01060086 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
883 BROOKGROVE LA COSMOS ROOFING 01060086
OWNER'S NAME: APPLIC TION UB DATE
SNYDER THERESA 450 SAN ANTONIO RD 06714/2001
PHONE: SANITARY NO. CONTROL NO.
(415) 493-6373
M rc0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w{-{-- - LD ELECT PLUMB MECH
NZa6 . I I_J —I
Z 5 y= LICENSED CONTRACTOR'S DECLARATION .lob Descrip On
Dy=ad 1"by affirm that 1 am licensed under provisions of Chapter (commencing
with Section 7000)of Division 3 of the Business and Professions Code,and my license REROOF.
_al c "'of foreeana� 9 2675—
, 44 T/O TAR & GRAVEL,
z w< License�Ia Lie.p
°a is.F °oi /oQ '— G°ntraat°r ADD 4 PLY TAR & GRAVEL.
ARCHITECT'S DECLARATION
O J i 1 understand my plans shall he used as Public records
�Y
use61 6 ca O Llfensed Professional
P3 0 OWNER-BUILDER DECLARATION
�3 1 hereby affirm that 1 am exempt from the Cssionslnrs License Law for the
t•Z_a following mason.(Section 7031.5,Business and Professions
3 ' improve,
Any city or county
o Isiah requiresa permit .tacp demolish,or repair any m
epri t t I r9.. tl 1,1man,rparral 1.file a signediaction,
that he 4,l csdt) om "'he for, rat c i t lu (Charmer 9F[ F1ooi.;Ared 1
( tpnx 'tnsu 7006) rDl 3lmBusiness and Prof siSnaCode) .�'y : �`.- }.f. .. ,. �C(.l,?.'9.nf 17e • { $69�'�cation
or that he Is exempt therefmm and the basis for the alleged exemption.Any violation i
of Section]03LSbya undredi dolls(550rmitwbjeds the npplicammacivil penalty 375 H ,•!.I .`hi (7CCapaRCy Type
of tat more than five y any dyed cant f s or a per). V tp
❑I.as owner of the property,or my employees with wages as their sale compensation,
will do the work;-and tht dt re is oat t , d' eredLaw r I (sea Toa t' 3 0 5 - FRAME Required Inspections -
B property
Code:Then Comment',License is data t apply m an
ow f p p mo employees. mpro th d wh h ore M1imslf
ooh ghti provided th t himprovements t' t dear _ _ 307_ _ INSULATION _
OFF-
off df .ale-Ifo he building - p 'emcni' old th' oney' of 601 - ROOF TEAR OFF �t I . ,, - �.,, -. '� a'
iompli,on the own r builder will have the burden of proving that he did not build or �'
mprove for purpose of sale.). 602 - ROOF PLYWOOD NAIL
...❑I a
t,hePope tY . 1 IY c i t g
_. . ....6 0._3.__..... .R._.O_.O_.F.. BATTENS
----
construct theorae 70Business and P r Code-)The Contractor's
License L des t apply to owner p p tty ti builds p M1 rc n 604 ROOF IN-PROGRESS RESS
d h contractsf h Pr cis th t r.) d pursuant t the
Contractor's Uterus,
- ' II
[11 ex� d S B&PCT this
_.
Oso
crom D s
( WORKER S COMPENSATION DECLARATION
Ihereby affirma underpe Icy,ofeel y Mai ofthefollowing d lamrcmn
O I he e e d' II ma nm n e C foof Cor . f
Compensation, as provided f r by
' Sn. re for Worker's
ecton
3700 of the Labor Code.-far the
rerfarmance of the work for which this;permit is issued,
`�I have and will m un Workers Co p i Insurance, 'qulred by Section
3]W ofthe Labor Code,for the performance f the work for which this permit is
issued.My Worker's C mpe s l insurance aciauirr cial Policy mbe n .
.w ..,..... ....- _
Ciun ..:-^ •iPol cY No:S7/ 00 /�ZS x x4 5 1
f '..CERTIFICATION OF EXEMPTION FROM WORKERS It'„ i•-t-I- j�- ' l�� .�t/-��4.>.e. .._-t f. -
,. CE
(This secuan neeJ nut bCcoinrlamJ if the perm t ..
_ COMPEYSATION INSURAN _ -
`a� is for one hundred dollars '` -''' {' +') 'C
(S I W I
of Icss.) ,
Ma
empire
that the o f f the work her.,
.which this -'"
Y P S Permit d I I'-Cs .IL . I I .1"; 7,!�
"sh II not employ voy pe ri any my iter so us to bedo ne let to the,Workers �� !,
pe Laws real r Dam
NOTICE TO APPLICANT ._._. _...._ ._... .._._.....__.... __ ___.
C
APPI cam ..._. . . ,..".__._.
It aReY uk g th C n f me r E opt 'y' should f
dual.1 this
ermit hall ho
ecame revoked
Q forth th a Yly _iN h p s a coirctm t on lamming ag ndY f..... rf must
Im b) a the Workers C p t p not th L ho Codit
F rn .` t f r 4u CONSTRUCTION LENDING AGENCY t '.
.� I h b- Fon that thempe Orta ace -
ofthewokfwhich th p tossa d(S 309] Clv"CI
a..QLiable,Name - -..z . . .. .. _"_.. _.. _ , ... ._..__ ......... _._ _...
]'Z Leede i Addr s
.toll ,
,^ 1 certify that Ihave ad this ppl t sad late that the b mffmmnis
correct,f mito-reply with all,y ty- dco ry,ordinances andslate laws Icing
.D.V mbut listing construction,and herenyauthoize represenmives m the city to enter upon
�„EW the ab i., 'Pproperty[ ' .p ti pry. ..
(We)as .ld d nify and keep hI vihe City ofCommon. paimt
Fa VJ
liabilities,judgments, t d rpenres which may in any y, gain It said
U Z Cry cnseq a ftle er m,ng of th p nt
APPLICANTtUNDERSTANDIS WILL CONPLV WITH ALL N70 -POINT"
SOURCE REGUDAT1oNs � ) ) Issued by: Date
.r::
$gnatae fAPpu<awcantr.ietar.', 07— Re-roofs
:,HAZARDOUS O ATERIALS DISCLOSURE.,''
` WII ih aPPlic t t tv build)% c p t foie orh dl'h' Nus material Type Of ROOF. ._ .. . - ._....__ _...,...._. ,-..._.,... ........... -----
as d,fiacdbytheC pen Municipal Cars.Chpt 9.12.andohHealth adS fry
d Be to 2551 (nl - - :.
�Y t If a roof is in'stalled:wrthbut first ob >
° All roofs shall be inspected prior.to_any rooftng.material being,installed..
i t allot list met b Ido c c
- ll pct g p ' q`P ' ),° g he�� [amm an ins ectlon I'aeree:[o'te'move
'en thzm t defrost by th avA eaA Quality M g P
all new materials for inspection Applicant understands and_ will comply with
ontam n t deC
D ti
;` QY` I:;l t all non-point source regulations.-, ,. - "
N
or authorized agen o m-n c e,rem ,t d Ch per 6-95
adunderstand m ohatCalf mHeahh&SaC dSet 25505 29533aofhe
fineb Ido gd not h Yp dr1myt r rybeoc po fd q ,ncwhich.most be t 25t f a Cenifica
Occupancy
of
.... ..___. s _ _.. . _. -_'_•._.. ..
Date of Applicant ..
-
_. .
I' , All roof coverings to be Class "B"orb
Did, etter
0 D
OFFICE .... ... ... . .. ...
', _ . ._ .. .. ... ...._ _-.. _ ._--. _. ..... _-
a+t