01050140,I BUILDING DIVISION PERMIT
BUILDING ADDRESS:
0984 Q1 AJES DR
'OWNER'S NAME: _
PHONE:
Z
114111f=,Z, ARCHIEEC (ENGINEER:
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O y Z (.ICI?NSI?Il CONI'ItAcroiI 'S OI!CI.AltNi'ION
OZ n O I hereby alarm that I a o licemod ander pnwiAhm.v or Chapter 9 Unioinen In,
F Z'[W with Senion 7000)of Division till the Business:mdl'nde.n§inn.. Cole, and my licence
Y E is in full prove and effect. _
lama License Class Lica
a �' Date Contractor
ce 3 w ARCIUTFCr'S DECLARATION
t y=yiz
w � 1 understand my plain shall be used an puhl lc records .
E53 p O Liccn.,cd 1'ml'c"i'ar'l
6
a. e OWNER -BUILDER DECLARATION.
I hereby affirm that 1 ran exempt from the Comanchor', License Law lot the
C'?Q following reasoa(Seelihn 703LS.B¢Jne¢ and lmAWom Code: Any city or county
i s O which requires a permit to aauma, alter, improve, demolish, or repair any.sau.ure
a3_°ef rt
prioo its issuance. also minims the applicant for such smanto file a signed statement
that he is Lccd.W for,unat tothe provisions of [fie Contractor License Law (Chapter 9
(contncnaing with Set nXXyof Division I 1 be H tomes, ad Pmfessons Code)
err that he is exempt oaefnmt uad the basis for tine allegedexemption. Any v,olmmn
of Secti1703 1.5 by any applicant font permit suh,en the applicant to It civil lunalty -
nl' am more title five hundral dollars ($500). -
t]J.ECiiwt cr of the pmpy, er
crtr my employees with wages its
their sole compensation.
will do the work, had the >muetum isnot accodul or mychad far sale (See. 71144,
Business and Ptofcsinn, Code: The Contractor', Lcense Law Joe, not apply hr an
owner of property Who builds or improves thereon, and who does such work himself
or through his own empiayees, provided that such improvements are out intended or
oRerc l for sale. If, however, the building or intprnvemeat k sold within one year of
nnpletion, rho awncr-bmf Idcr will have the bunlmt o1' proving that he did not huild hr
Impn,vm for purpose ul'sulc.). -
1: as owner of the Prgterty, air I exclusively contracting with licensed contractors to '
cnaxtmct the project (Sec 7614, Business and Professions Code) The Contractors
License Law does not apply to an owner of Pmpony who builds or matrices thereon.
and who c is far nh pmjcros x'tit a contmcor(s) licensed pursuant to the
Contractor'. LI ase Law.
0l am oxer pt der Scc. .B& P C for this ravwn
Ownnt✓ all
. WORKER'S COMPENSATION DECLARATION
1 hereby affirm undo Penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Content to wK insure for Worker's
Comtenxation, is provided for by Section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
0 I nice and will maintain Worker's Csn ri, tion htsara ce, us ralhimd by section
7700 of da Labor Cade. k r the psi.... of Ne work Iia which this pannit is
issued. My Workers Conlpenxatlnn Insurance carder and Policy number um:
Carrier: Policy No
CERTIFICA'1 ION OF EXEMPTION FROM WORKERS' _
COMPENSATION INSURANCE
(This section need not be completed if the hermit is for one hundred dollars
SES))a, less -
' I eerily that In the'aa I c of the work ho.whidt this permit k )Awed, i
- ,fail nm antploy any Ix7xan In any manner as m to became object to one Wnrkm,
ch"him t,mionLaw, of California. Dae
Applicant•
NO'[ ICI: TO APPLICANT`. IL after making this Cenificmc of Exemption, you should
z 0 Meome object to he Workers Compensation provisions of the Labor Code, you masa
forthwith comply with such pmvkiuns or this permit shall be, deemed revoked.
f" Vi CONSTRUCTION LENDING AGENCY
a 5Iherehyoffloorthinthere lA a rarenuethat luting agcf y for the inal'onu:mce
W of the word fill wbkh this penult Ix iseaed (Scc. 3097. Civ, C.)
