01050077 c►Tv OF cUPENo CONTRACTOR INFORMATION:
,..Un11,U1NG DIVISION PERMIT
BUILDING ADIIRESS: PERMIT NO. .
1 ' 1.0301 BYRNE AVE. CALIFORNIA SECURIT ROOFINGO1050077
OWNER'S NAME: "' APPLICATION SUB DATI7
RANDY & PATRICA SIBVERT .• 1.31 S -CAPITOL 'AVE 05/08/2001
PHONE: SANITARY NO. CONTROL NO, r
(408)254-1007
O O 'ARCHITECT/IiNCiINF:F:R: s
• BUILDING PERMIT INFO
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SLUG .[LIiC'I' PLUMB MUCH
��� - O CI •IJ I`t
i y= LICENSED CONfRACPOR'S DECLARATION 10b DZSCrIpIIOn s
O Z_ 1 thereby WE'.that I um licensed under pmv s ons of Chapter 9('theca mg _
a uJ thS t 700(dof Division Jnl'1he Btsnessand Profession,Code,and my license -
Srru. D to ____"1 �_ C—,Z /� - REROOF.* REMOVE EXISTING ROOFS,
❑a O Data d�—y" m/ Gmvacmr �e +�u , '
w a w�- ARCIIrn:cI IS DECLAR. INSTALL- 1 /.c. CDX PLYWOOD &
1 < Iunder,mnamYplan,shall ,,a,edaspublic reeum, -NEW 30 YR. CELTEX DIM. COMP.
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Licensed Professional
o that I a .Iexempt fr DECLARATION
a lmreby affirm that 1 1. exempt from the Contractor's License Law for Ina • ..
�6 toll g Section]1111 5 11 :' I P fen t Codd: pa ly ria sty ,
❑
which,t t, r tt esI t Il p J -rcpat y mute
that
t l 1 q m p(tl tl hl tl pl g d:mrta mem
m to With
n 0 p . ' nn t Contract 1' n L tan,Cor t Sq. FL Floor Area Valuation
(commune ng w m Seat on on a ofhe Basis
3 of the Bus ams and ioPren.Any violation
i Calc)
or that he is[scary merefmm ant the auris for the allege)exemption.Any viP salty
of not Section man
by any applicant for a retail subjects the applicant m a civil peachy
of not ntmm rvanandrea cosecs tssta). � APN Number Occupancy Type ,
°1,ns .or loo PrnpenY.or my an�ploycns with wogcs
.w B e n k d m t t th'm-e r ful s nmeilrsrolcsale nnpensminn
Business and Professions Come The Contractor's License Law does not apply to an
,
'
s Required
red lnspeclions
owner f lopperty Who pauppowl,damon.and ofir,enc such work himself
or through his nt, Yer. parmidiedtot suchimprovements ster 35711020. 00
lefor
saI If however.the building f caro Id one year rf
ampiti m nc M1 IJ will hu h d, p6theddtb'IJr
improver Purpose r.m 1 — FRAME305
Cl 1
arty I I> , i d re l t t r:t, 307 INSULATION' J` /
consume, l I j 1(5 7044. IP f. t Cade,)Th C t yrs $
a 1 J t apply t owner I politely who h IIs improves(hereon, O
and hcontractsI h p j,etn„m taytmcl a sed p recant to ma 601 — ROOF TEAR- OFF .
01 outnreL crane Sec 602 — ROOF PLYWOOD NAIL_
°lam esentpt under sec. ,B&P c holds revwm
owner Date 603 — ROOF BATTENS
WORKER'S COMPENSATION DECLAIM ION ': 604 - ROOF IN"PROGRESSO -
1 hcrchy tl'linn under pemJly nl'perjnry arta nl the following dmlarwinnr, � "
I have and will maintain it Cendicam of Consent to wirinsure for Worker's '
Compensation, as provided for by Section 37M of the La1x,r Cale, for the -
,ni mune of me work for which this permit is issued:
have and will maintain Walker's Compensation Insurunm,as ro'n"d by Secdrnt -,
1700 of 1he Lnka Cale,par ilia p..ionc ace or fle work to whish this permit Is 11 ,
issued.My Wm'Acr'u Compensation Instance currier and Policy number are'.
Carrier A/ 'nlicy No.: -
CE 1'1 KATION OP EXEMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be conidemJ if the permit is for one hundred dollars
fsiool nriar.j, -
I eertily that in the performance of the vI m for which this permit I.Issued.1 e
shall am employ any person in any manner so as to become subject to the Workers
C.,anwtion Lws of California.Dar
Applicant
NOTICE 10 APPLICANT.If.aOennaking lhix CeniBc to of Gumption,you should -
b
ca m, object mind Worker's Cmmpemmtian must
Mwisions of the Labor Cole,you u _
zQ O ronhwhh cmm..ly with such.....slam or this permit shall be deemed revoked.
Z) CONSTRGCrI10N LENDING AGENCY
C5 1 hcrchy anion that there No nmsaaction lending agency forthe perl'onm:mce _
fthe work for which this permit is IaveJ'(See 3n97,Civ,C.) -t
L Q I,der*s Name _
Q Z Leader's Address - r
C.7Q 1 candy,lia,I have mripplc( and,ttmtthe a hime informations
W �y
correct.I agto conjily with all city and county ordirances and.mt laws relaiiii,
QV tol leg a ( tlh -by t rp 't tv .r0city to t pan
} W to b .. I propeny for indlelliar,p rp
rF. G (Wel agree to save,indemnify unitkeep h I s the C'ry fC penin against
rn liablainceS.,im,ment t. nJ expe which may n any Y accrue again.tJ
�,) Z
City e, me gnntmg of lMs peons '
APPLIC UNDERSTANDS AND WILL COMPLY WITH ALLNONPOINT Issued by:VV C �w7� 000. ' Date
.OI n It TIONS. y'
rA,di / mracm. Mile .Re-roofs
IIAZARDOU up IIAZARDOUATERIA .CLOSURfi '% •.•
wJI me applicant or future building occupant sarc at handle bumpkins nercdnl Type`of Roof .
a defined by the Cupertino Mumrtpal .Chapter 9.12•and the Health and Safety
Cold,Section 25532(a)o
°Yaa erlb, , All roofs shall be inspected prior to any roofing material being installed.
Wit l menpplicunt or future building ant use egWpment lir devices which If it roof is installed without first obtaining an inspection, I agree to remove '
emithaeurdnun air commit inial u.dtlin y me Bay Arca Air Quality Management
naric'; . . all new materials for inspection. Applicant understands and will comply with'
°Ve 0 N - all non-poi.. a regulations. _
I have mad the ha:mdnu,materials requirements under Chapter 6 .95 at the
California Health&Safety Code,Sections 25505.25533 and 25534,I understaAthhe
if me building etas not curmmly have a tenant.that it is my respmsibiliry to morQ
nccupam of ymremen¢which must Be met prior to issuance of a Cmif
acs
' � Signature of Applicant�, Dae
Owner ser:mmarirm agent `Io All roof coverings to be Class "B"or better
OFFICE