03060027 CITY OF CUPERTINO1L 'a� ♦ y"�y7�� 4;;
BUILDING DIVISION PERMIT k ON�RAC"CUR INFORMdf�„$g�/M'"
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BUILDING ADDRESS: RONNING ROOFING CONST PERMIT NOO 3060027
1"16 BEEKMAN PL
WNER'S NAME: 1310 CURTISS AVE Pa"B"E" M3/2003
ALIFORNIA FAMILY RESTAURANTS
ONE (408) 397-8453 SANITARY NO. CONTROL NO.
ARCHITECT/EdOINEER: BUILDING PERMIT INFO
BO Q PLUMB MOECH
+Ipp LICENSED CONTRACTOR'S DECLARATION JbDescrition
1 Wreby.form that o
al l am licensed under provisions of Chapter 9(commencing p
with Smarr' Oro)of Division 3 or Weaa .W ofessiov Code,�n{my lice.I. ��I�� O �®
mm�r dercem •_3 / les3 / TER OFF CAP SHEET u w µ•e
°eLk ke A CHITECTSg1RYA ATION INSTALL METACRYLICS JUN 2 3 2003
1 wlderwml my plans shall W used u public mcc rN BUILDING,bend Licensed Professional OWNER-BUILDER DECLARATION BUILDING
gnn
1 hereby afnthat i am uempl from the Convthe
Convectors License Law far
00
O O following tenon.(Scetion 703 1.5.B.I.sh sea rte, ulou Cade:MY achy Of roomy .
which rets bgr n e,iso re cores The when improv,do permit
t or mash soy Nucture
pads LLl,lRnsedprsunt Into lheapplicant for Such Comumclit loBIC ssigned ehapter1
�< that W(wame licevddpuuuutro00)ofDivision
ivisuofthe ofWeBuacmr'Wcerofud. Chapser9 Sq.Ft.Floor Area Valuation
(eat he is ng with Seedon 70nd W h b Ione W lho Bullosa and Prufeu vis Case)or $10000
Nn io b comet tierermm and the bub far The alleged esmpnan.Any it penalty
of
not
Section atryreendoll.(Sp RNej=eu lne.ppllwnm.dvu pen.uy ar ppN NT18 .her Occupancy Type
oat mare thro raw 6uMaca dollatr(sero). 316 MAT 0 ,
❑I.uownerofUwpmpncy,ocmymnpl%=wedmatealkhmkm penudm
will do the wok.snd thestsuclum,1, 1landed ser Offered for N=(sere.7044.Bectineu Required Inspections
and Professions Cade:The Canvacter's Lt.=Law does not apply m an owner of 305 — FRAME q p
propertywho bulldsorimpmvee thereon,sndwhodousuchwark himselfor through his 307 — INSULATION
ownemployees,provided Nu such improvements see notinte
rMed reoffered forsake.if.
however,the building or Improvement is sold within oneynar ofewarflation,des owner. 601 — ROOF TEAR OFF
ulebuilder will haw the burden of proving then be did nal Wild or Improve for purpose of
602 — ROOF PLYWOOD NAIL
0 I,u mover of Ilan Property.am each dvely conlMing with lire^•^comraMn to 603 - ROOF BATTENS
consuun The project(sec.70x4.Business and Profession COae:)The Contractor,U.
arae Lew does not apply to an owner of property who Wilds or hometown themem.end, 604 — ROOF IN-PROGRESS
who contracts for such projecu with a eonuacmr(q licensed Pumunt to the Comeec ces
Limens Law.
❑l gm eacmpl under Sec .B k PC for this muck,
se Data
WORKER'S COMPENSATION DECLARATION
1 hereby afnoo ander penalty of perjury ace of the following deelarsom= -
7. 370)
1 have and will mdnuin sCenifew,of Coesenl to relf-insure for Workers Contra.-
sal u provided for by Section 3700 or the LaWr Code.for We peaomgaac of the )
k for which this permit is issued.
1 ban and will maintain Workers Compensation France,u acquired by Section
of the LAWr Code,far the performance of the work fo which this permit is Issued.
my Work=r)CpmpemJ lnsusence 'vwand Put.,nmethe eY o,a
�rje 5e ✓tel}'L YS— _
CG CER77 OFB%EMPr10 MWORKERS'
COMPENSATION INSURANCE
r
rnub section and rot ho completed if ere permit is fo ane hummul"Isu(SIM)
Of less.)
I certify that In the performance of the work for which this permit is issued.I shell nut
employ any person in soy mennerso as to become subject to the Workers'Compemu0on
Laws of Califam L Dae
Applicant
NOTICE TO APPLICANT.If,after making this CenlOcau of Exemption,you should
become subject m the Workers Compensation provisions of the Labor Code,you mug
,J 0 forthwith comply with such provisions o this peered Nall W dammed rooked.
CONSTRUCTION LENDING AGENCY
'[•. I hereby afl'mn that there its construction lending agency for the performance of
y'•7 the wort for which this permit is immed(SM.3097.Civ,C.)
W Q Lenders Name
P•z Lenders Address
t.p O I ctn fy that i have mad this application and gain that the show information la .
!+ room 1 agree w comply with all city and courtly ordinances and safe Is"misting m
0 rV' building Congmetion,and hereby swomme mprewnwaves of this ity In enter upon the
Nd show-memiuned property for inspection purposes.
(We)agree to un.Indemnify and keep harmless the City of Cupertino against a�
y Ilsbllitiu.judgments.coo and upcuu which may In any way ucma against said City
U in conwqwof the APPLICANT UNDERSTANDS AIN
of IND WILL COMPLY WITH ALL NO -POT Issued by: Date
rcml(h�ux�dom
S.
- .3D 5 Re-roofs
finApplicugCanlrs(or Dake
HAZARDO0 ATERIALS DISCLOSURE Type of Roof
We applicant of future WIlding occupanadare or handle hvuduu masedal
the Cupertino Municipal Cole.Chapter 9.13,sena the Health and Safety
n 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
s Nothe,pendant es Nthac banding maysmt o a=gaipm=rat ofd vim vert certIf a roof is installed without first obtaining an inspection,I agree to remove
v air ronlaminuts u&find by The Bay Area Air Quality Management all new materials for inspection.sttt���
❑Ys I�eNu
1 have mad the haurdou matoaah acquiacmenu under CWpun 695 of the Califor.
ria HUIWB SafetyCadc.SeNom 25M5,M533 and 25534.1 uaderguna Wmifdc Wilding
does not cuoentiy hew a anent,that It I,my nagamiihilily In n 'fy We necupent of We
my iacmcn w hmestWmetp r s eOfaCmincsu Occu Signature of Applicant Date
MnEF iff authoarcdagenl Dau I All roof coverings to be Class nBn or better
r
CITY OF CUPERTINO 0 3�lQa Da 7
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# lDate: 3 d 3
Building Address%
Owner's Name: Phone#:
Contractor: I Phoney#: 4 License#: / �(�"
h h l �f n LO:/,\ 3 9Q3l8 h 16LJ 2
Contact:, t ne#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
9- Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: t
e� n45, <!aec
Residential J4 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dent. if
there are any restrictio
Cost of Project: Type of Co n: Occupancy group:
Qty
A is bl Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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