00110104 CITY OF CUPERTINOBUILDING DIVISION ..pER1VIIT CONTRACTOR INFORMATION,' ' .
BUILDINOADDRESS: - 19?RMITNO. ' t '
11.411 xBUBB RD R J BEAN ROOFING 0017.01,04 ..
OWNER'S NAME. APPLICAPION'SUB DATE'
.MEYERS 1 5425 . SHANNON RD 1. 1/20/2000
PHONE: - - - - SANI'T'ARY NO: :" CONTROL NO.
(408) 358-4028 ;
A O OAHCIHTECTIENGINEER: BUILDING PERMIT INFO '
aoZ p -- - _ _ BLI HLEC'1' ' PLUMB MECH'
F LICFNSFDCONIRAC PORSDECLARATION� --
Z O y� i I hemby all en the,l' ,hectored 1 p fCl pt 9(commencing - ' Job Descrl On
PZC� w'd1 1 7W0)m'D" o3oflIt,Bi Profession,saddC 1d,ird my licence _ S 2 • x1
�9 rc �a r Cla,, ° °ai Li a SHAKE 'f0 `40YR EL DIMENSIONAL '
eie' d F
Dole C dract.a'
w 3°•m , - ARCHITECT'S DECLARATION
5C5 O 1 undcrsland at plan,'hall he used as publln records -
al�p0
OWNER BUILDER DECLARATION
I
hereby fiffirm that I am exempt love Ili C t'el License Law for the.
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31.5,Bmi,ins,4 and Professions Code:Any city or county
t lar improve,d II''h repairit i
,n 11 n 9 flu,.pplif hp tt fl g t mf II IS I 70
heli re4 a pe
m
'
co
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'hot he is i,mmedFulmination,p I he C t' t r License Law(Cpt 9 S Ft.'FloorArea _ luation
(0 6 with5 t 70110) fD'. 3111 Business add le'.' :Cd) q' -
or that he's exempt therefrom and the basis fur(lie alleged e rption Any violation � ;+� 000 -
- or Seel on 71 s by anY arra cam rot a surna,. hirea 16c apprcan in a ciml penalty - -
:nneare.rcl,him rise hundred dollars(S500) APNNumber .' '' - Occupancy Type ;
°i.a,rwdeterin,property, tiny cnpdoyer,will wagsasmeirenmennl,,loaeen. .356230A8. V.)0tx
will do the k I the t t ,intended offered to"f (So,.7044, -
Ba,iac,,-anal Plate. :Code:The Cordovan:i I t afid,al an '• g ; Required Inspections ..
fp b ty WI 1 'll: pow,thermal, h 1 1 kF-nsclf'
orthrough n. ply provided nm: n p r: not number! - �Q15 — FRAME -
offered f : If. 0 building 'n p e 1is: I Withincare enmplenn @eawo,,-mirerrwdnavetheb ran ofpron'ngthmhodidnotbu d,), - 307 — >INSIJI_A'TION
•urpooreri,rharpnsenfsale.l 601 -ROOF. TEAR OFF
°I of the punp6d,,dramorle,bel,malrodia,wish licersedecannuums m —, _• *.
rustt thprotect(s 7044'8 I Professions Code) rhe Cnmrmm�rs 60c ROOF F'1_YWOOD NAIL
Lr`crw d t pplyr - improperty h h Its p' m.enn ROOF. -•
and wn contracts for such projects with a r ndacdrts) r ised Pursuant in me 60:4:' BATTENS _
Central Lice eLaw., 604 '— ROOF 'IN—PROGRESS ', - v:
°l nm exempt under Sec. ,B&P C or this reason -
Owner' Date
WORKER'S COMPENSATION,DECLARATION
1 hcrcby ofdnn under penally of penury one of Wo fnllnwing dedaralioios� - - + '
- ❑ I have d will mountrain a Certificate o7 Consent Ili self-ansure for Worker. _
Cmaper,a(lon. a' Insider! for by,Secd t 3700 of the Leber Code, fnr thar. `
perm f the wo k f rich alias pe
it is 'sned. "
°I havethe
velli r Code.n Wacker CarperMian Ie war l the hien(hi by Section - t
- 9704 of y 1 Labor Coon, er the pInsurance c rr the work icy which(his permiP is, • '
' slued.My Wnrkery GnnpenFatinn Insurance currier and Policy numher ere:, - ''
Carrier: Policy Nn.
_ CIiRTIFICAS'ION OF F.XEmprioN DRUM WORKERS' -
' - •COMPENSATION INSURANCE '
' (This ration neednor boemnFirled f the pcmml is mature hmodreddollars - -
(S101Borles'.)
.I certif that in the Gmnunee ofcthe work for which lbis r is issmii,I r -
P P. ^
till moado iy may
i iy nth licca1� I] inane Workers' , -
nmp mo
nunn,l�yu� Il D'rase✓{ 1Jr'[RJ
Apple I X�l�Qaa..
NOTICE Ib 1PPACANT 11 fire r A 6 0 .C i 1 m f Exempt an ya shoe Id ` -
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ren
lido
a 'it
1 W I'll
C peri n ns titan'Lahnr calx vol sell - ° - },
F Ofnnhwi0 c , plY w'ih. ly ms nrlh 'p t:hall be da ncd evoked
- CONSTRUCTION LENDING AGENCY
1 herehy affirm not there 7 uvi out fending agency for the perrnmerne, - t
Lw7 i.y of use work rot which this per ed is issued(Sri.9(197 C v C)
Lender's Name
z land r,A d a
.V � I verify ton l have road lFsap1iCaimcold sen lflat in abdrafill orrunion is 4
correct.1 agree to comply with all oily and mnnty,mmmnees and cute laws riddling
O'V to hind ug canard on,und hereby anallanote reprebranowordbi,cty tomer po - .a
>s W mem t ndn nnyf r f 1 per, , .
seyW
(We)agree to save,indemnify andkite F Iss the City fCfelit against _ ... - t
Indbilifies,pigments,c is 1 d pi. hi,h yin anyveryto,bal,abu net end.d. 1
V z City consequence(ifdhe gonating of[Ills ove rat - .
APPI ICA TUNDERSTANDS AND WILL COMPLY,WITH ALL NON-POINT ' ' /
OUR r L IONS. Issued by: - - DafE/-�-0
nr � .
•s snob A enmlCommcmr - .- Date . ,
HAZARDOUS MATERIALS S DISCI OSURE Re-roofs
Will the,ppledv Ir bAa'ng -4 t t handle nae' 1 : serial Type'ofRoof +
mdel sed Fane Cl'prriurMrn'ipilCade,Cbalte,).Rand the Health and Safely,
Code S tion 25532(x) •• - •.71 ye, °N - - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant future buildingoccupant. : egib al or des :-hien If a roof is installed without first obtaining'an inspection, I agree to remove>to i dcontinuator,mdefred b$th•Buy Area Air Quilty Mrwgemrat
"Faro, all new materials for,ins ection..•Applicant understands and will comply with
40,
urea a17 No P. PP P Y
+'" all non-point source regulations. r-
I h' ad th h ai 'al t. underCh pi 695 f ther ' ,
'IfI Broth. Safety CUc Sections 255115 5533 add 25534 1 lilies to Illi t �p
nn,hulfyd . u Oyh i.artthat t yr p sfltyi il}ihe,
uwp t of the requ'm t which drat b act prior,to a of a Cert fwr of
Or'. *y Signatu eio�Apphcant - - - Date
- a .
- O € e aumnr rgral -- - Date - - - .'All roof coverings to be Class``-`B"or better -
t.
OFFICE
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