02060005 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
.BUILDING ADDRESS:. PERMIT NO.
19'919 PEAR TREE LA 02060005
OWNER'S NAME: APPLICATION SUB DATE
BETSY SHAFER 06/03/2002
PHONE: SANITARYNO. CONTROL NO,
ARCHITECDF.NGINEER: BUILDING PERMIT INFO
.. BLDG .ELECT PLUMB MECH
L`<`r .. .
=Ni-i `li2sS.m C•s!LICENSED CONTRACTOR'S DECLARATION'
JobDesc
r•iption'
OZ Z v-C p.l s..,A I hcrebypffirin'that I am licensed unJci p isions of Chapmr 9.(commcncing
F,Lt- tli Sec trn7000)o(Division 3oftbe Business a�°Profcisioni Code:anerp�y license RE-ROOF @� S
osa c-- 7`` 1
LL uo J` RCHITECI'S D CL A 10. s ps
I understand my Plans shall tw used as public records UN 200
2 1
�.rci p o Licensed Professional
OWNER-BUILDER DECLARATION
X`-" 1 hereby uRirm that I out esempt from the Contractor's License Law for the 1J'
F 3 a following¢asan.(Section 7031.5.Business and Professions Code:Any city or county' 13
CD's. 5 O O
E M o which reques ira pcmri.to consumer,alter,inPun ,deman
demolish,or repair y etmcmrt IV
W
3 .,prior to its issuance.also requires the applicant falsetto permit m file a signed statement- -
tWtWisli..dpursuemrothpppmvisionsof theCmurector'sLicense Law(Chapter 9 G� Fr F C-A d• x Valuation
kbmnisrides with sa4on t)OOp)of Division)of the Business and Prpfessam,Code) (`{_k:'ti,'3 31b'3UO.S�:'rU �':''s'f_k:` Zlil\:
or that he N eeinipt thircfro and the basis for the alligcd exemption.Any violation - I
-of Section 70 1.5 by any applkun`for a Permit subjects the applicant to a civil Penalty
m
of not art than five hundred dollars Sfum), APN t.'. ,1 Occupancy Type
305 -
01,
will d owner of the property,Lir my a i s with warts their role compensation.
- th - k and the wt is not mmoffered
not intended or Tarsale(Sec )Oast; "' "' - '
Business and Prof sato cad The Contractor s License law docs not apply to an 601 - ROOF TEAFFgdr_0Inspections''
owner of property Who W'Id proves then on,and who does h work himself
or to gh h" employees,provided tht n improvements tintended or ,6.02- _ROOF„PLYWOOD_ NAIL .__ _. __.. _-
'",ofcd'f ' "le If.h. ever,.the'Wldngr p 1ssold-Withinoneyar eof
- �- .. ._ .....—. ,Is -
._
dmpl(on,the owner Wimerwll have the burden of proving that he did not Wild or 603 - ROOF BATTENS •' '"' '� `
improve for mrposcid It,). 604 - ROOF IN-PROGRESS _ _
bwkrai fineproperty. . , . _ .. __._. .----...-. .. ._._......- . _.._.._... ..._ _._.
i
am exclusively contracting w M I ensed contractors to , itto s 5:G .met the project(Sm.7014.Business and Profesions Cade:)The Contractor'sse Law docs not apply to an owner of property who Wilds or improves thereon,wh c trot fo s h.pml t 14th a conueum(sl l" rip sunt.to.tnc. _. ._.. _.__-..___.. .__.-.._st t L Laates t' der$ - -s B&PCf this tenon :tcDut'WORKER COMPENSA$�Q��1 DECLARATION
the by offtatodePc lly of pcl ,N.c afthc full gd I tions.
hddl ind will mz.....d`Cent opme'of Cireaud to self-insure for Worker's
pensation, us provided for by Section 37W of the LaWr Cade, for the
_ pciforal of the work for which this permit is issue.
- 01 have and'will unimiain Worker's Compensation lnsordnee,ns rejuircd by Section
3700 of the Labor Cole•for the performance of the-work for which this Permit is
"su sd MY W kCPcsa 10n'1 ie � r,m Policy cY nmnhrart'' ..o.
........_•........,...:.,....v... ,.............._....-.:....-..._..,.....
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O •: ya
CERTIFICATION OF EXEMPTION FROM WORKERS I. I F+ F t i. 5 t .i- ^,��}12.
' �s '"' COMPF.NSATIONINSURANCEi` •s
' "^trlTii auction need riot W complcicA if the pcnnit is for one hundred dollars b ''
(Slip)or lcss.l
Icent .sur to ro - ' yWA If oaf conn t s'x.�ea'1 .. .--, .
,shall t P!yY Y Petlat q RyltCc leu!o the Workers
ons pe t L IC If t 1\fCl
-Applcpat
dCE TO APPLICANT If.after -making this CertificatefExemption,Y should
1viAn ”
r bj oto the k e C mpens,u provisions of the Labor Colic Yn,must
Q O forth th comply veitlistich limseam1mbil Permit shall W dee ed revoke d.
.91' , , :''CONST?UC`fION LENDINGAGENCY ' - 1
a I thereby (firm that thenc,,'aterstriction Ending agency for the performance
1
Led Aad _ ed(Sec 3097'Civ.C I
.,:
� of th ark for which th s perms s su
List 'I o f th t l h J thisppR t a sure Bear theabove i fo ado is
c
' r r 1 agree to comply with 11 city and county d' J state laws minting
619-7
V tobuilding c i,umcllur.add h mby aarhapmnoai,a ofth tyt,,enter upon
�] the above mentioned p pent for peer purposes.
._
'e. d col g t d fy dk ph I sth CityfC penno ranst
rn Itch I t 3 dg is t d pc ses which Y n any y me against said
CJ"Z city y once of h g g al to pc t wtzmmm
rTA`If AND WILLC LY wrl'H AL 'n' PO NT r%
uT N .• (, - O Issued by: Date
A\�
si w, of pphco ntmctor .' :' J 'S - "' Datc,y;." Re-roofs
Hmnt of S MATERIALS DISCLOSURE
wutne pplem M WlI Co«cpm.to , n ale Health a. t "I .Type of Roof ....- -.—_
asdl cdo ye GPcI oM ICJ Chapter 91 and the Health and Safety
Ceae Set on 2553 1a1 t I i '-''\ a') \ 1
All roofs sball be inspected prior.to_any roofing material being installed. _
;;,' W II the ppbc nt I.
e W IJ g pant useey p t a 'as which �f If a roof is installed without first obtaining an inspection; Ilagree to remove
nun not . del by the Bay Arco Ail Quality Mitio,ement
- . all new materials for inspection Applicant understands and will comply with
em t hazardo a c
Dit n
°Y, ," - -.1 - -all non= 'oiiit source-regulations'.
1 base read the hum s materials requirements under Chapter 695 oLrhe
Cal fo Health&Safety Cd Sections 25505 25533 and 25534 1 u d nta d that42
fifth rid ng does not cntly M1aveamn t hat tis ny re po 'h'Irymnuufy the"
a t fN'rc u' - is t'Ccnifi ¢of
Q nature of Applicant e
rte Allroof coverings to be Class B" or
better omen's l y a v must W m r p t
/ a[
o r�� :e �n�u k`_ —�- \ 1✓ .3 Z- better
OFFICE - . -. . .. .. .. ... .... _. . . .... _