01070102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 E ESTATES DR 01070102
;51 LL MELVIN R AND MARY L 07Y23/2001
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
an 5„= Job Description
ozgno�_o rebyaffmthatlamlicensedunderprovisionsofChapar9(c-mmencingPo� REMOVE EXISTING COMP ROOF--INSTALL NEW 30
with Section]000)of Divisi-nJof the Businesx and Professions Cod andncrecunse
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z3 isnfml -rcaaaefCwHa LiceneC 39
Lic,N
72U3 SHINGLE
Dale l
Contractor
ARCHITECT'S DECLARATION
C HO aj 1 understand my plans shall be used as public recoNc
r
pO Licea d Professional
ao. OWNER-BUILDER DECLARATION /
I h eby affirm that 1 am exempt from the Contractor's License Law for the
L'Z6 following reason(SectionRE,"Business and Professions Cotle:Any city or c-un[y,
E'x p as Fi which requirela permit w conswct,alter,improve,dean h,or repair any structure
n 3 _Fl t is 1 q ue the FlPIr tf ch permiuo fleas gned smatraa - - - -
Ihathe sl P'ad ! a 110 `
- _ @<p Provision, rinec-ntra<tnraLittns<Iawlcnapar9 SFk Floor Area Valuation
(c nnng with i ]WO)o[Div" J fThe Business and Pro[(sstoas Credit ," 1-. q .li i`. b'.
-r that fie i3 exemPnA refrbm end[he basis for the alleged ekem"Ia Any vtalso-n -
-
.11
r S702.2 00
ection]OILS by ally all",vol
n fora permit subjects the applicant to a civil penally
or not mare than eve hit it (asoo). APN Number ..':,I Occupancy Type
°,,Satowner-ftbeproperly,maryemployees'widMe,
astheirsolecompen.a[Ian, 502 FINAL PLUM13IN ENERGY
'will'do'the narda_.ad The'structure is nor intended oe offered ror sale(see.]Ow.' S 06 - GAS TES'IIiequired Inspections"t'
Business red'Prof<sslons Cod&The Contractors License Law does not apply to an '
owner of propeny Who builds of improves thereon and who does such work himself 507 - FINAL NAL PLUMBING
or fo h' n empl-yees pbuildin that such improv [ t mended or ._,__ _„__,__-_-._. „.-_ __.__,_. _____
"-�comptffo sal w er boulder
tiu)Itlmg or improvement s Id w[h n one year of - -
'coprase purpose b Id 'llfiaJe[\h a f -
improof f I .),/ P gM th did tb Id
_ .
DI q . .rof he
erty
popam exclusivelyc [ i with
Blicensed
contractors to
construct th project sec.7N4Business nd ei n Coad,)The Contractor's
License Law does not apply t f property who builds initial th on.
_. h conras f r such Jct,with mctoC)I d pam - he
C i License C 1 hsmasonEl 1 exempt under Sic.
• E le
..G
O"er
_...__... _•_
_.__._....
fes/- " WORKER'S COMPENSATION DECLARATION
I hamela,affiren orderpenalty of pe) y ne main,firributcon,dealsolaimn,t
-° I have ml will romplaina Certificate of Consim to self-tramefor Worker's
Compensation, as Provided for by Sectio 37W of the Labor Cod, for the
performance-n the work for,whieh this Penni,,is issued_
Iqt h and'will maintain Wok s Co pen ar reit Insurance.as removal by Section
]W f[M1 Labor Cod f theperformance of the work to which this ps T s
I,sued My is Compensation I trier and Policy mber arc: _ n
._:-_ - ._...
.�. t�K'4 I2g189� - �_..
Canter 1 Nd✓ , :Po1ry No. - ._ '.
10ERTIPICATION OFOF EXE MPOHONFRQMWORKERS':,""
u
COMPENSATION INSURANCE
(This secuan need not be completed f the permu k for one hundred dollars - '" i 10 I iLi,
(SIM)or less.),i..
.e
t 1sed,fythtnthepen n-'e fN so hch th pe ib is i. MT
,'1 I I ,
II [ ply say peers li ay ma n r c to bevu K ub)ect iii the W rkert
C
C pe b n Lew9 of Cali forms.One
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Applicant. . .
NOTICE TO APPLICANT If per m:k ng Ili Cn ficnte fE pt you hould "' ' - '
bec roes 13 coo
fnhh mply with WuckM1 p!roCve roopne this
et p et nhla�lflyha�La_beed.C.t revoked.
Z=0 - -
mus[
CONSTRUCTION LENDLYG AG Y - - '"
'i I h by aRrm th t then 'f¢rd g agc cy f r the peifumlentt ''' '
].Z
UQ�a 1 wmfy t6m 1 hove and th s nppl cation and smm lh uh aW a information is
0-Ft 'cones:14gree t-comply with all city ana compy-rtlinancex and state laws relating
QrV to building<oretrvttign.and hereby authorize rcpresenwtives of this city to east upon
,y'rte the bo f, dprope ryf .p^t nPnrp-
{.y:ps (W)agr< mca a dem fy dk ep harml..c theCry fC pert nn against
U V] I b lines Ivagmept o f tl expense h ch m y in a y y e e agai t said
6,)_'Z C ty onsequence f lhG gr t ih pe n it
OINT 7-s ,
sr APP NT UNDERSTANDS N �WILL/J�COM�PL�Y WITH ALL NON�P � Issued by: Date /L"�.JK
sbuBcr. � 72 3'b�
lura�t pplmanVCononc[or </ ` ,!'
Deal Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
W II the n'i cant o f t m b Id g occupant tore n h ndle haz4dous mat I ...Type-Of Roof, - .. , - .. ., .....
at der d by th Cuperlin C rd Chapter 9.12. d theHealth and Safety
,
C-d S ctmn]S572f 1 y - t ij; , '- i I Yq ray ) -I
°Yt5' s _All roofs shall be Inspected prior_to any roofing material-being installed
t_r1, W'II the,ppb eatoils,t b Id' g pant use eq yro nl de re,whim If a roof is installed'without first obtaining an inspectioti;Tagiiele to remove
°Y t m is ac aefi d by th Bay'Arc Air Q Ily Mdnig mens
all new materials for inspection Applicant understands and will comply with ,
rem,! rc - -.
ata
e I' I � alljpoint source regulaoI h d th hau m Iaqui mem. de Chpier 695 ElbeCalfmaH Ith&S fetyCI ScfoNotou t5t itis na155W I.understond thioifshe bu ld gd nm tl e t tthmTs y p hilyt ' try Inc _Z t ofth try e t hm rtb e fhCen f t f \t- `�'I V•✓ 3 /
Signature of Applicant Date
/W�Ji,/ 7'L
actin-r.:�a g rot Date All roof coverings to be Class"B" or better
. , . . . r .. t .. .. .. . .. ... _ -. . .._ . _.. _
OFFICE.