02040093 (2) CITY OF CUPERTINO •• - -
r BUILDINGDMSION PERMIT CONTRACTOR•'INFORMATION .
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BUILDING ADDRESS: PERMIT NO.
21941 REGNART RD OLD COUNTRY ROOFING 02040093
OWNER'S NAME:
APPLICATION SUB DATE
EVANS WILLIAM D AND GERTRUDE K 387 UMBARGER RD #B 04/18/2002 •
PHONE: SANITARY NO. CONTROL NO.
(408) 362-1111
O ARCHITECT/ENGINEER:
{n O O BUILDING PERMIT INFO
& BLDG ELECT PLUMB MECH
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0 N i LICENSEDCONensed " Rp DECLARATION Job Description
'
Z_ I hereby 0)I' Nm 1 am licensed un r provisions of Chapter 9(d license P
aht "Nsfl"..'01'afl in'�3nrtneB ss ma Pror<s.ie.nena.7amyuem:< REROOF.
is hn II oa<end eRa
ffi11
w�a. LicA I " T/O Q LAYER CEMENT TILE, INSTALL OSB,
u. ARCHITEC*SDEConaCho ATION ° 30 #FELT PRESIDENTIAL COMP .
5 1 ueWerstmd my plans N011 bu used a public rteoNs
Er p O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby ref.Nm 1..Tempt from he Contractor's License Low(or the
t z a following rAeton.salon 70313.Business and Professiom Cade:Any city car county
Fg O which requires a permit to(clonael.ulnar.improve.demolish,or repair my ran eure
K3� priono its issuance,also requires the applicant for such permit to role a signed statement, - -- - ._._..._ ___ _. __. _ --.—_-.-__..,,—...._
....
fammeninSwitpSee to the ptbrisbns of Ne Comrxmys Liana law Chapter S Ftl Floor Arear�
(mmmcain u s 1•_...f e ,t A'�"t� $13 014�ation--
➢.pv. dieFer;9mand tDivision for
the Business end Profcui vi code) '�`- _`k b gam_ 49 - .',L e...or that he is dempi my.,pli and the but,for Ne aurft bdeman,In Ani violation
"'ofratlorethiniv a undredleanrrorapermis sublauthe applimnno'civilpenalty- s
bri;oimareN:itradntrndrtamu�s(ssoo). b r a-:':r=�1;:�:: Occu ane
3 5 � �0 Occupancy Type
❑1,-d owner of.- nd the s,ser my employees_'d wages es Neir sole mmpensaion.
"Bas m,the�pdrk.-bion,ash:Trc,s nor miendad'or oB<rtd par sale(Sec-T ,- S!,r.. ti.F.
easineu'nad Proreamna case:TW,s Liana Law does ant appl,as an 305 - FRAME Required Inspections -
owner of pro«ny Who Wilds or improves Neteon,And who does mch work himself
an Neu n Ms own employees.provided that such,improvements Ate nes mnpnaea-« 3 0 7 - I NSULAT ON
leflved urruk.If:however Nn Wilding or impmvemcm isald wiNinonc yearn/ 601 — ROOF TEAR OFF s•c:!r=.ct"c
completion.the owner-Wilder will have Ne burden of proving that he did nes Wild or
improeftopurpe'<af.1a)' 602 — ROOF PLYWOOD NAIL
C5 ❑I:asownerPLNc progeny.am allusivelydPrxtisionsc c:)JU Contractor's 603 - ROOF BATTENS-- T..glcra:PSR,::n:f:;
canswn the prosect(Sec.7040,Business property
Professions Cador The Contractor's .!" -
- LiameLaw does nmApply menowoerof ds..anywhawnmorimpmvatnerean, 604 - ROOF IN-PROGRESS'''
.eM.svW.comrmnse Lawuch N.a mntrat `r ,,...h
_ .prgms.wi m(q.ticensea.pvuuot.w.Nc.. __. _.._ :._. :_._.: !:::.:
Canvvctola License V I•`�®O7/W E® - --'--- ---
❑lamucmptunairSer r ♦ { 1 8'h PCf Nis reason 1.�4 '4\..
