01110064 C[TY9'CUPERTINO
"etiiUINIFG mvtstON, PERMIT CONTRACTOR INFORMATION:— -----
BUILDING ADDRESS: _. ..-. ...._ .. - - - - I PERMIT NO. _... " .
.;2Q82,0.'•,B0NNY DR 01110064
OWNER'S NA ME:" APPLIC4T10N SYR DATE
KULLICK AUDREY AND EDWARD J 11/14/2001
PHONE: - SANITARY NO. CONTROL NO.
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o e z ARCHITECr/ENGINEER :° BUILDING PERMIT INFO
as
U- ... _.- _ _ - . .- .. - .' ._ _ ... _ _ BLDG ELECT PLUMB -. :MECH
o LICENSED CONTRACTORS DECLARATION -1 9lcomJob Description
z I hcrdp affirm thin metl u❑ p ns of Cnapmr menc ng' P
IwA+ 1 ]aro) rD 3 nn a . ° ar .e, �-c�Jlje lEa/
yfc t REROOF
x F a ri �7e< L CI Lie.u loV DLc, _.
Q Contractor
'
g ARCHITFCTS W DECLARATI f r
J51 ` fiCt ypin`hdine -a Phlbi N Yy
�Y P
OWNER-BUILDER DECLARATION -
u�-;,n ;-73"d'hcfeby affirm that 1 Am endmpi from the Contractor's License Law for the
t z> ;foiloviuit priona.(Se'mion.7031-5.Business and Pm eisnaw code:Any city or counts $12000
E 4L 1 hich requires a permit to construct.ahcr,improve,demolish:or repair any structureaad a.3leprion t once- Isorcq thy.pplcatf ch Permitt fl signed.n m
Mac hq' li ens d p uhm to Chep o s f th C t f re t e se lv (Ch pl i t) l'n '
{dam ncn6 with Seci:onl]000)of D 3 flh .Burnes and PmfessonsC de) - ':�3'§�1FI'(ff k9r. ®a '+ .1, [. - u .. ...
Valuation
• 1 ;or chat he v<aempt th irefmatand the bras for this spelled exemption Any violation - • ' �• - - - '
if Section J03I.S by any applicant for a permit subjects the applicant to a civil Penalty
of at more man five hundred doll...(s500). 30 EIPN OccupancyType. -
plias owner ofhc property,ur my employees with wages as their sole c°mrematim, 307 - INSULATION
:wilydo'he work,dad he swcture is mit intended ur offered for smrlse<-70,Lt 6 O 1 - ROOF TE
'Business and Professions Calc:The Contractor,License Law does not apply to an MRqt UFTInspeetions.....'
or du
r of Pr'peny Who builds or imnowes hereon,and who does such work himself 602 - ROOF .PLYWOOD_ NAIL
ureredfr his own employFt provided buinharsuchvemontemeol artnot intendednyew or .. - ._-__.-
mpleforsale.il'hobuildeclicl havnh --' me mensnsthat heidi one -
t t° building p`°Ve Y°°'°r. 603 - ROOF BATTENS ., ..
77.7 -
completion,the will have the burden of proving that he did not build°r
improve ka'amme°`sale.). ' - - 604 - ROOF IN-PROGRESS
❑1.a,owner f p ponye -'"
<dnst a th farjer.iS 70" Bmints., ad Pmesoinas Cattle.)Th
n Co tm tor's
'Lice'Licemse Law does nor upply to an ownerof property 1 builds improves mencon -
tand no c m f for such project,wiIli < nt nods)licensed pav m t°the. _. .... - _ _...
