06030157CITY OF CUPERTINO�
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
CERTIFIED ROOFING CO..
PERMIT NO. 06030157
22126 HIBISCUS DR
ER'S NAME:
PET MIT ISSUE DATE
MICHAEL MINN
CONTINENTAL DR.
6
PffONE:
SANITARY NO, CONTROL NO.
(408)489-7982
ARCHITEC (ENGINEER:
BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION IJob
Description
berth' affirm that 1 am Iheved oder pmWiov a chain. 9 (commeming
with Section 700Mof Division Sof Ne Business and p.1cues us Cde.ad my It.. Is
in full farce and effuL
REPLACE (E) PATIO COVER AT REAR YARD 12' X 2 7 '
Lice Us.
Class
+ e'"
ROOF COMP SHINGLES—CLASS A W/ICE & WATER SHIELD
Damnau
0Ybr
ARCHITECTS DECLARATION
I uduoand my plane Nell he usetl as public tuns"
F�►�
Licensed Professional
OWNER -BUILDER DECLARATION
ALE®
I hereby affirm I am exempt from cite COnuaclAnse Law for tite
fallowing menta. (Section 7101.5, B,dness and li Code: Any ttly or roomy
on
w, dem h.oany Nuwurt
which rtquhu a permit re conmm4 slat.Improve,"ermitt, orrepair
e
incensed esaareasig mmmt
sof for smhnuous'm
1
SQ• Ft. Floor Area (f 2pD6 ValuatiQIP500
mole aw(Chned
dustpoor
he Inte(covisio of law(CCapler9
(comm is Reeved pursuant 7000)of
of eBuinessa d Prot Code) w
with Section 7000) or Division 3 of the Business and
Division
Alma
Ors, MY A
Nal io r 31.5 b mertlmm and the bur for tiro alleged uemptiaa. Any vfurdon of
than a Is exempt
sullnn7o31smr,sly,vvnesntrun apermit +ubk)u the applkmtm.Civil Penalty ar
-
'APNNumberOccupaneYType
ml mese mm five hundred dollars (33003
3 2 6 0 2 0 2 7.
❑ 1, as owner of the property, or my employes with wages as th k auto cwnpa n Adan•
will On the work. and the muttum is on, intended w.Rued torur(Sm. 71344, Business
Re aired Ins ection
q P
and professions Cade: The Conuecmrs License law does roawes Of
apply 0 an awof
Pmputy with buil" m hoprow titewn. and who da+auch work Wd4adf or through his
own employes. provided thotsuch imFmvemmu art waf Breed lusuic B.
hwwew. the building or impmvemmt Is sold within oro you ofeemplotion. the owmr-
buildu NB have the Whieo of proving that he did rot Wild or improve for pwpcm of
uln.
I.,as awmr M the property. am exclusively wnlraming with Raved mnuanors an
conauuct the pt (Sec. 7044. Buainmtd Profualm l Cade:) The Contocmr's U.
Cense Law docs not apply on an ownu of property who bull" or Improves theman. and,
,
who comate for such pmjett+with ecanuaemRs) licensed pursuant as We Conuwwes
License Law.
❑ lam t:awep0un See 'BAPC or mi recon
'/y)^/g��tZPJ, Dau
ORK 5C MPE ND CLARATIO
I hereby affront un"r penally of perjury am of dle following declarati0v:
❑ Ih.ramd will mammin. Certificate or Content to self-insumforWarker+Compm-
u0ion, as prividd for by Section 3700 of that Labor Code. for the performance of the
work for which this permit is mood.
❑ I lave and will mainuin Warkrs Compensation Insurance. as required by Section
3700 Orth) labor Code, for me perfarmamt of me work rarwhich this Permit Is Issmd.
My Workers Compnmdon Insurance carrier and Policy number am:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This acetim used net uncompleted time permit Is foram hundred dollars (SIOD1
or tui)
I mrtify the, In the perform... ter the wk for which this permit r issued. l Nail not
employ anypermn in}ny gum is o b m n thewoRen'Cumpevdm
Law+of CSlifomW®m
Applicsnt—
NOTICE TO A P . I , kmg dils CemRea¢ ofemplTon, you should
became subject In the Worker, Compeneadon provisions of the Labor Code. you most
rormwith comply with such pmvidav on this permit Nall be deemed revoked.
j
CONS. ON LENDING AGENCY
I. a c on lending agency farthc performarc of
1 hamwh,Rum the them u a m
(Sec.
the work fes worn fur permit b lamed (Sec. 3091, civ. CJ
Lender+
'
Leder,,AdWdres
1=bfy that I have read this applicoion and rule deal the above Information r
comm l agree to comply with all city and county ordivnces and sate Ian relating to
building construction, and hereby authorize representatives or this city to enter upon me
above-memiond pmpuly for Inspection purple%i
a (We) agree to save, indemnify and keep herodea the City of COPerim against
r4j Ilsbilitics,JodgmmY,eosa ane uputes which may in anynyacwve agalnstssidCity
in consequence of the Stenting of this permit.
' APPLI NT U E0.5TA DS ND COMPLY WI H L NO -POINT
Issued by: Date _
SO REG) TION
Re -roofs
DY'
SIg a Is HAZARDOUS MATERIALS DISCLOSURE
Type Of ROOF
Will ftappliant wfuuue building aaupamcore w haridle haurdaw material
as dented by the Cupmim Municipal Code. Chapter 9.11. and the Health and Safely
. Section 13571()7 %
All roofs shall be inspected prior to any roofing material being installed.
IF❑Yu I�.Na
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment ar dcocen which
emit h UAVION air conamtnanu a Rrcd by the Bay Area Air Quality Management
all new materials for inspection.
Dimict7
�Ycs u
1 have mad the haurdaumalerlarmquirtmcnu undcrChapur B.930f dm Califor•
ma Huhh&SalclyCodc,Seai 23505,27573.,12553/.lundcnwdmoifth building
door note ody m a fun et it Is Pofiahllity to notify cite Pant of the
mqo saw estm q an of rteslear
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner ter anmarimd a e o te