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water Data
WORKER'S COMPENSATION DECLARATION - MAY
S/ 0 <S r)00q
L'::h..c I11F1I a L L
1 heuby aAmm uMer pemlryof pe jury'otic of tW following dedarniov:'-'
!� O 1 luve'nind'will'molnums�'Ccnifinae''eir6onscni,io'ulf-insua for Worii
compmspthm.-a-oto,•idea-r«-by-Section-370(1-nf Ne-Labur code; ror Ju BUILDING
performance of Ne work for which this permit is issued.,..,
C"
he" hid 11 nwlnu Wu4e i Compcnsat an Irhitinrrte n req eed by Sean;a
3TW of tM Uba-Cade (or Ne perfoimmtt o(N work for whhch N s panto u
MY Woke s Compenseupn Ina yraae came nd Pobry number art ,rn _---
-_
b
a-.h-h re. n:'; .COMPENSATION INSURANCE• sec-.,
(5100 toles secthon nod na'be edmpleted if the permit is for ane hurMrtA dollen "•1'" wn,.,.: ,�;!,?^.,T\C
-
r, •s IexmfYN iivN perf i rear New rt for huh Nµpertnt smu<d.I
shall n s cmP1oY ariY P son many mann' m to becdp2 t bJect to theiWorkeri s '•
Compe et on lis o(Cel foto Dele
Applaanr.. .__ .:...__.I_.. F- .._.__._ ______....._.._ ___
iNOTICE TO APPLICANi.'If.MurtwkMg Nis C<nlfcote of Esempdan You should
z0 __be.c_omw—eN suebinplmy N.'_ienh.Wocdhuprovisions osmopnes nosn0uh Permit
erm t osrhaelblfbNe deemed
Cod revoked.
u must
.__....
'I P ' U^PCdNS1Rhii ie LENDING AOENCY '"" :! ..i l".i ;I11`.ID _._.._._.
"t 1 nertby aR{iin nhas Nert n a co"strvn o I ding reg nay for the pMok6ce
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afthe pro k rot' hlch Nµpcimlt s,)ssu d(Sec 3097 C' C)
W'Q -Iknadr4 Neme.-.a,u __. ..._._.
D.Z Isida^eAddressrh
ct 1
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�_ I Anth t 1 h d Al s pphcet d same Nn the above inon n
F colle . grtra t comply with 'tY.ond co ny cadirl.tia,end stem lawsaws relating s
0 U' toWilding- hµonced n dhfori Non rep unuuyes o(this city to enter upon
-V the W x t arca property for IPspemio p ryous,
(a.'a&a tt acosts mmfy end keephamay in he way.Cdpeiiim esunu
I
lieb 1 t es fu gmenb,costs upenus h mail
may ny way ecc a➢east send
Z Cisy n o nee orUu hhhRm➢a[N sperlmJ
It APBLTt r t U5 \D 35iri cD��PI\'-14trif ALf:.b\PDtj.'r'- r 0
o to a s + 1 '+ /�pj Issued by: Date
Lgmmle pf A an�/ConUea r ,' I t t f.ptat.
Re-roofs
.Srt1 HAZARDOUS MATtMALSD7SO.OSURE
,<, Wal Ne appbcSnt a amu bwldmg atupant short aebandlc har<Mws tmrcnal _Type of Roof
indefined by the Cupertino M nkii cod Chapter 9 13 and Ne Health d t
Safety 1:1
Code OYes 8532(.1
4 1
All.roofs.shall.be Inspected.pnor.to.any.raofing material.being.installed. ....._,_„
;, Will the Apple.,o nateWltimgoecupn, equipmenttodeia,whch If a roof isinstalledwith6utfirst tainin anliiis'ection;-Ia reetotiemove
entre baron sera nnrra it defned b)she B yAsi.A Quality Metgem t g P g
Davin , e T -_-all_new,materials for inspectio Applicant understands and will comply_with-,-_..,_.-
;ai.l rO Yale stshi, s. aF �..,..... r Gln lrt .... [a 1 all non-poi n Ce regul _...t' .-
., 1 hA.2:rtad'ihe heallous mpudab q - menu under CTept n 3.9Yof Ne
Cel!molµH IN k Skfcty Cod 'SkuoI-15503 I it
aha 8330 1 mhdententl Nat ...._
-if Ne Wdtlng mcmrced ea¢nmt Naw is my rtspovshbillrymnotify, Nc
dapant of omemcn mh most b<,ma pnor,m u'suana of a Cgiificete of
Grown Signatur. . APPlicant. ...._ - Date
._
M1 j' g All roof coverings to be Class B'or'beiter
A nh < v tot -d,�i r f - t '0'
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, . t .. . . --OFFICE....._._ ... _....... ..
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