01030160 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BU I LDING ADDRESS', - PERMI'I'NO
10424 NORWICH AV EXTERIOR SOLUTIONS 01030160
OW NI1R'S NAME: APPLICATION SUB DATE,
MITH AVE 03/29/0001
PHONE. SANITARY NO. CONTROL NO.
C rc m ARCHITECI'WNGINEER: BUILDING PERMIT INFO
LL BLDG ELECT PLUMB MECH
CI C1 I= I=1
�r= LICENSED CON'TRACTOR'S DIiCLARA'1'ION Job Description
O _„ 1 hereby affirm Thal I am liccnscd under provisions of Chapter 9(commencing
-utj with Section Division 3 of the ldu,imt,,and Yndc„u,m Code and my license
infnll''nymw`•1 `39— }ly(3.S REMOVE COMPOSITION
�w annaill _ I.ie.a_ e
s LL y Dale a4 I Ga.thowmr C�Y
nRCamiCI S DITCLARAA�70N INSTALL 30 I_B. FEET R• CEI_0'fEX.
F I=O 1 understood my plan%shall be used as public recoNa SO"r7 �`
w rr
p O I.iccnv_'J Pnd.neional
°'°• OWNER-BUILDER DECLAI M[ON
�—'u,
Q 1 hesny aRm,Thal I am e,wn from rhe ConNecmr's Liecow Law far the
C% fulkwing reamn.section 73I5,Bu,inr—rd Profession.Cate:An,city nr cnunry /
x�G which - O It t telt p Th p any structure
W I'Ot I 1 .tM1 pl l caudI II - 'l II i,l,desmon
>.s
11.1 hn is licensed t . It th p,,),I...nbof N c I I Licem,Law Chapter Sy. Ft. Floor Area —Valuation
Iconnncncng with SWioa 9fXXB of Division 3 of the Blm odd f ,s Corbel
or that he is exempt Nercl rom and the nasi%for the alleged�\cmpfon.Any violation
to Section 90315 by any applicant fora hermit subject%the apprcont m a civil Penally
III tool mom than live Iamdr..doll::,,Isswo, A PN Number OCCuPICAtbw
❑1.as owner of the progeny,or mr cmph,cev wan wages as their sole cmnpenuffon.
will do the work,and the struaum is nor intended or offered for sale(See.9044,
Bns'ine»am rfnm..%not.%Code:rhe Omma,bu'%Licm,c Law dnea not apply to an 31.609101..wired Inspections
own.
r of pmp.ny Who builds or improv.%.here... and whod....such work himwlf
or through his awn ampbyr.th building
that such iem n t is sols are not one
or
cofferalompletion,
for sale If,however,the l have t e improvement n%that within nese Wild of
n,mpldinn,the nwnerMtilJe will have the buNen of proving that he did not Wild of 305 — FRAME
Improve for Pnrptou of xulc.l� �t
❑I,as ownerof the Prnpeny am e¢luniwly counadng will,licensed contractors m StLt7 — INSLII_ATION
Lconstruct the pmjem(Sec.9044.Business and RnM1�%%ions Code:)The Contmcmr'x 601. — ROOF TEAR OFF
icense Law clues not apply m an owner of Protein who builds or improves thereon.
ml who stomas ar ams pnij.co with a mnlmctml0 It....ed pursuant a,the 602 — ROOF PLYWOOD NAI L
Command Linn%c I.aw.
G l am esempsuode,See. E K PC fa,Ihisreaeon 603, — ROOF BATTENS
Owner Date 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARNHON
1 hereby auinn mode,lanallr of,,,jury ane or the fallowing dcchmdinnv. .
❑ 1 have and will maintain a Cenificme of Cement a selLlnwre for Worker'%
Ounpawuion, a% provided for by Section Par of the Labor Code. for the
1/t ounce a1 the work Nr which No permit i.issncd.
V I have and will maial,in W..ker'x Compensation Insurance.no,.•quired by S«pian
371X1 of the LAWir Code,far the perfnnnanec of the ss'ark for which this permit is
�I p�,Cw IrII�ygt _1_ Tier rend l�nlicc. nuymlymr u,c: p�,y
Cordnc_iw/j
CTIn 111C [_N 01:1 TIbhcYNIO.: PRSOMvNiOyRKr 1.7RS'COMPENSATIONINSURANCF
}G.ZY
'
('Phis section rend not he aom.I,l,d dth.l e nit ix boli un.hundred dollar%
(SBXII or less)
I victory[hot in the pedommnn al the work for which this permit is issued,1
vh,11 not employ any p...on in any nn r sn it,Io Ne,mac-bora ,I the WodkeW
Compcnsminn Lawsof California Unto
Applicant
NORCE T(1 APPLICAN'1:If.aRcr ,making this Celificom of lNeirlitinn,you should
hemmer mbjeat to the Worker's Comlenmtion provisions of the LaWr Code.You must
Obmhwith.on,ply with such provisions ser this nerd.hell he dee nvd mvnked
F7CONSTRUCTION LENDING AGENCY
.K 7 I hereby auinn Thal There is u cnmlrvetinn leading agency fn. he performance
of the wed for which this errair is issued(Sec YN7,Ci,C.)
P% A Lendcr'%Name
.7 Z [,rudcr'sAh1u,,.v
4. I eeniry to comply I have¢sol this ity and on any sato Ince shed st a ina,,Mati g
Iso t,,, ,Recd.1 agree rr nI,a with all cilli and county uNitmnao and%city laws Mating
T..l Haab ing.nn%oned,,,anJy hors authmieealla"1 natives or this city mcmo'r ufwn
the anoWc)agieeto save. icy manly nd Ie.p harnil..
E0., Ix'elagrcct, cl inJe usiamd keep harnd_mthe city'It Cmetinoagaims '
Vi liaRylg
mems.cuss and eq ethic 1 n-i Y way me ugainu sail
UZ Cioa aftmm p ///fff
IssAS'llAN 1 W%II f MP�IIALLN POI Issued by: Date �� 7^3re pIr a„v'%,,mem nate Re-roofs
I IA].Ak WIJS MATERIALS DISCLOSURE
Will nmapplican or future suddrig naapanl store or handle havadoas mmedm Type of Roof
us Jelinel by the Cupertino NYS p'aI Code.C'aapm,9send.12. tha 11,411 and Salcty
Code, ,coon 255321u40)'I A
0 Yr, L\ All roofs shall be inspected prior to any roofing material being installed.
Will live appli.amarTime holding occupant a%cemirvmemnrdevices which If it roof is installed without first obtaining an inspection, I agree to remove
saris ha.ardnu,allminas -defiard by lac 13;,y Area Air(jnuEty Mcenguomnt
Di%tiler, all new malu iuls for inspe• ion. A ant understands and will comply with
❑Yes I,No all non- ill source re ul• io
I JOV.read the ottaabmx m:nchols regniminvms under Chapter 6.93 of the
Cullfood'llcuhh N Snldy Cole Soc(ums 255 1,211 land 25534.1 unduuomd Ihnl
ifthe bo' jId,;.nnuvrrc dyle ban hall, matt reupxm..bilisy m notify she
icecap n o the rega renmt h vna of a nilicac
("` a Ig tune of Applicant Dat
actor aalhai.mrb ages, a'X3,1 All roof coverings to be Class"B" or better
OFFICE