01060106 CI BUILDF ERTNO
BUILDING DrvONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21608 FLINTSHIRE ST 01060106
OWNER'S NAME APPLICATION SUB DATE
DOWD NANCY A AND WILLIAM F 06/19/2001
l� HONE: SANITARY NO. CONTROL NO.
QO O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
,a I-
LICENSED CONTRACTOR'S DECLARATION
O,L - 1 hereby aRrm that I am licensed underpmvisions of Chapter 9lcommansing Job Description
I-=tw with Sewion]000)of Division3oRh<Busimss and R°fessions Code,and myliarlse REROOF. T/O SHAKES .
=iew Licensis in aClasforce aMemo3do ut.n ?2oS57 INSTALL 1/2 PLY WOOD, &
w3°� owe _ - -� / Cusumam' 30 LBS FELT/ LIFETIME COMP.
ARCHITECT'S DECLAR ON
��� I undcnnnd my plans shall be usN as public mcoNs
T
m p Licenced Professional
OWNER-BUILDER from
DECLARATION
w- 1 hereby.(Sero than 1 oro exempt tram the ConnmmC s License Law for the
t?Q
followingreason.a.permit
to]03Lm r.on, and Professions h,de:Any city or county
to D which requires a permit ne c°nstrun,atter,Improve,demolish, fi repair any structure
a 3` Pr t t ..trance.els req ' J ppl um hcsCon Perm t t is agncaLb cement.
- a,0exlatxdpat 'tin p i.ian,°nneenmmrl° Law(G1tapte,9 -. Sq. F Floor-Area- ,, _ xr.,, $160 nation
(c ren enc g with Section]0007 f Division J of the Rusin and Professions Coda t ,
or that he s exempt themfnm arM,he basis for the alleged exemption.Any violation '`
:of Section 7031:5 by any applicant for a permit subjects the applicant to a evil penalty ,Qt
of not mte
orean file hundred dollars(5500). 356�,{ZVULt"b !n:' Occupancy Type
❑1,as owner of the property,or my employees with wage as their sole compensation,
-wureo he work,aad he xtruwan;s not intended or offend for mle'(See.Tau, Required Inspections
Busine.is and Professions Calc:The Cmantem,%License Law does not apply tut an 305 - FRAME
owner of property Who builds or Improve thereonand who does such work himself 307 - INSULATION t
.. r through h'. employees provided that such iprove t t intended or _.. -.. .._... .. _... ... .,, ...._._ ..
n
m dI - tI o 'he rmy enc la one rar Of 601 - ROOF TEAR OFF '' ". _...
it mpinion,the nwner bu Idcr will eros the bunko of proving that he did net buil]n
mprove for routine of sale.). 602 - ROOF PLYWOOD _NAIL
_.
❑Lasowner Donee pism.7 4.c Business
and rowing wishCode:)The onctorsm 603 - ROOF BATTENS -
- _ Liceconsmw the does
(Sec.9na4,Business and Proproperty
who hi Code:)The Commmw's 6 04 - ROOF IN-PROGRESS "
Litems co docs not apply,o an owner of property who builds to improves n.tIm
.
and who cnmnco for such Prolu,s.with a comrecmrts)IicemM pursuant.m the _ .. .. ... .. ........ 111- - _ _. .- .. _ ..__
Contractors License Law. I.
❑1 am exempt under Sec. ;B&P C for this rtaon I
Owner Dan -
', ' WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury e of thefollowing dedarvuona,
1 Woe and will mention a Certificate 1 Comant to selfimure for Worker's
Compensation. as provided for by Section 3700 of ,he Labor Castle. for the /
performance of the work for which this per n n is issual.
..
131 have and will'Ormatem Worker's Compensation Insumen,as required by Section
37M of the Labor Code,for the performance of the work.for which this permit is
Issued.K�1R.Rlon Insurance carie,end Poll,number am e _
�_!Al.-. . . . - .
Came'.. - ._Policy Nu: O O ->')'3-Y
CERTIFICATION OFE%EMPTIONFROM.WOR RS'n
_ COMPENSATION INSURANCE
'(This section need not be completed if the ��"'"t. t,"_
(Slip)or less.) P permit is fn one hundred dollars
. - .. .... ....... - 1 :. ........ . . .... .... .. .. _..
1 coolly that' person
p f,mance f tl walk forwhich u ct ,t a issue] 1
shall cn adrm U-any pecten to any manner so os to become subject m the Workers''
Comitant iron Wws of California:DateAppl ---
NOTICE comeiu O APPLICANT
the A r TIf,
attar making this Cmifican of Exemption.you should '
Obecome iubjeci m the Workers Compensation provisions of the WMr Code,yoti must
forthwith comply with such provisions or this permit shall be domed rooked,
rn - ... . .. .. .... ._. _ _
CONSTRUCTION LENDING AGENCY
;
ai- 1herebyafii,m thauermiss construction leading agency for the pedom,antt I •- ... -
�; of be work for wnich this permit is issued ISec.309],Co,C)
LL 9z Lender's Name .. ... --
Z Wnder's Address
-
V 01 eenify that Ihave rcdth.application d tt fl nth aboinformation'
fi H el t 1 agree m comply 'ih II city red c° ty minimum.,and state law,mlaim,
W tub line- ret t dM1 by tithe z p .mi ea of this cityt t pre
a. ,he h e , d p.Renyde pat p rp
[r'4 IMl gret indemnify Jkeep M1 rml..the C'ry fCna
Z Cit I t judgment. c t d expense h h m,y in any way wens ng,mst sod
[,7 Z City in consequence UNDe f the g ming1)this pe t t _ -[
APPLICANT UNDERSTAND D WILL COMPLY WITH'ALL NON.POLNT
Ss .NEIIUt.ATIONS. -/P-C/ Issued by: Date
trun of ApP;canaontmm ,, Dae Re-roofs
HAZARDOUS,IATERIALS DISCLOSURE
Wllthe applicant or future building occupouson or handle hwwdous enaadal Type of Roof
as defined by the Cupertino Municipal Cale,Chapter 9.12.and the Health and Safety
Calc.Section 25532(x)^ ' - - •'
❑YeoNn
" -. . a :._ . All roofs shall_be inspected.prior.to.any roofing material.being.installed. ._...._._
.`WiOcheapplicantorfuturebuildingoccupantuseequipmentordedceswhich If a roof is installed without first obtaining an'inspection;I-agree,to remove
or huzardoox air contaminants as defined by the Bay Area Air Quality Management
Dionarl - p Applicant understands and will comply with
all new materials for inspection. A hen
"' El No all non-point source regulations: , I ;
1 have rcad1lhe hazardou.i materials iequinmems under Chapter 6.95 of the
California Health&Safety Code Sections 25505.25533 and 25534.I understand that _
, zebu ldingdnsnimmenD hich mate,thm it is responsibility tonotify the
occupem of,he rtquir mems which maw be met poor to issuance of a Cmifcae of
Occupant ^`. .
�p Signature of Applicant Date
authorized on, _ Dae All roof coverings to be Class "B"or better
_. ..
- OFFICE