01060143 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
944 FERNGROVE DR ARMSTRONG INSTALLATION 01060143
OWNER'S NAME: APPLICATION SUB DATE
DAVID YAGGI 774 HARRISON ST 06/26/2001
PNONE:
(415) 777-1234 SANITARY NO. CONTROL NO.
nrc0 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u BLDG ELECT PLUMB MECH
z y z LICENSED CONTRACTOR'S DECLARATION lob Description
o z_❑ I hereby affirm that I am licensed under provisions of Chapter 9(cammencing REROOF. 2 8 SQ. S . P
,.,_Fm with Section of Division 3 ofthe Businawind Professions Code,and my license
z m 2 is in full roma ane effen
25 LicenseCass p S"_!Z T/O ROOFING (FOAM SYSTEM)
m C O N Dote Contractor
a. ARCHITECT'S DECLAR
1 undersmad on,plans shall be used as public records
doi cLrensed Professional
x,,,a OWNER-BUILDER DECLARATION
Let— I hereby affirm that I am exempt from the Contractor's License Law for the
F'Z fallowing reason.(Semon 7011.5,Business and Pmfessions Code:Any city or county
HD which requires a permit to construct,alter,improve,demolish,or repair any stmcmrc
a 3 a Priorto it, 1 q tl Pul' it P t fl W t t
Ih.n - d1 u m p-....... f Is,.r l 1 L- Sq:Pt. Floor Arca— 'Valuation
.lu.l,or(am
evin Section 70W):f Divi' 3 of be Bunn<; uei )pnoaiCe) .l' , � :,, .. `.
or that he s exemp[then@oto and the bans for the alleged -lmpdon Any violator
- nn
of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty
'ofnatmore than rivehundred dmmrs(SSW). APN Number .. . Occupancy Type
❑Lae work,
and be
nr on,is o t intended
or offered
ed f r sale(Sensation, —
FRAM
Businii m[he work."and the structure C n d intended or offered roe sale f5=c:7043,
owner of prad operty Who
Code:The Contracmrs License a dodos not apply to an 307 - INSULAT hired Inspections
owner pent Wh Ids _
or through hemploy.,.p dad th t M1 tin ro l a tintended ar o
dffrcdf Lome er,thebldn y _._.. _ .. _ ._- _. ._... ._.__.....
vet p e h khmslf 601 ROOF TEAR OFF A
g pro a ii m 'tnttan=year� f 602 - ROOF PLYWOOD NAZ'L
complc,iun,the owner builder will have the burden of proving that he did nm build or
improve for Purpose ofsach. 603 - ROOF BATTENS
OI mr a(iho ph,peIY exd -iv coi t g -it hl i cf,n xrd cu tbro..t o m r a- .. .. 604� OF IN--P ROGRESS
co , t thep d t IS 7044 B ..d Pref on Cad )Th C t for
LicenseLa d of apply t an f Progeny ho builds improves thereon,
.and who c miens fsuch
Contractor.,L eno s h p olects w th calculations)I en ed pursuant to th
--
_
❑Iamexempt un c. ,B&PC for this reason
Owner_1 from
'i /�
WORKER'S COMPENSATION DECLARATION O
I hereby affirm under penalty of perjury one of the following declarations /
0 1 have and will'mairmin'a'Cebificaie'of Consent to self-insure for Worker's
_ Compensation, as,provided far by Section 3700 of the Labor Code. for the
_ performance of the wmk for which this permit is issued.
❑I have'and will maintain Worker's Compensation Insurance,ax required by Sedir�n
3]W of Notabor Code,
for
the performance of rhe work for which this permit is
issued My Workers Comperi 'ju'rance carrier and Policy number arc' - -
Ca c
ERrTIFICACOMPENSATION INSURANCE
t - ,,
(Th art n veee rat he completed it the permit is for one hundred do[].. `
(S I W)or less.) ' 1 ' ' +
. ... _ .. rv__..., ,. ... . .,,
l ICertify thatiner performancerrth inb Which this le is coil
'shall not employ any person n any manner sa as to'tiecom<subject to the'Workers'
Compensation laws of California.Date -
NOTICETOAPPLICANT If,after making this C<n fica,e of Excifia ption you shm old _• r . _
bee m b)nto theta ker C tpensat 'pm'a ns ofth l-m C ee.you ust -
0 O forh th c n ply with such prevolim,or this permit hall he demand rc ked
CONSTRUCTIONLENDINGAGENCY'
a.'
I hraddby offirmch tbar 's .duce I97 gagencyfor the perfomtance
W Q
Lend,
WI.F., _ p n s iwue I(S 309].Civ.C.
z, Lend Name' ..,. .._ �, .. ...
=,Z Lender's Atklress
U-0 1 family that 1 have mail ths application and state that the above information is
W [.y cott=a 1 agree to comply with all city and County ordinances and state laws testing
0 U no bolding construction,and hereby impolite representatives ofths city to enter per
,y'.[,a the idowemormumcd property I -inspection
OVO) Fmo to save,indemnify and k ep ha,a,.IO,,ihc City f C prnmo agains,
F4 AIlab'lire judgment, t J t expenses h h y a any y a against said /
C,7 � Cityconsequence Of b noting f thi p= t
APPLICANT UNDERSTANDS AND WILL C WITH ALL NON-
POINT' Date
souace olvs ;•_�'"�.{ (_o Issued by:
Sig VCuntmcm4 .Dat= / Re-roofs
FIAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future banding r sco
anding croppere or hand],assume.,maren't Type of Roof
as ace - ... ... ._. ,. _. .. ....__..............
red by the Cupa die,Municipal Code.Chapter 9.12,and the Health and Safety
Code Section 25532m)
°Y a All roofs shall be inspected prior'to.any roofing material being
emithJ .installed--
i
Will the ppl nt rf t b 'IJ g < P tp,e eqp v , ode twn eh If a roof is installd-wi[h'ou[first obtaining an"ins ection,'I agree do remove
Di
" '. i is as eneearreagQuality5
rlanauoram, Stall,
g P
nt t air dfid by he BA
_❑Yes all new materials for inspection. Applicant understands and will comply_With..
- �e all non-poini source regulations:
1 hall*red the Nimindar, ad,
imperial,
mrqu
Cal f lin Healh&Safety Code.Section, 5505 r pr 6.95 of he
25533 d 25534 I d i d thatrfthebuilding ircurrently rtc t that rep n"I n try the
Occupant f the
req requirements hieh must hem t prior m su c ofaCertificate of
�
Q
op
--
lgn uleDate
,o_ Applicant 1 _
Jjkaa�ftbdrim
e ag=a, Do,e All roof coverings to be Class."B" or better
t . . . .. ..OFFICE . __ ..