L Q Lcudcr's Name
7 z Gender', Arches,
U O 1 certify that 1 have read this application and same thin the above infommtion is
cone., 1 agree to comply with all city and county oNimnces and slam laws relating
C V to building constriction, and hereby authorize mice,ematke, of this city m anter urynt
'y ry the ahhve-acmroned property, ibr inspection purptncs.
(We) o ice ur sive in lcnmlfy and keep hanWess the City mf Cupenlno against
Vi I'1 II ) J6 1:I c I i t,c: 'f 11 Inty In Any way cCeine agahh.l said
(,J� 'Pt sequence of fl yrntg of this p 't "
,R ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT `Issued by:
S^t�
Date f
Sign'aiurc of APPlicanA-Dare
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will epCare m atom building n
oma nr Land
Type of Roof -
IfTRACT0R INFORIVIATIONd.
Cuda, Section 25532(ud -
El ye" D Ida I ' _ -
All rool's sfiall be inspected prior to any roofing material being installed. -
PERMIT IED. '
If a roof is installed without first obtaining an inspection, I agree' to remove
chit hamrdous air contaminants as defined by the Bay Area Air Quality Mtmapeaent
Distinct !
APPLICATION SUB DA'rl!
wee ONO
all non* point source regulations.
SANITARY NO.. CONTROL NO.
.. -
Culil'Dram. HcnlN&Salary 6afa Smtions 253x5, 35333 and 25534. 1 underawnd thus
BUILDING PERMIT INFO
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BLDG- ELECT PLUMB ME: If
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Occtt " � -
uT 16» I
Signature of Applicant ' Date -
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Job Description
RE—ROOF ..
FINALED
JUN 0 6 2001
Sq. Ft. Floor Area
BUILDINrialuation
-APN Number
- - .'
" - Occupant, pe `
Required Inspections
305.—
FRAME
307 -
TNSLII_AT.TbN'
601. -
ROOF TEAR OFF
602 —
ROOF PLYWOOD NAIL
603 —ROOF
BATTENS.
604 —
ROOF IN—PROGRESS.
Vi I'1 II ) J6 1:I c I i t,c: 'f 11 Inty In Any way cCeine agahh.l said
(,J� 'Pt sequence of fl yrntg of this p 't "
,R ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT `Issued by:
S^t�
Date f
Sign'aiurc of APPlicanA-Dare
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will epCare m atom building n
oma nr Land
Type of Roof -
ealth,antiSafetymcnal
e, Chapter th
Ax de,ratedSec by the Cupertino Municipal Cwle, Chapter 9.12, and rM1e Health anti Safety
y t
Cuda, Section 25532(ud -
El ye" D Ida I ' _ -
All rool's sfiall be inspected prior to any roofing material being installed. -
_
Wdltheapphcantmmarebaddingmcnpa%tn,eeifmptmnaordeviceswhicri
If a roof is installed without first obtaining an inspection, I agree' to remove
chit hamrdous air contaminants as defined by the Bay Area Air Quality Mtmapeaent
Distinct !
all new materials for inspection. Applicant understands and will comply with
wee ONO
all non* point source regulations.
I have read the haeardmu nmterials requircnem, ander chapter 0,95 of the
.. -
Culil'Dram. HcnlN&Salary 6afa Smtions 253x5, 35333 and 25534. 1 underawnd thus
it tilding docs not ourrently not, a tennm, that h is my rusponxihdaymnntily the
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cul a afthc requhcnanp which must be incl prior to Ismance al a Ccnil'lcada of
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Occtt " � -
uT 16» I
Signature of Applicant ' Date -
%r
All roof coverings to be Class "B" or better '
ammodaeaagont alae
OFFICE