01020040 CITY OF CUPERTINO
BUILDING mvISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PCRMI lNO.
20620 RODRIGUES AV NEW AGE ROOFING 01020040
OWNER'S NAME: - APPLICATION SUB DATE
SPIELER BARRY AND IVRIF SUITE 608 02/08/2001
PHONE: SANITARY NO. CONTROL NO.
%D00 ail J--_ /a;)C2__ (408) 261-3503
O Z Z ARCHITECIA NG EER: - BUILDING PERMIT INFO
O O ❑LD ELECT PLUMY MECH
W�
Gan
y b
LICENSED coNnwd tod Ms DECLARATION lob Descrip 'm
2 G 1 nonny chiral that late.3.1(lotcd urn,pmvi,ione ill Chapter n id er,In¢ing
F 4'=� with sadt�n 7axuom'lvidondt,r doe 1)u.inexat,dP,fe„ionseoJ call lny liocnm SHAKE TO 40 Y AR COMP .
full force an feet
od irtcn,r c �— Cnmer,or_<uL...-tyydn-an�in
a�nxcul'rl:cr's DEr,1.n11nI]ON
NO 1 underomaimy plans.hall he used us public mcold,
s
wa d p O Licen,'eJ professional
OWNERt c.,bDIIIt DECLARA'T'ION
uKl a 1 hereby¢(Sect thus 1 1. cscngn fmnl the Contractor'.Liccmc Law for the
following (Section 7od1.5, t.aftes and Profession,Cale Any cin nr oounty
`F O
which if, pens t t c fru t It t p demolish, p Y structure
ti pr ort t munin,Asia,1lie,the ,dicau tor,uchre In file r,i,ad rt halm
e,
libut lie is fiLauldp a It (Ile 1 I fla,C t t W. Licensi, aw(Chillier 9 Sq. Ft. Floor Area Valuation
ao..crux ng w m So,tioe 70001 of D'sisio t 5 ul he Bw rese cad 1 r r::ion.Cale) $7400
or tta,he is exempt them4om and the basis for the alleged e.emdion.Any violation
of Section 7031 S by any applicmn for a permit,object,the applicant to a civil penalty
oormnmre man lie handmddallar,(s500). ANN Number Occupancy Type
❑1.a,ownerolthe property.or my elrrployee,who wages as heir.,ae etnnpen.amm. 3591 1017. 00
will do the work,and the,wcture in not intended or offered for.sale(Sec.7(W.
ml,me,s and r ofe,iou,Cale:rhe Contractor',Lie...v Law does not apply to an Required Inspections
owner ,IpropertyWI I,nEtao,ion,ro .meteoll,nrdshe,does.uatworknimeelr 305 — FRAME
or through his own employees.provided that such onprovemcnu arc not intended or
offered(or,ale.If.however,the building or improvement i,sold within one year of 307 — INSULATION -
Irmplenon,me owncomilder will have the burden orpmving that he did no,build or
Ltnprove to,pmpa,c of sale.). 601 — ROOF TEAR OFF
Cl 1.as owner of the pro,acry,am cxdu%ively contracting with licensed eusrdba,ua,ill 602 — ROOF PLYWOOD NAIL
Lun,wct the project(Sce.7044.business and profession,Cui The Contraction's
icense Law does not apply 10 an owner of property who builds or improve,memo, 603 — ROOF BATTENS
and.1 ernnracrc bu xodi,mij, ,with a en ate,fa(,)Iice....I pnrsnant m the
Commctor,Lieeme Llw. 604 — ROOF TN—PROGRESS
❑1 and amort under See. .B&P C fur this mason
Ilwner Dam
WORKER'S COMPENSATION DECLARATION
1 M1emhy afford underpenalty f P) ry one of the follow g Jed t n.: 7
Clh and Aid t 't.... fCertificate f Consecttt) 01-ii,ine lor Worker's /
C l,per,ation, a, provided f Ir S t 3700 ill I Labor C,xE. fin, he 3
,eformance offal,work for h h this penult ed
,.Xhave and will rionactim Worker's Counilwasation liburance,as inquired by Scuion
)nl II a Lida, Cada,for the pemfnrma nc J the work I,r which this is
issued My W'orkd, nmpensation n,msec anis,and Policy nun Mr are:
F
('arrin:.l �Q C n� policy Nix:
CERTIFICATION 01;1 FMlf ION FROM WORKERS'
COMPENSATION INSURANCE
(Thi,section need not be nonpleted if he permit is for one hundred dollars
A 1010 or Icse.)
I eenity that in the performance al tlm work for which this permit is issued I
stall ant idd,,any reams in any manner w as to bevonrc subject to the Worl
C"mpcnxaliun Laws of California.On¢
NOTICE
NGome,,TO,object
to theCAN Warl:r%Cou making this provisions
nue of Exemption.You ushould
st
'Q Obecome w,a,y the Worker's Compensation p.fit ha nl the Lamm Code,you must
Innhwim comply wilt each pmvisinm or this permit shall M1c JartmJ mvokcJ.
F ^ CONSI RUC I'ION LENDING AOHNCY
I 1Immhy of rte that there is it eomuuction lending agency fm the crannunce
,(the work for which this permit is isued(See.3097.Cih,C.)
Q Lcoder's Nmme
Z Laufer',AJAfc,s
U 0 1 certify that l have read this application and state that he move information i,
ti P correct.1 agme ,,comply with all city and county ordinances and state laws refusing
Q U Io mildingemnmaioo.and herchY amhurire represanutives of this city to enter upon
the amtvann slimed pmpcny for ia,pcaioa rugose,.
a DA)agree it)save.indemnify and keep brands,the City ofCupcnlnoagainst
(A liabilities,judgment,cost,and expenses which may in any way amme againm said
V z,
City is"onsc0ucnce of the granting of hi,remit. O -D�—O/
APPLICANT ONON NDS NO WILT.COMPLY WITH AI. NON- INT Issued b Date.
SO CIS RLGU S. �� oa���1 y'
grmtnre ofApp iam/Cr tractor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appneuln or Wmre btdhliagtceupeo store or ha":Ile wr,ardou,nan,:,ra Type ofRoof'
as defined by the Cupertino Municipal Calc.Chapter 9.12.and he Ilcalth and Sufmy
Code,Section 25552Ia1'/
E3 Ye^ ON^ All roofs sha/be spected prior to any roofing material being installed.
Will lheapprc:mlorplan,building t,wpamit,eanipmamordevlceswhich If a roof is installed without first obtaining an inspection, I agree to remove
colt haourl air c omminams as defined by the Bay Area Air Quality Management
District. all new materials for inspection. Applicant understands and will comply with
'C Ye, C2 No all non-point Source regulations.
I have ad ]of hil,archm,material, y ' e'order Ch,bar(95 t f the
California Health&Safety C I Sections 25505 5571 and 255541 understand that
If the building dt s armally1 a count.that t :myrcpt %ifti fify no notify the
aevpa It t l lie Ret' testees 1, ntlby ans,p b,lee- ' C 'il-le of
Ceap°"err' �{
Date
°aSignature of Applicant
rKl/eri ale
o e o amnorirc, gent D:ur All roof coverings to he Class "B" or better
OFFICE