Contractors L La
Oram pc Deis c - _ ,. ,B&PCfor this reason
Own •" - 6inj ///30f`
WORKER SCOMPENSATION DECLARATION
f h rchyff d pen Icy fpeJ ryrte of the following declarations
sd jwfI'ma tan'eCertfi 7 f Consent to self-umme self- mefor Workers
pe ided for-by Sedan 37NI.f the Iznur Code.for the
Ilcrfom,mx<orthe work far which his permit is issued. .
i f71 lism'snuilisili maintain Ar,pa Cmnp Oiai 1 . nee,as required by Section
13700 of the'L b°r.Cor for the Performance of the work'for which this Permit is
'Cf !isiued,MyWorker's Comperi,salion Insurance carrier'and Policy nombernre
•an ... �..... _ _
Caren 5 .( W', •11'{,- Policy No - .t -s s •11%•1 .t
.r.10ERTIFICATION OF EXEMPTION FROM WORKERS', { 2��'•:-• „:1 _ . . .
COMPENSATION INSURANCE""' -
(Tn hon need f be lioinpleed'f he permit is for mic handled dollars �1� n• i-,^,, �- It .:'
I c n fy lh t in the p,nmorounce of me work for which this permit is issued,l ]I )t'f t l T'. f-' `•• - _ ..-w_,� • �_.." -
-thall net employ any peomin in any mannerwas to become subject to the Workers'
Compensation Laws of California Dam
-Applicant . .a - .. .
'NOTICE TO APPLICANT If.after makingth Ccm,2cf of c.pli im.you should --” -- -- -- - -- -' " '
z neco bJ..a the Wo A C' pc 1 p n- `the Lab C dy rest h
Z O - forth th °'ply with such-......ions or rb s perm t shull bed - rcvaA- - "
.. s .... .. -.... .._.
} - u-"CONSTRUCTION LENDING AGENCY': "i '
h rtby aRrtn that h a romwm on lending agency fonhe performance'
!W-p Leihe"r Nhure"o-thv permtfis issued(Sec.309],Civ.CJ ' "' "
:Lender's NSme_:....,••s....v::... u-:::a.•' .•.-..:_ .<_.�, s :..u.....xa _ .._-.- . . __._-...-_..
'a — —
Isnaers naaka.'. ..',
tV^o .�J cagily Thai I have read this application and swm ha he above information is
tobuildi agree to comply and be abb maand county ordinances and scala laws enter
upon
CtV ''tobuilme mentioned
noperty rtbyopurposes. Ives of this city to ca¢r upon
r Loa he ab' nr o o property farininspectionpurpo. . _
(.s y1 IW)agrc f sao rid (ya dke ph ..less the Ciry of Cupertino ego nst -
F. h 1 ahifides J Jg Is 1and enpe s s wh ch may in ivy to y isecon,against said
(> � Ccymc nse u 'ce of th gram yg fthiIpermit I ' :"•
y APPfI5� Jnb ASTA A bWl OMPLY xITHALL NON-PONT'
SOL c 'bl ons O Issued by: Dale
"u'ru mr(Apple of to t Re-roofs /
rt BAZAR DODS I T Rif L IS OSURE� t
++11 the ppl cam far bud ant 6 handl ha timaterial Type of Roof
a defined by,theCupcn M pa oda no -9.12.and five Health d Safety 5 P
•Code SMI 2553 f {^ I1 , s..s.
_.All roofs shall be inspected prior to any,roofing.materlal
air
beinginstalled. _
,� Will the ic future braiding occupant c equipment devices which
_
If
haucomm, tdef a b)the se Air Management a roof snslled without first obtaining an ins ection, Iagree to lmove
° "
¢N all new materials for inspection. Applicant understands,and will comply,with
❑Y -
Q 1,I r + r '` '�..! all non-point source regulations. - --'
have rmjthe,'ha dq s renals y ems rndfr Chapter.6.95 of the
Califo Heahn&Safety C,d1 .Sect ons 25505 25533 and 255341 understand that -
'ifhetarlding Jueo m
s nut currently hose a ranam.chat it y responsibility to notify.me - - -
nccdparr of he am
qui ecus which must be met prior m issuance'of a Certificate of e as
Occupy .. ,.. .:.
Signature of Applicant D e
Owneon
uit cdagL- -r„ art, , All roof coverings to be Class "B" or better
OFFICE- . ._