01110030 (2) Cl BUILDING m ESSIIONNO CONTRACTOR INFORMATION:
HERMIT
BUILDLNGADDRESS: PERM"NO.
20781 CHERYL DR WAGNER ROOFING CONTRACTORS INC 01110030
OWNER'S NAME: APPLICATION SUB DATE
Il•CHILDS VERNON S AND BETTY N 7R 12242 SARATOGA—SUNNYVAL RD11/06/ 2001
HONE: (408) 777-8331 SANITARY NO. CONTROL NO.
O O ARCHITECTTiNGINEER: BUILDING PERMIT INFO
in
R w C BLDG ELECT PLUMB MF.CH
y a ou IJ L=.1 L"J L7
LICENSED CONTRACTOR'S DECLARATION
S In 1 herM Rtnn that 1 am licensed under f Chapter 9lromose rein Job Description
Sz=o provisn,mn P e REROOF.
_Em with Section 70(0).f Divisien3of the Business,red Professions Code.and my license
[mss ,in lull raree,nae t. Z.�Z� REMOVE SHAKE
,ado License Class f`_�39 Lica , INSTALL 35 YR.
Date SDECLA ELK ELK FIBERGLASS SHINGLES .
tau, ARCHITECT"S DECLARATION
u 4 1 understand my plans shall be used as public records
:ce
l O O Licensed Professional
' q OWNER-BUILDER DECLARATION
to I hereby a10rm that I am exempt fmm the Conuaaor's License Law for the
Z following reason.(Section 7031.5.Business and Pmfes%mrx Code:Any city to county _
E s p which requires,permit to construct,alter,improve,demolish,or repair any suuaum
63$ .pri t l situ elsorcq «acne epplkent fw such lemon El<eagncd ammt«nt. -. - ___ _._.. -_ _ - ____._ _.�_ -------------
S
_ __ __
that he' Ittnwd pufsuen(Nthe pm it murthe cuntmetnr L«nae�wlCn,pta9 S F'ttFloor-Mea" ,-
(cn7s s thSect 7000) fDivision3oftheBoldnessandWild unscode) (.,?`a.TtE.lq: �,�•,, k•ot vx,ii jyi't)w' $76�uation
or that he ts'excmpttherefrom and the basis for the allilged uemdtibn.Any violation
-of Section 7031:5'byany applicant for a permit subjects the applicant to a civil penalty-
Infant mote man five nunarea sonata(ssoo). -_ ,3 5 9P1l? NI1mb910 i:.i"•o Occupancy Type
°L as ow«r of the property.or my employees with wages as their sole compmenumn,
-will-do'the work.and the structure is not intender]or offered for sale-(See:70L1;"
Business and Professions Code:The contractors License Law does nut apply to an 305 - FRAME Required Inspections Ir^wB
0
rnf property Who builds«improves thercon,and who does such wa,k himself 307 — INSULATION
«tn n n ply p am- t n improvements are not intoned '
'.orf li sale.If,however.thlihave 'rep eme pis sold he did out year of 61)1 - ROOF '('EAR 'OI'+I'+
compl,ogttirmserbale.).ll have theWNenorprovingthatM1edidnmbudsor 602 — ROOF PLYWOOD NAIL
improve for purpose of sale.l.
:,.<. ol.,sowner,ofthe property,anexclusively contracting with licensed contracmrstn "-- --603-..-- ROOF—BATTENS--_._..i_..____—._._- __--
construct me project(sec.1044,Business arta Professions cnae:)The Contractor's 604
- ROOF IN-PROGRESS '" " e'�'r i
- - License Law dies no,apply to an owner of property who builds or improves thereon, "
.and.who.commcufor.such projects with.a.contmctoNs),Iicens .p nuant.ro.tne_
Contncmh LicenseSec
l
❑ am exempt under Sea f^' 1 'B'&P C fonM1is reason 101,,
Ow Dat ...
p�V
� RK R S COMPENSATION DECLARATION
I hereby affirrounder ptursillyof,briaryoneoIthe fall 'ng dealrastion:
° 1 have arta will butinner a'Ceitificute bf Consent'io self-insure for Worker's 7
Compensation, as Provided for by Section-37110 of-the Labor Code, for the III
performanceof the work for which this panni,is issued:
°1 have and will main sin Worker'{Compdnvdon Insurance,as iegvirea by Sectioa
3700 of the Labor Code,fol the performance.bf the work'for'which this Penni,is
ax isiued MY W kiss Com n .Insure«exam d Pol cY bcr
corner- Lvi ianl yNo ZrYS —OI'- vtpoy3l eJ. ..
