01080017 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
19927 TWILIGHT CT APACHE PIPELINE CORP 01080017
1OWNER'S NAME: APPLICATION SUIT DATE
A
K LAI 22622 SAN VICENTE AVE 08/03/2001
/V PI[ONE: 4089976237 SANITARY NO. CONTROL NO.
µIi ee O ARCHITECT/ENGINEER BUILDING PERMIT INFO
�w- BLDG ELECT PLUMB MECH
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Hz LICENSED CONTRACTOR'S de,p DECLARAT[ON Job Description
�+ I hereby affirm sed that 1 am licenunder provisions of Chapter 9[commencing
w with Section 7")of Division 3 ofilic Businessund Professions Code,and my license REROOF.
�xxis mronse uoreeana <�q r n� T/O SHAKES . RESHEET 1/2 "CDX. &
to
LiceCla /1B%-
Dae 11 sf d3 Comracmr
w 3 a y m ARCHITECTS DECLAA15 ADD 25 YR. GAF COMP. SHIGLE.
I undersand my plans shall he used as public records
f'^ice
to pz Licensed Professional OWNER- '
BUILDER m the Contractor's
��+ -��E O
.e m 1 hereby Orion that 1 sin exempt from the Consaaor's License Law for the 161'.AE90
t 3 a following reason.(Section 1031.5,Business and Professions Code Any city or county
Y�.Q which requires a Permit to construct,aper,improve,demolish,or repair any structure
,e pri.,lo it, I. thr,plicantr hpe n file a signed statement.
h,11lost,edpt ,sto,to die revision, fdve C t t Limcn,c I, Chn,m,) S .121. 'e nation
Ida einewithSena,70M)ofUvil :3 Of heBO,iruv itPnfassenseoam y' . . .;, j�y't, $10A
or that he is exempt therefrom and the basis for the ulRied acempten.Any violation
of Section 7031.5 by any appl icant far apermit subjmt the applicant in a civil Penalty eN p�
of not mom than rivehundred dollars(ufnl. 316�-1-U]�ftDING Occupancy Type
01,as owner of the progeny,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.7614.
Business and Professions Code The Contractor's License Law docs not apply to an 3 05 - FRAME Required Inspections' \
1th
owner of property Who builds or improves thereon and who does such work himself
.
ooh gh his own employees.providin that b' p t. not intended Or 307 - INSULATION _ .-- _.-
RT dT I If h wcvcr,the building ,_ _ _. ._ _ _... _ _ . . ._. ___
._... ------
.
cot s la '" r 601 — ROOF TEAR OFF
'con Piet on.the owner Wilder will have tgi,e buN n or proving that he dm not e�id or .• ,
impro.=for purpose Of.als.), 602 - ROOF PLYWOOD NAIL
❑1:.i"ric:oithe prwpimsy,amd:crud:eiyconimOJngwith he:�m.dcum,v.or:.. -- - .._- 603 -- ROOF...I3ATTENS'.
lonswct the project(Sec.71W.Business and Proressions Code:)The Contractor's ',
icense law does not apply to an owner of pimpeny who builes or improves thereon. 604 - ROOF IN-PROGRESS ". - .
:. ._and who contracts for such.project.with a.contractor(s),Iicensed.paaOam.tO the -
ContmemrsLicenselaw. --- --- - - -- --- - -- _. _
01 am exempt under Sec. .B ffi P.C far this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
01 have and will maintuin'a Cenificmc'cf Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of rhe Labor Cade, for the
_ pe fumerec of am work for which this permit is issued.
1 havcand will'mainmin Wmkcr'i Compensation Inaumnee,as required by Scctiun
_ 31(X1 of the La1wd Code.for the performance Of the work for which this permit is
issued.MA�Y W�orkerQs Com cflat ad Gslirance carrier and
'Policy number am: _._... _ _.._. ..
Camer: f�TPolicy Nu_rl 9T -ZO 6 / . ''.
y CERTIFICATION OFEKEMPTION FROM WORKERS; • `• '\ s•t-
_ ... COMPENSATION INSURANCE" .,. •. ,.... ...�.,. .. ...._._... ._._—___..._..__----__._-. ._.._. ._.
'i l:(Thie'section need nut be eontplciN if the permit is for one hundred d011nrs � sl. •' iCCI'�:11'x.s m •
(Sl Wl or Ices)
I c employ
that in the pe f :lith k f nicn to. at t p tis isaues,l'
'.hall oY Ire any r
f'ban bje t to Wers
me work
Copcnsalion Laws of Cul fur 'a Date
Applicant
NOTICETOAPPLICANI' if.aftermakingthsCeni catcnfE c pf you should )
z become subject to the Worker's Com,ensation provisions of the Crier Code,you must
0O forth witc ply wiih- h p ons...h' pe t hall be de reed a ked.
_ __. .._ - _ - _-
F'fZ) CONSTRUCTION LENDING AGENCY ,
;a 1 hereby art,.that her.is a comorsinioi mithin,agency him the in,fomrmm
Lender's Nameame 'sued(See'JIN] Civ.C)
n
_. ._ ._.
a,Q t r orw c
Lender's this pemld is _
'N
U1 cenify that Thor and this.,plicainn and'tom that the above information is
W F. icnrrtct.1 agree m comply with all city and emody mdinamm,and Stam laws retain,
D.0 to building construction,and hereby awhorimopresenmtives'ot this city to enter upon
w the h i <J p,,,,city f 'n,,,l n ,
F 0. pVq g to a indemnify and Ire,harmlesstheCty fC penin against
(n liab Iti: 1 dg us. t J pence l h Y n:uy Y'1. gains,,) 'r
U 2 City neon. a eOf thestanding of thisPermit. D `
APPLICANT LINGERS U ND WILL 1PLY WITHALL NO OI r
S6URCEREGULA S �j7Q/ Issued by: Date
1
Signwure O fApp
an VContrn<
't . Date( /L Re-roofs
HAZARDOUS
dTERIALSorLOSUR
IIthe aagOr oo, uvautsull.olousmaterial Type of R
oof �
nsJefneJb the Cu�n o Municipal Code Chapter 9.12. J the Health and safety
C s i ,
2553 1 1 /` s l - _t s
❑Y �1F All roofs shall.be inspected prior to any rooting material being installed._. _. ..
u Eth pplc loom h'IL gO p t useeq p t to devices nen If a root is installed without first obtaining an inspecttori,'l agree t6'remove
cmd,hazitodou,ar cotemtums a derndM1 y Area;kit Q stymy Management
Di p t. �`� -. all new materials for inspection Applicant understands and will comply with
°Pei all non-point source regulations (- e,• . •!,m,l. -
I have end tic le raJ v Imucli.11 m eimircm,utoln,Chapter 695 ohne
Califurrom Health d Safety Code.Sections 25505 25531 and 25534 I understand that
oocu, W ge.,Oimet Tin
oc< p' r f the rcyui c nt M1 h mail be met pr rt w i., f tilieme of „{FF���
OccuPanc- .
9 Signature.of Applic t Date
�
3 6 _
All roof coverings to be Class "B" or better
own nomOrmea ns t Date -
._„ . . . - OFFICE