04100080 CITY OF CUPEWUN0
BUILDING DIVISION PERMIT CONTRACTORBINFORMATIION .
BUILDING ADDRESS: PERMIT N04100080
0815/25 ALVES DR
OWNER'S NAME: PERMIT ISSUE DATE
fik RICHARD GASPERINI 10/13/2004
IIONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
uoo LICENSED CONTRdanderSDECLARATION JobDescri ti
U w1 hereby affirm that I em licensed under provisions of Chapter 9 my license is p
with10" nd of."'adn]of the Busincax and Prufcssinm CnJe,end my license is FINALEU
in rnl caned f`t. _yG REROOF W/ SHINGLES
'�= Lie` laza Lla" CONTRACTOR: GUARANTEED ROOFIN�QV /
n=p Dale Lic.#lrr
`—I undcrssanJ mY plans xha116c used asARCH TECTS E^un R�TlOds 2004
K
�yV
0, Licensed Pndcssinnol
BUILD tI
g OWNER-BUILDER DECLARATION LO�peo9frgJ
1 hereby affirm that I am eacmpl from the Contramot's License Law fur the
n o rallawmg reason.(Section 7011.5.Business and Professions Code:Any city(it county
m which requires a permit to construct,alter,improve,demolish,or repair any ameare
Fir priorsoits issuance.also roquiraz the applicant for such permit to rile stained statement
a�0 that he is licensed pursuant to the provisions of the Cnmmnur's License law(Chapter 9 Sq. Ft. Floor Area Val a1i�19
Vit- (commencing with Section]IXq)of Division of the Business and Professions Code)or
i Nat be is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant to a civil Penalty of - APN Number Occupancy Type
not more than fvehundred dollars(SSW). 32630129 . 00 p y Yp
I,as rawma id'the property,or my employes with wages as Ncir Bole eompawtion.
will do the work,and the structure is not intended or offered for sale(Sec.7(k4,Business
and Professions CUJc:The Contractor's License sew does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself orthmugh his
own employes,provided that such improvements are not intended or offered for sale.If.
however,the but Wing or improvement is sold within one year of completion,Be owner.
builder will have the burden of proving Nat he did not Wild or improve for puryou of
sal.j.
1,as owner of the property,am exclusively contracting with licensed contracu rs to
construct the project lis¢.1054.Business and Professions Code:)The Contractors Li
cense Law dors not apply to an owner of property who Wilds or improves therein,and
h contracts rsuch prat is with aeontricut licensed pursuannothe ComreChas
c
Liw.
QLa
air
Li
t am acmpt unticr Scc. .B h P C for this reason
M1as, Date
WORKER'S COMPENSATION DECLARATION
41 I hereby affirm under Penalty of pc jury one of the fallowing declarations:
❑1 bare and will maintain a CcnifiCme of Consent to self-insure for Worker's Compcn-
sation,as provided for by Section 1700 of the labor Code,for the performance of the
work for which this lermit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of But labor Code,for the performanec of the work for which this permit is issued.
My Worker's Cam pensalion Insurance cant raltd Pohfy number see:
or: ePrWtE`rI,No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he completed if thio Permit is for one hundred dollars(g Hp)
or less.)
I ecnifv that in the erforrounce of the work for which thi ued.�{shall not
employ y pthersnasta twome;•b�' e F�r�sy¢orithcns.Bbb
111 // VV✓YY✓����
Ap is at a'� N.Tt
NdIVE TO APPLICANT:If,after making this visa n s of of Exemption,you should
.J Obecome subjh comp y the Workers Compensation prone steal or the meedLebor evoke you mon
forthwith comply with such provisions or this permit shall W deemed revoked.
'ZZ CONSTRUCTION LENDING AGENCY
'r+ I hereby affirm that there is a construction lending agency rorthe performance of
CL the walk fur which this peamil is issued(Sol.3W7.Civ.C.)
aLerdcr's Name
U Leodct. agreet V
O Q 1 eenify Nal 1 have mad this applicmion and x11 Nat be
aWve information is
U.� bonding 1 agree to comply with all city and county ntatnances and sty t laws relating to
pU Ahow-mentionednn.and hereby amhonprpresenmtivesof his city to enter upon the
above-ms,judg dntopeny for inspection which ms.
rlr„ y (We)agree In save.indemnify and keep usua lcE the Cdr of Cuperlinn against
N inconsequence f thets,granting
of this Permit, mayin any way accrue against said City
Vz consequence of UNDERSTANDS
this pc WI
AP RCEA UNDERSTANDS AND WILL COMPLY WITH ALL NppN-PO Issued by:
Date
.. ��CEP€GUL ION //�� 9� /
��////���� // / Re-roofs
Signature of Appttant/Comfanor /Date'
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IN application'
pplicantn'future building occupant store or handle bavarduus material
as defined ion 8511(:rt the Cupertino
Code,Section Kips]Code.Chapter 9.11,and IN Health and Safety
❑Yea No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emtl hefardous atr cnnmmina es as defined by the Bay Arca Air Quality Management all new materials for inspection.
Gavial
C3 Yes Nu
I have read the haiand. aterials requirements under Chapgr6.95 of the Califnr.
Iia Health 6 Safety Cede,Sccdum 8515.35533 and 8534.1 understand that lithe Wilding
docs not Curtcntly hast a tenant.that it is my marmot hit by to and ly the xeupan of the
reqs menuwtutmmlbcmotPtiormivaaneenracemfca¢olio, parer. �a5'` natureofA leant `�_� Date
ow ammnrocdagert �-- Vatic All roof coverings to be Class "B" or better