CERTIFICATION OF,F.XEMPr10N FROMWORKE r t0..NI. "
'COMPENSATION INSURANCE:
.: r.:Z p.. �...__.�.._._. _.....___•__...
,
s"a'Mis'scation nccdeied if the permit is for one hundred dollars
(31(q)or Icss.l s
I
Iterhythatinthe,se mareance of,M1e work for which this Permit is issued I! � ----•�--_ ,,.. ..__,., „
shall ,employ any'pesonl y 'noers t'bc me bJ n theWorkcri
Co pcmavon Laws of C I fo .m'Due; //'�/O/
-Applicant_' "•0 .'. .•••m. ..:...
'
Q TOAANTIP after missingth Lenticale ofExemption. should
zbe'..slntotbeW rkera Compnsate ptonsLxb�,r Coda.y.a must
fotrm y wim such provisions or thp.itshll the seemed
f~ � e ' CONSTRUCTION 1 ENDING AGENCY ' •" - - 'e
> 1 he by vffmi m t me <Hsi ct I tlivg age«y f tti perfdima ce T - ,..
,�":�: of oe okfo h hints perm ns is d15 3091 Ce C) "' ��
� Lender's Aaartss'>•..•:. : . . ._.. _. .._—.__...._._
V."0 �!1 certify mat I have rens this applica,ion end orate itis,the'ebove information is --
-[..t damn:l egrtt to comply wire all city.nnd county,ordivnnces arta ante.laws relating
i 0., - to buildin tmaidn.aria herbb -...._.. _._. -_.. . _._._.._.._._.__...._.__.__._.____.....__.... ._
,f) Sco^s yamhorizFreprcscnmtives of this`ciry to cn¢r upon
>;:W Ne above-mcmioncd property for inspcc,ion,Purpous.. .._ ,y, m .
_-y '(Wc)agree tos ctndemnity and kttp harmless'me Cty ofC pertina against .. . ...... ._ _..._.., ... .._..__- .. r
VJ lion 1 t es 1 dgments,c sts d expenses hich. y_in any y come agaimt said
f.1 ,'� Ciry m ebnsequenm of Ne grant g of Nis Penna -
APYLICAK UhT3LR$TRh US PND WILL COMPLI'H'ITH ALL hON-POltv'T't" I -
SOURCEREGULATIONS '.' ""f;' - Issued by: Date
az refund
nerur or Appl"nVC t '•c 1s.11 D tc ! -Re roofs
- -
S
HA]ARDOUS MATERIAL$DISCLOSURE x -
sen me avvlbans r roNre lu la ng« p t t "Hartel ware' i l _Type of Roof... _<--. ._�. . _
_c./
f ectheCupertino Municipal- Code Chapter912 and theHealth dsof Safety — --
Code Section 2557 O ( + i I
3 y 1c� 1 P ... ..1� f�.Y�{� } ,i Y•,,.
°Ye °No cz 1~1 + _ All.roofs shall,be inspected pnor.to_an .roofing material.being.installed.
1 W11 the mor acuses ., '-- —"
applta t u r ture wilding«ass at usecgo If a roof is installed without first obtaining ari ins ectidti,-I'a Tease remove
it hazard c ream t def ed by th B yArcaA Q it tyMa gc Hent, g P g
all new materials for.inspection. Applicant understands and well co_rnply with
Dyes., ON. all non-point source regulations , „ --- '
1
have rand the mandoust=led.],rcqutrem nu undo Chaps 695 of the
C lifom a H Ith&S fc,y Code 5 n ons 25505 25533 red 25534 1 underst d th,
'foe building does not ec n0y havea,enem tht us myrt pomtb l,y,o onfyoe - -- - - -
occ ipant of the req 'remenrs h Is us be t p o t a;vett f e Ccn f ere of c l/� 61---
Occupancy Si nature of Applicant --_` _-- ,. . _ /
PP Dare-'- - -- - -- - -
own munaedPg .� Data,, All roe coverings to be Class,.B or better
,
.......OFFICE--