00110089CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUEDINC,Aal'&n,6 SCOFIELD DR
PERIIITNO.00110089
OWNEWSNVihRXMILLER KARYN M AND J
MES A
APPLICA'I'I(I�Sfnylf /2000
1 T.�
IONS:
SANITARY N1O.CONTROL NO.
ARCHIL PC 171 I GINEER.
BUILDING I•HRMI'IINFO
BLDG FLECT PLUMB MECH
hICI!NSED CONTRACTOR S DECLARATION
Job Description
1 hcmby of f irm the Iran live n>al under prnvi.inm of Chapter 9 (n.mmmocing
wim Sccoom]aRn,fDomon3onhe ea.me„a.,d Pnle,iuns Cedc,anemy license
REROOF OF SFDWI_
i.i,, n all rorce non g 2
ieen.ecly.. C� Lic.s_�'�'�-__
-elf/S+Oo cnnl,,elm-�OrNt4-S {Q
p
,ares,all
I unJumm�J my plans shall be nseJ m peptic rca,rJ, ie(/p:{.,� /,'
housed.,,aRn tZ
_ i—
Licemed Pmfce..maal
co-0vvlaDu',R DECLARATION
Oce
CoutrIUN
1 hereby muni that 11+ x I'mm the Cunaacm n, Law
I
,force t
]031d�llu.inos.and o A
fallowingmm,a (Seel sin Atry city uracture
or repair any structure
which requires a pernil m, awamc. spec impnwe, debnsc, or
i improve,
th Permit tofilorsi,edontonnorm
prior a it. e, elm tegairee the applicant toe wch perne,to filo a sign%(Caenmm
Sq. Ft. Floor Area
_
Valt
he clowd
(but
commesnansedpmwaotmlhepfDivisin3ofthe usima,LimmeWw(Cnapmv
is loop Section ]red) of Division 3 of the Reines and PmfA
vi Code)
],
Any violation
,it he, a n,
nr that he is exempt Ihaefmm and the beers for the alleged emmm�t
vi
of Section ]OILS by amy applicant for a permit subjecss the applicant via civil Iemuhy
live Indreddola,(S5(0,
AR"NjTL�
Occupancy Type
'IF anteurethun
09 00
❑ L or, owacr ai the popsoo, or nry employes, with lal their sole coml+nwtian.
.
305 — F RAIKF_quired Inspections
will do the work, and the ,Imclurc is not intended or offered for elle (Sec. 70,11
Ileineaa and lm,feaon, n,Ju.Thc Contractor's License Use does not apply can
nal of pmpeny Who (wild, or improvc, thereon, and whn Jmu such w k himself
impmimended
_
307 — INSULAf ION
t though his own cntplovecs. provided that such arc I,, not a,
aeve
offered for site. It, however, the building or Imp uvenat nt is ,old with'm one year of
nmphei.....Ihaowaallauldcr will htwome bamenot lteodmg t eat he did mm build a,
601. — ROOF ,TEAR OFF
l„povelurparpu,eallas.).
602 — ROOF PLYWOOD NAIL
❑I.a%owner (if the pmper,amc,cluovely contracting with rcenwil contractors it,
60� — ROOF BATTENS
,s ct the project (See. ]IW, Busineand Pmfission, Code:) Tho Cormo0or's
6
Lmsw
icense law doth, not apply to an owner or pmpenY who Will or impmoc.o thee"%.
604 — ROOF IN—PROGRESS
and who comexn for such projects wim a commo arul licensed pursuant n+ the
CuliacanI Cleanse Law.
,
Cl I am eventual ander Sec. . B h P C for the.. reason
Owner Dam
WORKER'S CONIII12NSAI'ION DECLARATION
1 hereby a from aWcr penaltyof va Jury ane ofthe following declarations:
❑ I have and will maintain a Certificate of Cumene m whorsun fit W'orkds
C ri,r,,atiun, as presided far by Section 3700 of the Labor Coda, fir he
,return col'the work fur which ,hie Pcnnit i, iswal.
❑ I have and will maintain Works', Compensation Insurance, a, required try Section
37W of the tabu Cede, for Ibo Performance of the look for which this permit is
uuW. My Word, Compemaion h varance carrierand Policy number ae:
Poll, No.:
CliKI'I FICATION 017 E%EMKfION FROM WORK12RS'
.
CObII'Iiol ION INSURANCE
,
('I his ,cotion mc,1 nm be completed If the permil i, lir one hundred delle,
OHIO) nr Ica.)
I modify that in the performance of the work for which this permit i, issued. 1
shall not employ any Imnen in any unnnner w, a, , bathe, In the wb,ken'
co,I,pen,uratcarR a.l�` s/�o .S .Oo
Anphcam —MIt LL!4—JflL4%'�1
.
NOIICE'10, I' LICAN'I: LnBe. uAla,Ihv. Cenlliane el' EaumpJon, you,hould
become .el jer, antic wa,ker's C...npeonion provision, of the [,shot Code. you must
fbnhw;Qt m.+,ply whn such prevision, "r this penton shall be dcceed revoked.
CONSTRUCTION LENDING AGENCY
I herehy of oto that there is a con,tmction lending agency for the performance
of the work for which this permit Is issued (Sec. 3007, Civ. C.)
Lender's Name
Lendar'n AJdrees
I verily that I have mad Itis application and.smac that the above i larnttion in
correct. 1 agree m, comply with all city and county ordinance, and ,ate laws telaing
— s1
to building uonumniom, and hereby authorize mpesvnalives of this city u, enmr upon
the also) menioned pmpe,ty fir mspeninn Purpose,.
(We) a,me a save, indemnify and kccp ham,le, the Cuy of C,orhna against
liabilitiesjudgment,, coos and cspcn.cs winch nay in any way .,me egeina said
City is en...cepmmc ofthe "I"Ohn g ormin pc,mil.
APPLICANT UNDERSTANDS AND WILL COMPLY WI'I'If ALI, NON-POINT
Issued byX6; Date '
SOURCE REGULATIONS,
Re-roof
Signature of ApplicanUCnntractur Due
IIA%ARDOUS MATERIALS DISCLOSURE
will the applicant or future Wilding occupant store or handle hasmrknw numnal
Type of O
.s deemd by the C"pmino Munldpel code. Chaotic, 9.12.: aid the Health and Safety
Cala, S,clion2553200?
El Yc N
All roofs Shall be inspected prior to any rooting material being installed.
Will theapplicam or future bolding occupant use equil!mem or devices%Inch
If a roof is installed without first obtaining an inspection. I agree to remove
emit mount.ns air co nium men(, a, defined by the Bay Aura Air Quality Msm movers
Di,mch
all new materials for inspection. Applicant understands and will comply with
'
❑Y, 0 No
all non-pointSou lations.
I"' J the h . 1 t iu1 1 a' old Charter pt 6.95 of the
1 -
Calif ` II III kSul lyC I. t f ry SSt15 25511 d255W a.nJ thin
T� '
it th he'll (,I of ley have ishancon.that it is noy«p iolity ill alidy the
,mcupam of the re,li¢meno %hills must be mel prior n, i„mance of a Cemdicmo of
Occupant,
Signature of Applicant ` Date
All roof coverings to be Class `•B'• or better .
I
Owner ormill ti,edagent Dae
OFFICE