE.
Mfwuome and e � Lia.a .3.r INSTALL 30LB . FELT, 7/16 DSB
rc� Licenseee Cla'
3�u D`t` SDEContCtO` & CELOTEX PRESIDENTIAL.
understand my plan shall be Asea as public reeds Sve.eJ/o N5
ise
p O Wcensed Pmfesltonal
s�m OWNER-BUILDER DECLARATION
assI hereby affirm shat 1 am excmpl from the Comran is License Law for the
following reason(Section 7031.5.Business and Professions Code:Any city oreminty
ce t=-❑ which requires a Permit ,,construct,alter,imprme,demolish,or repair any sba,tam
=3m pn t t I q.ocanne rhplirsomf µun,im fl g Lasemen,
Ihathy f salp rs nto.ttlep eon f0 Cu trit f 1 La (Chaptcr9 .SC.-.f I I'loor•Aleu 'tuition
(co c - Swlh set nlU(10) fUvi 3 fineB tc pQet fie ns Cale) 4 ,�1 ,, i w,. 2�'ti ' 4 I $105,(ary
or Ie I he's 31.5 bt mercfmm and the aper Gtr the alleged applicant
I.Any violutinn v v
of Senior than
LS by any dreddollfor apermit subjects the applicantmpcivil penalty'
or Bol moreroftfive haadtor my
employees
356 ' !�F6 � ,.:,r.. •.'. Occupancy Type
❑I,m owner of the property,or employees wile wages as their sole toconstriction,
will do the work; ad the structure is nos-intended or'oWrce for[ale(Sec:7014,' _
Business and Pmfessions Cade:The Conlmctms License law does nal apply as an 30,5 - FRAME Required Inspections'"•
owner of proper,Who bolds or brummeadaram, ad who data such work himself 307 - INSULATION
or through his own employees provided that: h p em t. a.?intended o t
-"oRercd for sale.If.however.the W tiding mprovio i i sold within one Y of """_ - _ - ..
compinov,Ine annermildc,will have me baNen of pmviag that he die not Wild or 601 - ROOF TEAR OFF
improve lar pnrpose°f ale.). 602 - ROOF PLYWOOD NAIL
o 01 en ranee 603 - ROOF BATTENS__ _I_t_...... .. i,. --- .. .--
pmpeny,am excluavely �-uxu g with I'ttnscd mrvclors m ---
const n she project(Sec ]to a Business ad cm,,who
ons Code)The Commnor s - '
e' License Law dace not apply monowner ofpr°penycams)lice ord "arathereon, 604 - ROOF IN-PROGRESS ""'
vnd,wha cs License
for such-protects wim.a,commcmr(s1 licensed pursunm m meCombactor' _ .. -. -..... ..__ ... _. .-..
❑I amexemptlnrler5_c," ,B&PC forlhisreasans."
Owner o :. �.- : a Daie '
WORKER'S COMPENSATION DECLARATION
`- 1 hereby affirm under penally of perjury one mthe following declanniuns:
❑ 1 have eml will mpialain I Certificate a(Consent to self-insure fm Worker's FIN ALE D
Compensation, as provided fnr by Section 3700 of me Labor Cale, for the
pert of the work for lus,Pe 1 is issued... „
1 ha d ill mai u n work pe i Coins i Inserhnce;m rtquveJ by Senior J U L 0 3 2001
C f Labor Cad (r Ih pe f rm f Ore p'work
f/which this P t .
�%CHN�VypYy' n - PPyuhccySN��e.S-IJ.IL/ _ __ _. __ _
e .CA/CCI/QA/ dPolicy be�
Isld Mn CERTIFICATION OF EXEMPT ION FROM,, RKERS". {,BUILDING _......_
COMPENSATION INSURANCE ' I I,, -
"'" or l s suetu, ccd no[tie cnm letee if the t t _-
P permit is for one hundred dollars '•(��'•�I•" ., �p iIC:N;•?1sT:
($I(glinless.l :
",bill
1 mfy lhas'n the pert nc<ofm work for hch thisPermit is I ,.,, I.Y �.
stool a ploy any p any manner x to become ubl n'm me Workers `- '„ ' '
e:
Campc. f nhuws of Calfmin.Date ""•'
. Applicdm. . . ,
;NOTICE
subject to
WTI` urmakinglhlsCnf to fExaborCre you a,t
bac to theta kt Cmpn r rip 'o ns nfed Luber lcvu you must 1
Q Q foithw m comply wish xuch Alae sines or his permit shall W deemed revnkee
r
a ' 1 h by oft rm Ih t the n.trues d d agency f Ih p mor ace
r
�Dz
V O s
1 n fY mm I h eJ Ih ppT m d lase m rhe ab f mwurat is
wit,Ea oro I 1 t < ply nh II ly nil c ty N' a d tel 1s res ting
�'V slab IJ n6 uncC dnarebY m ¢ p roti s fth. ryt ter upon
�
&.t W 'the h t' ti p p ry fo p�ci p p c-
it
[r4 'ACPitPy Lm' TqUueNnD<ERo,oS h g m .to t d
aynanyy e Boegainto vnsamidU Z
IP WITH ALLM1 P NT•
Issued by: Date
_ III ig uraofdpplic YCmnracmr D.,tea. Re-roofs
HAZARDOUS M VERIALS DISCLOSURE t
/
Will dk ii,lican,6r tore building accu,surn store'or handle himmus te ial •Type-of Roof
as defined by she C pee n abothin 21 Code Chapter 9.12, d the Health ad Safety - -
Code S uon.5532(a111 'r :• t - - t
., ❑Y r No q,:
All.roofs shall be.inspected prior to any.roofng material being installed.
Will the ppdntam rfuwmbuilding cupantuseequipm t de is which If a Too ' installed wltho t firs obtain 'g an Inspection; I•agreet6 remove
•mit h N s wm t. defied by me Bay Area A Q I ty M egemem p
War, all n m terials for,insp ctio . p c nt understands_and will comply with
�• riY t`- --all on int so g arse
a
1 ha a re d'.the h Nous.materials ralmlearints`made,Ch pr r 6.95 6f the
C cal,n&Sir fety Cad ti 125505 25333 and 25514 1 d rsmnd ohm
If Ne CW mg does not cu mly a ns maths y tespons Moly lonmify the
nca gPme recut els et p oma,!see of a C' locate f
,,.. O ancy ,-
�9 _ignature of Applicant,
y n aInna:;eaaB nt ,p.pate All roof coverings to be Class `B" or better
OFFICE