01070018 'CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22141 WALLACE DR DONE RIGHT ROOFING & GUT ER01070018
OWNER'S NAMEAPP LI TION.UB DATE
NEIL HAYES 1129 LONG FELLOW AVE 07 09f2001
PHONE: (408) 377-8777 SANITARY NO. CONTROL NO
l
❑ Z ARCHITECT/ENGINEER: UILDING PERMIT INFO
lam O B ELECT PLUMB MECH
<z LZ LJ 1-. 1=J
Z LICENSED CONTRACTOR'S DECLARATION of Chirpier
Job DeScript' n
0 Zy 0 1 Hereby alhnn mm 1 ten licensed under provisions of CM1aptcr 9lchmmencing REROOF. COMP TO COMP.
re,ticyrm Scmion]000)of DivisionJofthe Business anJ Profasiuns Cede.and my license
1inmuTo a fR GZ
e Liens Lic,p
w 3 u. m Contra"
ARCHITECT'S DECLARA ION
sand my plans Shull he med as public record,
w <0 Licensed PmPossi...I
OWNER-RUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the I
F following mason.(Section 7031.5.Business and Professions Code:Any city or corny $19000
E S p which requires a permu n)nmamct.alta improve,demolish,or ocia"any awnure
i3 _ -Prior to its issoancaakmouts've,Nmpplicant fa such pemdt anile.dgrcdsmmmem. - --- --
thmhei9littnieapursubnitothepmvtzionsnfWeConoacmr'oLicense taw(Chapmr9 , ..-.3,2U&)455or�.peu v Valuation
(ci,mmencing with$<etion,]Il(10)of Division J or tM1<Business and Prof<ssionz Cale) r.t I .A.. r+,
or that he is<xempt theterrom and the basis for the alleged exemp41o6.Any violation
-of Section]036.5 by any aPPllcaot for a permit subjects the applicant on a civil penalty
Of our are than eOe hundred dollar.(S5Ws 3 0 5APN PgUq�Ig Occupancy Type
G L as owner of the prnpeny.or my employees with wages as their sole compensation. 307 — INSULATION
still do the work;and the structure is not intended or offered for sale(Se:ra ]our 601 - ROOF TEAS (p�FeR Ins ec[ions"'
Business and Professions Cale:The Contractor's License Law does not apply to an CI p
Owner of property Who builds or improves thereon,and who does such work himself 602 — ROOF PLYWOOD NAIL
or through his pl Yc s.powuled that ch aripmounment,me Out intended or
oR dI Ito - th b Id g p ne sold m Y r 603 ROOF__BATTENS
completion,the bid ll have thenJ fp ing that he did noth 'IJ or
improve for pur,sme r I ,) 604 — ROOF IN—PROGRESS
❑1 fth P Pent' xl elYc nmRngwth licensedent than[
construct th p reject(S 7044Business d P fe. ons Cab)Th C tncsm
LicenseLad t apply t f p pony h bu'Id. p -th neon.
_mrd.who coutueb,to -Bch Pruleus w th a emanscums)f nsed pursuant to the.
Contranars License Law Q/
nt exempt under$cc. r,B'&PC fe"his rcasmn
❑le
c own c, Date ..
WORKER'S COMPENSATION DECLARATION
I hereby a?nn under penalty of perjury,oric of the following decorations:
❑ 1 have and will team am o'Certilicaie of Consent to se f insure for Worker's
Compensation, as provided for by Section 37W of the Labor Cale, for the
petfonompeoftheworkfurwhich this,,.tIs u,t l
❑1 nave antl will maintain worker's Compcnsoiion Iniumnc<,.m required by Section
3700 of she Wbur,Code f th performance I the work for which this permt is
sxl MYr'ern pc m Ins5.)/d ace ca dPol y bet
r a9sy� � _.._
Ce .',CEFICATIIO
IONUoridi i NFROMMURKER51 '�.1_ 1•. 1'.1_f,.l ,,. s.+c'; :H1.:, •'y': i
T 7 ,_COMPENSATION INSURANCE r'• _,._. -.... _ .. __.. ._ ...
tl '('inis'idction need"motbecompleted ILthe peanuts future hundreddollars _ -- -_`-' .. .
(SIW)mlessd _
1 Gen fy that in he performance f th 'work for which this permit ie issucd.'l
fossil
net empldY.anY.peroon to any manner vo ax m hecome sub)ect to,the Workers'
Confpen,mion Lows lir Calif m a.Date
Applicant - _ _ _ .. . ... .. . . .... .. _
,NOTICETOAPPLICASf If ft rmakmg ImitCeinficalentExemption:you should -
Qpe on hjccuutheW k C mpen t p - sof theLadCode....must
forth .the comply withhprovisionso th pc n hall be deemed revoked. I
... .. _ ..._ _ _ - .. .-
V] `A' T'V'" " "'CONSTRUCTION LENDING AGENCY .. I.
C ; 1 h<rchyaffirm thin there is a construction lending ogency for the performance t
L,Q oft, work for which this permit is issued(Sec.30W.Civ.C)"
Lender's NSme'
D,Z Lender's Adtlress', u•
V � 1 cenlfy that 1 have read thi,application and mate that the above inronmion is
correct,I agree to comply with all city and county mcbmar eats and state laws relating
0t tobuildingeummielinn.antl liercbv umhurize reprcsemmives of chis city renter upon
;i.:Ln: the abnvemerro.red pruperq fm inspection purri
L (We)agree to.vase.indemnify and keep harpresi_the City of Cupertino against
to Iiabiiities,juagmenu,c ,t,and expense,which.may In any way accrue again,,said
U:Z City in cunseyuence granting of chi,panni[. �
LION t'. ' .WNDSA\D WILLCO\1PLY WITH ALL- .!
NON-POINT Issued by: Date O
U )NS. .' t �.
Si yl e, phe.WComract6r Date' Re-roofs
fLAZARDOUS MATERIALS DISCLOSURE
-'. wnllnd applicant[nr rdmrc btalams ac<npant store er hwlle naaardnm mater;:,, Type of Roof
as defined
iy the Cri,p ter 9.1'_.and the Health and Safety ;, n _
asde:Swo the Cupeninoihluni<ipolCWe.Chap l,t
'are, " '.oNr; i. ,--All roofs shall be inspected.prior.to any.roofing.material being installed. _. . ..
:Will the uppllcant0r, mture buildlns nccupzm no,e,tupmcm nrdevice,which If a roof is installed without first obtaining an inspection, I'agree't0 remove
cm it hareNous air contumimanu as defined by the Bay Arca Air Quality Jlenagemem
D"hier. all new materials for inspection. Applicant understands and will comply with.
- ❑vga: o'Nn. -'. -- ' all n -po In siownce regulations: .
t "1 have read the h ouv materials rcquirements under Chapter 6.95'of the
Icup
ria Heat &Sol Codc.Sections 35505.ZSSJ3 and 3551J.1 undersmnd tom _buihh dylime a tenant;Cher it is my iesponsibility m m ify thea a ocs h rent ms which must he met prior m Issuance ofa Certificate of
Pay
s
gnature.of Applicant Dale
/ownernfanmprRWagent Date All roof coverings to be Class "B"or better
OFFICE. . . ..