00110082 CITY OF CUPERTINO
u iu,ntNG DIVISION _ PERMIT CONTRACTOR INFORMATION:
BUILDING ngpLe5g, a CRICKET .,HILL RD FOUR SEASONS ROOFIN PERM] Na 001100822
OW'NER'S NAME: - �' - APPLICATION SUB DATE
GRAVES F _T 645 HORNING ST 11/.15/2000
IONN, SANITARY NO. CONTROL NO.
p (408)278-0330 - ...
W O O ARCHITFCCUHNGINEER: - BUILDING PERMIT INFO
F mp,,j. 'BLDG' ELECT' I'hUME MECII
.roan
LICENSED CONTRACT'OR'S DECLARATION' _
„'� Job Description'
0 I hcmhy nflinn Nm 1 nm licensed undnr provisions of Ch:gncr9lanntncncing -
�yFw with Section 0000)of Division 3 of lire Business and Prucssiom Cale,and my license
�� �i«nfo°cmeand&`3 "t 70108' ,TEAR OFF. CEMWOOD ROOF, INSTALL 1/2 5 G
a°LLN _/,i- � c,mraaer_ - ANn GAF '40 YEAR GRAND SED. COhIG.
ARCIII rIiCT'S UECLARA'"ION
t O g e I understand my plans shall he u+ed as public are ds
pO I.icen+ed I'rofcsurairl — -
P3 0
OWNER-BUILDER DECLARATION
u'3 1 hereby option that 1 am exempt from the Contractor's License Law for the
F-Z following realm.(Section 7031.5,Bminesx mad Prdfes,lons Gale:Any city or county _ -
rt0
which ectlsionlitt t l alley,improve,dt lit (it train,an, lcure '
3p , pro 1.its ,oulawc,alkare,moohe applicant h : 111purnalt It'tke a 11,11.1 Inflaccan
mat he i,lanamialp : tt t "o'kiter, iflit C t t Licton.La (Chapter 9 Sq. Ft. Floor Area 'Valuation
(commencing with Se,t on 700(11 of Division 3 of the Business and 1 ronfic ns Cafe)
or that he is exempt Bmrefmen and the basis for,the nllcgcl exemption.Any violation
of Section 7031.1 layany applies I fora permit subject,Ice applicant to a eivll penalty
OCC e
of ou n me darn rive lmnfired dmm�e($500), - APN Number ,
o I,as dwncr ofmc pmpeny,or my employecx with wage,as lheir,ole compensation, '
will do the k and the t t t nooded or offered for sale(Scc.7000 >�t— -
Bn JP f:: CoI; n Contractor's Li t Law I t aptly to - ,34235,?019. ffZ uired Inspections /
ownerI property Who ha IJ.or improvesmennor,and who does such work h' If
or through h:ow'a empl Yee. provided II t such inipmovurnervi an not jacandeaL or
n c i t If,however,d building p er ill la 't f. 305 — FRAME
,tpll II huldrr ill have f d ,of proving dal head t,l ha Td(it
.
`mprmefpr pnmac,rul,ale'L 307 . - zN31_ILArION..
0 L anwner oche mapeny.ton exduxlsely contracting with hecroed contractors to -601' — ROOF TEAR OFF
Lnsuua the..soja,Star,964,limina,,and PmE,..ants CnJn)'Fill Cnnurunr's '
icense Law alae,ran apply n,an owner of pmlimr y who hada,or inpmvex hincon 6!712 — ROOF PLYWOOD NAIL
.
arta who contracts for satin prnin'ts with a commcmrc,l licensed persaen to the — '
Contractors License Law. - 603 — ROOF BATTENS -
❑IataexemptwaderSce. ,B&P C for this commit
Owner Date
604 — ROOF Ihl—PROGRESS
WORKER'S COMPENSATION DECLARATION '
I uachy oftirut nnderpmmllyofpot'luryonc ot'I hu followingdecla'd a,: `
I have and will m mean o Ceniiii of Consent to"If-h om,for W'eaker's - -
on'rommil, as pnnlJed far by Section 3700 of the Labor Cale, fill the
turf omruma ut dai work fm which this..smart is issmd, -
have and will mrmaim Wader's Comperowne,Imannce,a,required by Section
37W of the labor C,de,for the peafonnaone of be worpe
k for which this rmit is -
+cued,//M��..y WorkersCompensation Insurance currier and Policy number are: r'
'cr:7s-tT�—Policy No.: -
CERHVICATION OY.BXGMPTIONfFROM WORKERS' .
COMPENSATION INSURANCE -
('ehis section need net lac completedif the permit is for one hundred dol' - -
(SIM)nrless.)
certify but In the pe,ti,rn gree of the work for whish this pemat is issued,1 - - -
sLnll col employ any person m Itny'nnnner son,m become subject m Ilan Worken'
Cmnpen.+mion Inws of Culifnrnia Dam
Applicant ' -
NOTICE rO APPLICANT:If,after making this Cenilicme of Exentgial you 0—m—d
Fleme,longe In the Workeron ...
's Cntnp ...mor.......critic habit-Code,yon mrul
Z O fonhwill amply with.such provisions or this pencil shall be demand revoked. `
4 CONSTRUCTION LENDING AGENCY,
I heruny chant Thal Ilwre Is a consionlion lending agency tiu the aid, name,
ol'the work rot which this pencil is issued(Sec.3099,Ci,C.)
S lender's Name -
7 Z Lerall A 1J , _
U0 1 candy an l Lve read flaka,pliwali i and;nt Ihot our h,),.infornerfin.i.+ '-
;T+ t., a me t I grdearennin,ly w tit aII cnY and my tin J t tc l malting
0 U to building c .t cttand hereby ammorra,representatives ofthik city to enter upon
(11 Ne Aswom,durnmed,,roperry it,, n.peau n I
ted (W) , d law Isee,1 y ,,tire a,u,nore nsg said - •! 1 ,fl^-Jit �.
44 Vi Citynliabilities,)eq I e 1 y t any way Dane uga r st said 11`
U.� any aosTUNDnftheprinting this WILL tin
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
SOURCE REGULATIONS. lsSu by: - Date
Signamrcof Applicant/Commefor Dare_ Ike-roo -
HALARDOUS MATE-RIAIS DISCLOSURE I '
Will the appltwlm or hart,budding occupant stere or hawue hnnrdoa,nwteHal Type'of Roof -
n,denied by,the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety p '
Cede Section 25532m)^ - -
' - Dyes Dam4 All roofs shall be inspected prior to anyxroofing material being installed.
Will Ncat,onif..mail,s mwNng1, Ill,Bay
.A,In o aIMan gewhich
ment If.a roof is installed,without first obtaining an inspection, I agree to remove
earn h 1 cam t.a.J tined b)the Hay ArcaA r Corday Management
all new mater' Is for 1 pection. Applicant understands and will comply with
I7Y. ❑N all non-poi o r ulations. -
I base read are h a door,r tot owl napalcumull ods Chape,645 if the
California HalthA Sofuyentlly Sections 25505titis and 25534.lit Jt)n JNm
fthe buildinge revuirm not ,whi eatenant,Tthmi0 )responsibility Concur Ne
enpamy.the rcgt ter acme witsit must he et prior xl anw da Ccn'lxme'nl'
oennpaney' - .Signature of Applicant Date-
Owner
ale-
t _
Ownera audtortrcdpgeltl Date All roof coverings to be Class `•B"or better
OFFICE