00100104 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIUIhDINC ADIIB i. 275
VIRGINIA SWAN PI_ CONRAD ROOFING SER q_@NSix NO. 00100104
Ow Ea'SNAMIRAJEEV SETH PHELAN AVE APPLICArIONSgI�TA 6/2000
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raoeE: (408)294-7615 SANrrARY No. CON'IR(1[.NU.
o ARCUnHiC15ENG]NIPR: BUILDING PERMfr INFO
F HLDG ELFC] PLUMbi MECH
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LICENSIincorvranCluasDlicl.nanTlDN Job Description
z = 1 hereby mean m:n I ua,Iice)ccd under pod P-m of ns Codew n.........eneing
omCo w.nn Section 7axum umiaon? nhe susines,and rrores,i,ns Code.and my ecense SHAKES TO COMPOSITION
<x i,in full fame.edctf,`e-3`1 211 SL
sc 6 U I.iccnx s, LiC.M
Dae IL=ao G,n,mmnr. i-R=�J-
w 3 F ARCHITECTS DECLARATION
u I andeommi n,Plan,.hall be.,oil an public rcco.if,
I = / /
oov. p p Licanned Prafc,slomll O
On 7031.ISER-13Busin ss Od Prur,A'1'ION
1 hereby aural,that I stn crempl from the Contracts",Lieence Utw tin the /
f-=. ounty
C whlulfiich, n,a ,rad,,, 710 L5.Business and improve.
de ism lb.or Any city I ante
x p which requires u peal,e,com,the pylic improve.n pacho t file
repair any swdara
�s pdorm h,i.wang rasa myoims the applicant the
.on ri Lac e s Law(,mtemem
(namei.named wrsuonnumep fDisstp 3 o theBusmrs Cracow Law(ChapterCorq Sy. Ft. Floor Area I�lt�f360
Ic that he is a with t therefrom
ora and
Division?of the Business x and lanion.Any vi Code)
or that he 7 exempt therefrom and me basis for the,lx he exemption.Any violation
of nol more
a man iv ttnindred doll fur a pem,e wnjeam me upvncam,o a ei.'tl lx""I'y APN Occupancy Type
of nut more man frac brmdred donors(Ssau), �i 18t#8�01.6. IZ10
❑1.:0 owner"f the property,or my empmyces with wage,us their solo csmpeoc iflon.
will Jo the work,and the,vucmre i,non intended or offered for,ale[Sec.7144.
Business and Pmlkseh,n,Code:Ile contractor,License Law doe,not apply m on 305 — FRAPEired Inspections
r of property Who mild,nr imprmx,morson,and who does such work himself
or through his own employee,.provided that such improvements are not intended or ,307 — INSULATION
oB'cmd for sale.If.however,the building or improvcmem i,sold within one year nI
completion.the o,v,er.huilder will have me lumen ra proving mm he did not build or 601 — ROOF TEAR OFF
npro,eforpurpa,coftale) 602 — ROOF PLYWOOD NAIL
CLa ,one "nhe piopcny..n,ondusivel.comrndng with licensed anliLOors to 603 — ROOF BATTENS
nsuuc,m=ployco(Svc.n4o.Bas and Profcn s Code,)the Ganmcmr,
Lieco,aLawdocinoapplymtmownralprolxrrywhnbu:Idsor'tmprovestherc"n' - 604- — ROOF IN—PROGRESS
and who contract%for.such project,wen u.ontramon0 licensed pursuant In the
C,mr.nors License Law. .
❑1 am exempt under Sec. .B&P C for this reuren
Owner nate
WORKER'S COMPENSATION DECLARATION
I orchy affirm under penally of pc Jury an nl'the following deefunnionn:
❑ I has,and will tnainmin a Ccnifcme of Canaan to ,elf-rann, for Worker',
Cnmpcn,atinn, as provided for by Section ])1x1 of the Labor Gude, far he
I e,hamance of the work for which illi,Iambi i,issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
171M of the L.near Calc,for the performance of the work for which this pervan is
issued Al )rker'x Cot�9-Crfi�n.,wi In,umine carrier and Policy nun ter am:
Carrier: 1'"I'icY Nn, w'_�/'K .
CP.II'I'IIICATION Op IT 17MIll ION rItOM Nr)RKERS'
COMPENSATION INSURANCE
(This avis,aced not he n,mpletaJ if the panni,is for one hundred dollar,
(SIM)or les)
1 cenify that in the performance of the work for which,his permit is i„sed.1
shot]not employ any perm,in any manner so as n,become subject to the Workers'
Compensaion Laws of California.Laic
Applicant
NOIICI?T(l AI1I11-ICAN'1':If,after making this Cenif iamc of Exemption,you should'
hcao..m subject m,ha W"tkcr'n Camp.nmeon......idol,ol'Ihe Labor Code,you nmol
(] O fmtho llb comply will such provision,or this panni,shall be deemed revoAed.
F y CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the perfrmtunce
of the work for which this permit i,issued Nov.3047,Civ.C.)
0. p Lender's Name
Z Lender',Address
U 0 1 comfy that l havo..ud this applicmin i end xlate,hm,he above intent i i-,
ks seg”. correct.I agree to.nmply will all city and)aunty....lumucc,and dine lawn mining
C U re building co.....m va"and hrmhy vud,orim t cpmmoOlile,of thin ill It,c,mr upon
the above room need rrgmm for inspection pullowel
(We)agree to save,indemnify and keen amide,the City of Corsican)against s
tq City in clan eclonots.cows and mining
of this
which may in uny Bay accrue agoinu raid
U Z ClylncANIT'U DE the granting ofWILL.maiCO ` /� _
APPLICANT UNDE cT DS N WILL COMPLY WITH ALLNO�NY(11M' Issued by: D:IIe t/ C7J
'OURCE RCGULr/9 - /0—fl
—M
ant/ck signtne , A„rmi h
[late '
Re-roofs
willh,appe!lAZIJOIS MATERIALS a15CL0.SURE
aan,...mum bd un1aeallou, A type ofRoof oof
as defined meCnpeninn Municipl Code.Chuplcr9.12,,and the[health and Saloty
Gds Section 25532(a)?
0N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or device,which 11'a roof is installed without first obtaining an inspection. I agree to remove
cull,hazaNnux air cunoundants as defined by the[toy Arca Air Quality Management in”bac'Ys oN - all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I ntwo d,d tba ety tte. Action,s 505.2513,ondor 4.1 rtaan eros or rat p . /�40
�� ^ -
:ulehuiai.,dosmafeviCade,Seca nnvot.th259?auJsfansi lay eralit,
lha {I//�/�-- "00
d me(wilding duns nm currently have n meant,than it is my nspnn.,ihiliry e,notify the V
weupam of the mituiremems Milch must be ran prior to i,w:mce ill a Certificate of -
°v)tivane Signature of Applicant Date
OMnororconni ed agent Dau All roof coverings to be Class "B"or better