01100157 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18671 NEWSOM 01100157
'vNF.R'S NAME: APPLICAPTIONUB DATE
OMAN AVILA 10/ 31/2001
I PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
a m— 1. ELECT PLUMB MECH L-J
t to
o
LICENSED CONTRACTOR'S DECLARATION
5 to Job Descri n
i z_O I hereby aBirm Ne,1 am liamed under provisions of Chapter 9(commencing P
_wFm wi,hSmion]000 (Divi on3oftheBusin<ssa fc �dmylicense BUILD UP ROOF TO COMP.
In full fn •effe •Z-
Ia
s aLic a
:O a U Contract.,
3 a zs ARCHITEC(%SDECLARA O
u.O to— nd ders,a -,s lF6"sed as public records
H " ,here y a OWNF UILDErom the RATION '
1 hereby.Isom,ht.1 exempt from,he Contractor's License Law for the
my
a which rep its. Section 7031.5,Business and vet di ions Cadet Any ca.st county $5000
_
S D which rcquircs o perms, corthe aper,improve,demolish,or repair any structure
-.prior to¢ c Iwrequirespi applicant forsuchCon perm no Eensele a,Lw(atmpter9 - - .--. - - - - .___._.._.._ _.._. ._ _. ---------_------
that _
— w,pi remid Sec i, Nepo6 nsnr oftheBusin,s and Fh Law(Chapter 4 [ a Valuation
a,��'a Ari f..
(comment eeNScehM]ooa)d the aion3of thelagad xYand PIni.A.,vi COdCJ �•�t-f \ 1�•��!.-�®•�v./�R,�1 �,
or that he is exempt anyetrom and the basis for the zpelged'oremynoa A.,violationPennon
of Secnot mot than v anyapplicantamfor v5l)(3) subjects the applicant mvcivil Penalty
of not come conn Bye honored dollars(s5oo), 3054P.N VgUI&g Occupancy Type
❑1.asrof the ppeny,or my employees with wages as their sole compensation. 7 INSULATION
will do the mwork:and thestructure is not mtended'or offered far at,(Sac:]trot' 601 - ROOF TE7 }yt4t1E'�'Inspections'
Business and Professmns Code The Cont=lor's License Law does no,apply m an
mviver of property Who Wilds or impact thereon end who does such work himself 602 — ROOF _PLYWOOD NAIL
through his own
mpleuon,the W Id_ p 11 haJved,hhe wWrad,eM1n of pmronng'that ahre dnmd nmomt WrdeJJd oor
ot(eied foalr howe etheWld'rg ranpmvmimansold within o<ycaropr 60'3 ROOF BATTENS
pmefarpumimsmr I ) "� -
604 ROOF IN-PROGRESS
❑has owner of the property.ameosins it hot.,i ,tholicensed,)Thcomrac,nrs,'a
cancrum the project t5 a ]Oa4 Business and Prole. n CMe)The Contmaor's
L cense taw docs no,apply, a cf p pent M1 builds or improves Neuron i
A who contncm for
Conuaaors License la
❑lam exempt under,Sec. - '' B&PCfor Nnreuson 0:1. l /
_ wee. , : ;:• :. `oa,� .� ,. � . . : . 9
W RXER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
❑ I have and will maintain a'Cenifcem'of Consent to golf-insure for Worker's
Compensation, as provided for by Section 3700i of ,heli Labor Code, forthe
per(umur,ce of 0e work for.whi<h Nix permit is iuued.(�,. '
❑1 have and will maintain Workcr's Compensuion Insurance,is required by Section
37W of the Lxi Code,for the perfoimunce of'he work for which,his permit is
_hsavied.MyWaers compertaion Insurance come,.4 Policy number I: - - -^ - "
Catch, k :'Ia-�,tr..volerNn.' d. ail \'Tr.. . . , .t a'. i',`:. i_b}:�:1! ',,'i'i,.}`3, `• t -- —'
1„�CCRTIPICAFION OF EXEMPTION FROM WORKERS' ,'
•, _ ”COMPENSATION INSURANCE"'�''""s
i':s"iThis union'heed not be compinnd ifthe Permit is for one hundred dollars
tg100)or los.).
1 ecru( that in th'porno once M the ork'f which th perm t i>sued,l i V, 1 ,
to
KA
n , rub ,pe_ 'y m n w cn < hject,o N�tCis � �f�m� .A AN :IL aR n ,g,his Cenihcam of Exemption,you shouldbjemm�he Wit if'aC pcnsutiobprovisions onhe lAborCMe:you must
Q comply with such pro .,ons or Nis pcm n shall be domed revoked..l�, - t•''CONSTRUCT-ION-LENDING AGENCY
ai ', I h by apron that d - s construct ]ending agency for,he performance - v
W ,.., pc .._issued(Sac 30910 C) __—
Q LLaand`�Addax'- ......_.:. _. -._._-._ .._-. ..... ... 1_
of Ne k far which Nu mons¢sue
,' 1 cenify that 1 have read this application and state than the above information is - —
(L try correct.I agree to comply with all city unit county ordinances and state laws adoring
0,U to Wilding construction,and nemby authorize represenadves of this city to enter upon
the above-memioned property for-inspersion.purpose?,., o _
(We)-g tSaa d fy and kap harmless,he Cly ofC perin'egmnst -. . . - --
rn liab I t 3 dg ts,costs end penes h h y any y g mat said
f,J ,Z, Co W 1.of th grant n8 f Nn t -` ``.�, 2 _
Ic DERS 4 A W CCOMPLYWIr11ALLNON IM' Issued by' - Date /y %�/ /
r e 3
wu mkJ
Aepp'pl Pi c am Ar mut i - PteI.
Re-roofs AD MATERIALSDISCLOSURE
Wilding ap no or handle n do material Type of,Roof oof
as defined by c l th and safety 1-
Cid s«r n r'f..1 w� r r . .--- •- -'•.
.y. ._..
25532(a) ter it z .v 1 1, t
❑Y< I QNp. ,.w ;„ R All roofs shall.be inspected.prior to any.roofing material being,installed.. .--
I cut applicant (t Wildingoccupant.useequip tordeviceswMm If a roof is installed'without first obtaining an inspection, I agree to'remove
emit W=1 contaminants r defined by the Bay Area Air Quality Management
District' „ .. ., - all new,materials for inspectici Applicant understands and will comply with
-.. .... . . ___ . -,
❑yes •ea._ No .,k -X.,i all non-point source regulatrons:, .
have reed the hezallous ma,eriali'requirtinems under Chlp,e,'b.93 of the ,
Califm H Ith&$yrely Cole;Sdaions 2550 3533 and 255341 understand that
f W Idi gdo/not cuncntlY hovee Nn�nrsmy rcspons,bdiry to nota( ,hc -.-
m r t -ahluircmen c,prior to tuuanct of a Cemfc c of
Signature of Applicant Date
:r '; coverings
d 3�m All roof coverin s to be Class "B" or better
m All roof coverin s to be Class "B" or better
Own ogam onzagem' - 'r - :Da, g
^. Y
...OFFICE. _ . ._.. .... .._ _. ... _