00080073Cl'1'Y UNCUYEKI INU rbRMD NU.
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
SANITARY NO. APPLICATION SUBMRTALDATI
22616 215 SILIVER"Y R E ROOFING 0 0805173
OWNER'S NAME:
NIC CON'fROLg
PHONC'. LOO OAKLAND PL ❑ 08/11/2000
ARCHITECT/ENGINEER (408)925-9995 BULGING PERMIT INFO
LICENSED COsnTUkCLUR'S DECLARATION
I hereby afftrrn Ned l am Barred under provisions or Chapter 9 (commencing Job Description
with Section T000)of Division 3 of the Business and9ofessiom Code, and my license is
In full force and _
J.
LCM11CC15s�41 --" — -?� REMOVE EXIST. WOOD SHAKE INSTALL NEW
Dehe
UU ARCH CPSDECI�. PLYWOOD 30# ASTM FELT AND 40 YEAR AS
Lica is d Pmfessi«ul
OWNER -BUILDER DECLARATION
I hereby To. the I em exempt from the Contr¢toYh License Law for the
following reason. (Section ]031.S. Busitiss and Prefceiom Cade: Any city or only
which requUes a crout to comwct, alter, improve, demolish, or repair any soucmre
pries to its issuance, also requires dw appficant for such pmut b file a sighted statement
that he is licaruerl .or to Ne provision of the ContractorsLicrnre Law (C'hmgm 9
(commencing with Section ]OW) of Division 3 of the Base. and Professions, Code) «
that hen exempt dtercfrom and the basis for the .Magni caemption. Any violNon of
Section 7031.5 by any eppliceot f« a Strout mbjecrs the applicant In e civil penalty of
not more than five hundred dollars (53001.
I, as owner of the proKnY,«my cmdgw with wages as their wlc rompewtion.
will dothewonk. end the)"ComisnoniLi Lion,
ka, ad apply.o�lan owner
ata Rty who b Code: The Cmeutm's, sed we law dw rd apply to lf ow«r of
W.... who build. or improves thertnq and who does such doh himself or through
tis own owevc m, pmlding Uw such im a, is mi w are caw inwnd>d «olfared f«
saleme If, however, the building ur improvement is sold within ane Wild
or improve
the
owrherf Mr.). will love the burden or provin¢ that he did non bona m improve for p«
past of scoOW1efne
co h m of the propenY, am exclusivelyed contracting with :)11he xl mnnanzon l-
cmrswa the e. and (Sec. n an Business rend Py w1ar, i Code:) The ConOacron. Ll -
center law d«amt apply b an owner o(proleny who builds reimprove.ethereon, erd
who contracts.s.for each molae with amneactar(a)littered punwmto the ConvacmJa
Licentelaw.
❑ I ane comp undo Sec. . B k P C f«this mason
Owner —
Dan -WORKER'S COMPENSATION DECLARATION
1 thereby affirm under Realty of perjury one of the following declmetiwm:
❑Ihave and wied!for by Sectors
37W of the
telt,,forthor Woheis Codthe,
scrim, as providd f« by Section 3]00 of the Labor Cade. I« the perfomum<of the
which this petunia is issnM.
M1ave aM will maintain Workcfs Camprnuaion I....m required by Section
3T of the tabor Code, f«the pcolunnama of the work for which this permit is issued
My Wohr�,e�y���pepyl I mrance curia aM Pali�rp}yy�lii7U -12b
Caroicc� 140 M7t�Y _ PoIicY No. W L
7 CEFURF CATS OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ntis sxtim nced ma be romplercd tithe Parent is foro« hundred dollen (SIM)
or Ian.)
I cmlfY dont In the performanwe of the work for which this rout Is Issuand, l shell
not employ any periost In any manner s0 as to became subject to the Wohere L'ontpea-
much laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter indent¢ this Certificate of Exemption, you should
hern me, subjacun the Wa hale Countim. ion provisions o/ the Lubor Code, you must
forthwith comply with such provisions or Nis permit uhall be deet«d revoked.
CONSTRUCTION LENDING AGENCY
Q O Ihereby all. that them is s coWturto, larding agency for Be pmformame of
z dhe wont for which this farina 6 Wund (Sec. 3097, Ci, C.)
Fw Lendelu Name
a 7 ladee Address
[kJ I unity that 1 have read this application and all Cher the above nand. is
d G correct. I .gine to canPly with all it,, and county ordiounaa and sum hws relating on
.7 Z building conswetion,andhemby amhorier rcprcsrnutivn ofrhilaly toemerupondc
U O aona.-t«miored property for inspection purpose,
lar f' (We) agree to save, indemnify and keep humans the City of Cupanim against
() Iishiloies,Judgmcmn, core and ex,moes which may, in any way accrue against said City
conquce of Ne Brandng of Nis pit.
} 6. AY . rnmi
all.
COMPLY WI'I H ALL NON -JOINT
Will the applicant or future bide
m dcOnd by the Cupertino Municipl
Cade, Section Z533(e)T
[IYcs [:1 No
Sq. Ft. Floor Area
handle haumdms materia Re -roofs
std the HWth and Safety Type of Roof
Will the applicant or future building «cupunt use equipment of devices which
emit haradous air conwninane as defined by the Bay Arca AG Quality Management
Uiatriel?
❑Yes No
\ 1 have read rhe h rtardma material. rwuirements under Chapter 695the Cali -
and 25534. I undvstand thpr if the
34212059.00
305 — FRAME
307 — INSULATION
601 — ROOF TEAR OFF
602 — ROOF PLYWOOD NAIL
603 — ROOF BATTENS
604 -ROOF IN—PROGRESS
All roofs shall be inspected prior to any roofing material being
installed. If a roof is installed without first obtaining an inspection
see to remove all new materials for inspection. Applicant
un nd will with all non point source regulations.
I
liana of ADoI' ' Date
OFFICE
All roof coverings to be Class "B" or better