01050187 CITY OF CU13ERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22750 MERCEDES RD DONE RIGHT ROOFING A SUTTER01OW187
OWNER'S NAME APPI.ICAI'[ON SUB DAI'li
1129 LONG—FELLOW RVE - 05/29/2001
10NE: SANI'TAR1'NO. CON'lRol,NO.
(408)377-8777
m c Z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
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1-N LICENar t t CONTRACTOR'S DIiCI..RICON Job Description
oz,- I hemby alllnn thin um liav'nscJ nnJcrpmvi.iun.nl'Chupncr 9[eonnncncing P
wllhsccniarectudelceir n3 flue l3usinrvaunA l'me.aom Gale.and yliamxc
¢Y is In full farce Coil dlca�(_
m w a Leense Gln,.._ �1 Lie RE ROOF
LL LL o.y Dole 5,. 'Q! enmmetnr_ -
ARCIIITEC-S DECLARATI
-O os- I andervand on,plot,shml be used re,public records
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Licensed Pf -' 1
OWN(R BUILDER DCCT \RATION
r,Z I hereby 11 that l Blanc,,
theContractor 1' 1' Sir the r/7
Y Z Y G,IIo b .(S t 7031 5 H .' I I '( I ,Any -IY .......Y v /
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which y permit t t- r ft o.ourprove,dicionah,li. p Y structure ✓
w f m prior tt d,o,apone,the p,he I f l tilo,file amcmcm
'bar he is liceinedlpursuant athe provnion,ofth Contractor s LLaw(Chapter 9 Sq. Ft. Floor Area Valuation
((commencing won Section 7(XXU of Dienton 3 of,he Rusmc,.and Pmfe,slnn,Cale)
I),that he is eaemp,IhcmBom and the basis Rican,alleged exemption.Any violation 0241 14
of section]331.5 by any applicant for a permit subject,the applicant to a civil penally
of not mesa than five hundred dollar.(5500). APN Number Occupancy Type
❑I,all owner of he O;optal,or my employee.whh wnso,as Ihclr vole compenxution. 3422-0
will Ao the work,and the income is or inanJed or Cline d for sae(sec.101,14, Required Inspections
Harare,,and PnE,,sions Code:'rho Contractor:,Liens I.aw Use, or apply to;m 9 p
r of property Who builds or irip so,thereon,Coil who dons cCah',ork hin..ch
or w
through his on e^rployee.,provided that such iarprevancrhs are not trimmed or _ 305 — FRAME
oflbml Ino sale.IL howmea rhe building or improvement is sold within one year of
eompletimh,the ewacrhaimer will Iowa the border„f proving ma he did nor builder 307 — INSULATION
mpmve for purpn.e of.aloy. 601 — ROOF TERR OFF
❑h m owner otlAe proprrty,am e,rmsi,'ely Council with licensed a,amrlors to 602 — ROOF PL MUM NAIL
Lmotun the project(sec.1M4,Business and Pmfe.s;ons CMe:)The Contractor
icense Law does not apply to an owner of property It,,build,or improves menton.
and woo contract, lin such projects with a contmcted%) licensed pursuant m the 603 — ROOF BATTENS..
Contractor',License Law.
n 1 uT asetnpt trade,Sec. ,B&P e lo,ft, ,I 604 — ROOF IN—PROGRESS r
Owner Due .
WORKER'S COMPENSATION IJBCI.ARAI'[ON
1 hereby affirm under penalty of perjury one of the fallowing beelamtlom:
I have and rill maintain a Certificate of Consent u,sdGnmrc for Worker's
Compcnsalion, as provided far by Section 3100 of the Labor Calc, for the
,]
0rofontaic.of rhe work lin which this per,nh i.issued
❑I have and will aranmin Workrrk Compen aio 0Imumnec,as ac,mrrd by See tla 1
311111 of the Labor Cale,Iia the ref ulamove of the walk for which tills par nit Is
issued.My Wor,I,C Cam Int Insurance Carrieerrr aatn I Valley number Creme:
Carticc Cylt.��vl( pItE pulficy N,,:
XEMPf10N 'TNi)�KORKHRS'
COMPENSATION INSURANCE
pros section need not br completed if the perhnit i,for one hundred dollar.
(11100)or less.)
I emir,thm In the perl'oname,c of the walk I'nr which this permit,s issued,1
shall not employ any pct's....in any nwnner sin as ,I bceo.nc sobject m the Walker,
Rnhtremalian Laws of Culilirela Darn
Applicant
NOI ICY.To APPLICANT IL afar,making this Cenifictie or Esenmtion.Yam.should
necome.abjerr m o
the wooer.Cmnparnalion provisions oabor f the lCMe,you[Dust
Q 0 fenhwim comply with such provisions m this Event shall he demnal revoked.
Vl CONST RUCTION LENDING AGENCY
a } I hereby affirm that them is a construction ending agency for the prrlormantt
of the work for which this peril i,issued(Sec.1091.Clv.C.)
L O Lender's Name
:D z Lcndcr,Addres,
U C 1 certify that I have read phi,application and nolle thin the above in troult nn is
I. F corral.1 agree In comply with all city and county ari inuneea and stare laws relining
C V to lwilding comWetion.and hereby cathartic rcpuwraaloce of this city to enter upon
} W the abide-mcmioned property lar impaction purpose..
0. I1VO agree msovc.indnnnify and keep hamdces he City of Cupertino against
N liabilitie>,juOf t costs I expenses which may in any way azCmC against slid
U CG City int a,nmyven ,f a ming D this pcmhit—�
PFI NTU )1 IA SAND WILL COMPLY W'ITILLNO—��oINT Issued by: Date •ti �f�e ^�/
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Sign I App ,nn/Curnall a lime Re-roofs
IIA%Alt DOUS MAIPRIALS DISCLOSURE
wiu meanplirn,nereporelwlldl,hgmenpmi
aslarI),handle bnaahnlnn,tmnetinl Type of Roof
a,defined by the Cupcnine l\1nnicipm Calle.Chapter 9.12,and the Health and safety
CMe.Section
pYcs 25532001'! s'Nn
All roofs shall be inspected prior to any roofing material being installed.
Ask wil,Iw lirantoria[asanailamgovenpamancwipmemm&,viceswhirh If a roof is installed without first obtaining an inspection, 1 agree to remove
�mjt hazaNnto Cir ao usi m or%its defined by the Bay Area Air Quality Management
ys,.a `_ all new materials for inspection. Applicant understands and will comply with
❑Ye.: yNo all non-point source regulations.
I have read the hvaud nnacrial,n,rircomnt,order Chaple,6.95 of the
California Health&9dcty Code,Sections 25505,25533 and 25534.1 mhderaand lull
,the lit' ngJ not ran nl)h.vcamnant.that 11 i.my rcarymsihility enunily lac
rootm far the hich,on,t be men pricer v,issuanm of a Ceniticme far
°c • `y' cG D I Signature of Applicant Date
Y
o m anmedr age
Data All roof coverings to be Class "B"or better
OFFICE