01100144 CIBUDINmy SIONO
BUILDING NPERMIT CONTRACTOR INFORMATION-
BUILDING ADDRESS: PERMIT NO.
10246 WILL CT PETERSEN-DEAN INC 01100144
OWNER'S NAME: APPLICATION SUB DATE
FORTES GERALD R AND JOSEPHINE 7980 ENTERPRISE DR 10/26/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 494-9982
oO ARCHITECTIENGINEER: BUILDING PERMIT INFO
O
m DG ELECT PLUMB MECH
�ag
FF LICENSED CONTRACTOR'S DECLARATION
O I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job DesGripti n
-n I- with Section 7000)of Division 3 ofthe Business and Professions Code,and my license REROOF.
`8le" Lii. x1°Siro une� `tB9 hex d / T/0 SHK, RESHEET 1/2 "CDX,
33°0„ Dated Connaror ADD IKO 30YR. COMP. SHINGLES .
ARCHITECT'S DECLARATION
1 understand my plans shall be hard as p.him records
}
A i p au Liceaised Professional
o ima, OWNER-exempt from the RATION
1 motto .sect that 1 1. exempt from the Contractor's License Law county
I
t=, county
0 follwhich
ream..(stran ,on 003sumer.nexsand prove,demolish,or
lan city or nuchum -- --- -- -
which requires a permit to mneWe6 aper,impasse,demolish,rr mpmr ed stew..
.priormikirumce,also tequirtsthe applicmtrmaucM1 permiuo film signed suteiaem - -- - -- - - ---- -- - - ---
°• that h$is lic0inscd pursiianpothe proslsivns of the Convanor's License law lChnpter9
eontmennn Division 3 of the Busirtea mQ Professions Code) •'• A,. e 'Sq. Ft. Flopr'Are¢-t ty' f !., 92 1a[IOn
f gwitnsertmn7B0o)orD' # 1.::) " [ti._, t k. AV ..'•Y?..k�'13.�,f�.J- $
or that he is e;rips thekrrom and the hasis for the alleged a ertlptihd.Any violation•
of smion 7031.5 by any applicant for a permit subjects the applicant to o civil penalty
Plural momtnanfive hundred dollars lSs00f 318Ytb1�1UP.b kJ o Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compon admn,
will do the work.and the shucmre is nm intended or oRened'for sale(Sec.9044,- n; •t i
'Business and Professions Castle The contractor's License law does not apply to an 305 - FRAME Required Inspections'-''
owner of property Who builds lir Improves thereon and who does such work himself 3 0 7 - INSULATION
or though his own a nployces.provided that such improvements arc not intended or _ - _ _ 1 _
"offered for aide.If,however the building P or int m einem is sold within One Yrar o 601 f — ROOF TEAR F -------- -. ..�.... _. ._
OFF _ '..
reprove for the owner-builder will have the burden hl proving that he did not build or
completion,
mprove for purpose of tele.). 602 — ROOF PLYWOOD NAIL '
❑1. arwmrof;M1eProperty,amexclusir9Y�nmmmin L ® 603 — ROOF BATTENS C. .
construct the project(Sec.]044,Business and Profesin s a:a cmarractora 604 — ROOF IN-PROGRESS' ', at 4,1
'- a . ,.
- Licensewho
law does not apply man owner with
property,who builds or improves Ncreon '
ad who commas for such projccca with a conh�actorts)licq�gt yrstAit tl(�
Contractors License Law. tilPC U L
❑late aemPt under Sec. ,B&PCfor this¢sten � t �. tl„p � line
_ Owner• .,” ' Date' .
WORKER'S COMPENSATION DECLARATIE1 Vl
I hereby affirm under penalty of perjury one of the following declare ions:
❑ I have and will maintain a Certificate of Consent to aelLinsum for Worker's
Compcnmtiun,as provided lot by Sectio 3700 of the Labor Code, for the
Performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as impart by Section
3700 f,ha Labor Coda,fon the performance of the work far which this permit is
nam d-Myy/Worrkerrss C , t, 1 sine e c "e nL Policy pmlbe' ro:
Cam r!/PI/ ".�f/s err rW"f,olcv Nm WC, fj-y T-T� 4\t•�{{ ' K•)-n VSIa
CEWTIFICAT10NOF.E%EMPTION MOMIWORKERSr - - -� 3. :,,j pS/ Y,(
COMPENSATION INSURANCE''. "" '" ""
YThis action used bot be completed if the paimit is for one hundred dollar - - "op t. i\
(SlOgorless.)
"' 1 cenifY that in Ihe.peiformanee of the work fur whlch Jhi4 penult ix iasuc0,'I � •� - -- !\i,;p Jl''� •�-�^tVl:>i �' • ' ^,
shall our employ any person in any main td become subject to Ne Workers' -
Compensation Laws of California.Date net"so as''
NOTICE TOobject
APPLICANT'theWOrIf,arta making this Ccnin s of ofExemption.Lorde,you muld
st "
becameith comply
the Workers Compensation provisions of the Labor Code,you must
0 p (onhwiN rnmply with such provisions lir Nis permit shell be deemed revoked.
Z V) "-" CONSTRUCTION LENDING AGENCY "
�:; 1 hereby affirm that there is a construction lending agency for the performance ••"
-W s issued,(Sec.3097,Civ.CJ_ n.. _. .._....- .. . . .. . ... . . . . ..-s,s of the work for which this permiti
Q
Lod Name
;5:z Imdr,sAddress
V. 1 axially that I have read this application and state that the above information is n
i tri:H casted.I agree to comply with all city and county ordinances and state laws refining.
�rV to building coushuctibn,and hereby emhbria representatives of this city to enter upon
the mme- tentioned property for inspection y purposes.,,,
(We) to mve;indemnify and keep hamlesa the City of Contain.against
7Z) liabilities,judgments,casts and expenses which may in my way accrue against said
).z City in consequence of the granting of this peron.
.^' APPI]GNTUNDER5TANDSANDWILCCO 'LYWRH'ALCN/JN-PO Issued b Date
SOURCE REGULATION IC, Y• J
Signmure of ApphcamlColarralf., Re-roofs
HAZARDOUMATERIALS S DISCLOSURE
W '
lltrapplicmtt hate building carport handl h itadoos mamnel Type of Roof - - .= •. - -. .... -. ..
as defined by the Cupertino Municipal Condm 9.12,a ad the Health and Safety
Code ❑Yes 255331a1pi Ir e AO:.I ' sf . . - t..1J�. ): 'k art'.- I k L t 1
All roofs-shall be inspected pnor_to any-roofing material.being installed.
Wdl Ne apP}Fmtrr rote¢bh lding p t -wyP tmdc 'sxs rich Ifaroofis insialledwithout first obtaining an inspectional agree'to'remove
u za
emhardous ter com
mamanr as dein he Bay Aim AirQmht,Management
Diannall new materials for inspection. Applicant understands and will comply with
0 Yer I., 1 1, ; 1 _ _ all non-point source regulations.
y' I toe d he ard ,mnae'ek hattainturterns ander'Ch.pher 6.95 of Ne, ,t
California Health&Se(ny Code:Saatihn,25505 25533 and 25534 1 understand that
if Heb Idmg docs rm�cummntlyh atenmt that ito my msposuilAfit,to nmifythe
occupant of the acquirements which most b t pum to issumce'of o Ccnificme of
Occupancy. '
`.
Owner or authorize .,, Signature of/Applicant Date _
!/ k , All roof coverings to be Class "B-"or'better
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f _
OFFICE
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