01090094 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ''.CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10749 BROOKWELL DR 01090094
OWNER'S NAME: APPLICATION SUB DATE
MCGHIE DUANE B AND GENE M 09/21/2001
PHONE: SANITARY NO. CONTROL NO.
Pit O O ARCHITECTIENGIN£ER: BUILDING PERMIT INFO
uOt BLDG ELECT PLUMB MECH
a a LJ C:7
ti Z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing
(:y with Section 7000)ofDivision3Otto Business as TWeasinsCndaana�y.l ms PATIO REROOF.
[m is in full force an a
License Class �``- Liox a g T/O EXISTING & INSTALL
0 a U Dare omtaaor
33LL� ARCHITECT'SCo)"I AT 2 LAYERS OF MUDIFIED BITOMEN.
nON-ii I understand my plaj� 1 used es public recalls
I O O Licensed Professional
OWNER-BUILDER DECLARATION
vs o a, 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason(Section 7031.5,Business and Professions Code:Any city or county
S C
which ' s p ren to radial alter tmpro a demolish. r reps y stricture
ce
uys 3C3�m •.pri q sore9 ireslhe apple Ifo s hpe ft flee g edsate t .. . . _. _ ._ . .. .,._.... . _ ..._... _._....... __
t t Dance,of
Thal h T dsed pars ant to the pr 'isi0 sof me C t t Cees !a (Chapin 9 �i t y Sq,kit.Floor Area u anon
(commencing with,Section 7")of Division3 of the Business and Rrpfasrons Cod) Y ti til y ��f, tt +r 1 1,i_tr 9�� z e. $47�
or that he rs exam t therefrom and the basis for the alleged wmighod.Any violation -
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
.four snore man five hundred dollar,($500). 3 6 Hi'0'6U3tb6r0 Occupancy Type
°I,as owner of Ne property,or my employees with wages as their sole compensation.
will amine work;and the structure is not amended 0r Ofered for sale(Sec.7041, aired Inspections
'Business and Professions Code:The Comment',License Law does not apply to an 305 - FRAME Re 4 '
ower of property Who builds or improves thereon,and who does such work himself r
othrough his own empl y provided mat such improvements e mended or 307 - INSULATION
-'oReted for sale.If,however h building or tmpmvement in Itl wiflo.one year of
completion,the owner builder will have file burden of proving that be did am build or 601 - ROOF TEAR OFF '
improver pip° id I ) 602 - ROOF PLYWOOD NAIL
_ . . .
°I as owner of the property, exclusively clummilingwithl nsed cardamomto 603 - ROOF BATTENS ]
on mon thep,.jm(S ]044 Business and Prof ons Code)Th C auatac 'a
Line se
does nor applyt an owner ofp hobs la improves therm ,
604
end contracts for such Projects with a coronations)lned purmars,lo.me. — ROOF IN—PROGRESS
Co V ctL n Low,
❑1 �ptbar
'
am
under Sec B&P C f r his reason
Data �
i 'WORKER'S COMPENSATION DECLARATION
I hereby aRrrn under penally of pepory one of the following declarations:
❑ I have and will alumina a Citi ficme of Consent to self-insure for Worker's
j�Compensation, as provided for by Section 3 70 of the Labor Code, for the
pert l.ce'of the walk for which this permit is issued.,
°1 have and will maintain Worker's Compensation Insurance,as regrind by Section
3700 the Labor Code,for the Ill.nnanu of the work for which this permit is
ipso d My Workers Compensation1 'sora a cartier_i d PoI y mate re
Cather Y No. 1 __.1 L. r x .3 ''.r l •" ..-r .,. �.�-1
Yt CERTIFICATION OF EXEMPTION
MOM OM WORKERSi �' .. ..
„',.� t', " COMPENSATION INSURANCE .'
t (Th s iemam rieal ma ha mmplead d the permit is for one hundred dollars
($100)mless)
P Y �m nn work which rift is I certify that in the rf_onto nce of the wo pa issued,I '-
shall of em to any pc y man as to beeom subject to the Workers
n
Compensation Loss ofC 1 f mm.Dae
Applicant -.
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should -'
O sumaco the W rk
Q z Compensation f Precision,of Ili Labor Code,you most
forth nh comply with h Pon, this Permit he deemed revoked.
,
-� .. CONSTRUCTION LENDING AGENCY
I h rebfifind that th e consumer..lding agency for the mr-mornane
of the k f titch his
a. pe t s issued(S 3097Civ C)
t:= Lend Name ..... .1-
, .
Z
Lem Aad s...' -. .. ., ..
1 unify that I have read this application and state that he above information is -
fas-Ex correct.1 agree to comply with all city and county ordinances and state laws relating
0'V to Wilding construction,and hereby authorize representmives of this city to enter upon
>1fro the above-mentioned property for,inspection pulpoxs._
Fe Ctit' (We)agree to save,indemnify and keep harmless the City of Cupertino against
V] liabilities,judgments:costs andexproam which may in any way accrue against said
co
V�4 City in nsegticau of the graming f this permit.
AP LICANT.UNDE ANDS'AND WILL COMPLY WITH ALL'NON-POINT'
URGE N 't ". °' �c - Issued by: Date
at reof Appou anaminactor' - ,Data Re-roofs
t' HAZARDOUS MATERIALS DISCLOSURE.
as d . b e a C scant future bidding oa part r or handl hazardo s material Type of Roof.., ._
Will thCupertino Mun_tpal Code Chapter 9 12,and the Health and Safety i
PP
Cod Ely s 25332(e) t °N -(', 1 f 'v. '�t}s l r .n X1.1 IrA
All roofs shall be Inspected prior to any.roofing materialr being.installed.
Will the uepplicant ar future budding occupant use equipment o neat cps which If a roof is installed without first obtaining an inspection;I'agree to"Pemove
mit hazard r complaints as defined by the Bay A s Ail Quality Management
''tato tall new materials for inspection. Applicant understands and will comply with
1f'; ❑Y ❑N all non-pointsourc _regulations'.,
�I :
t 1 have art&Se h z de, materials q rcm nts unae Chapter695 of the ---
Calif mm He Ito&Safety Cole Sections8505 titin my responsibility
1 do motif that 1
(thea loftding donnor ,whicly veain b tthatt myrepce of atnlift'the ;/' 21'�n
rampart of the iequircmenn which must be met p to issuance f a Cen Teale of 1� CGG���� 1
Contumacy: ,.
Signature of Applicant . Date
Locard awn,,,d agent '., nae All roof coverings to be Class'B" of better
f .. ..
OFFICE . .