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00070051CITY OF CUPERTINO ,-. c CONTRACTOR INFORMATION: - ' BUILDING DIVISION PERMIT 191.DINGA T R�.G�p N ROOFT IMn 9' N(00070051 05990 R�Y tilOD� _ R05M 00050031 C44,IRD OWNER'S NAME: IBES jR�jEjD W .TR AND DEAN -. i��ppTTHH ggTT K . `�T1� 0N' WN'CT' APPLICATR@71Jj IIAJE/"2000 05/04/2000 'BONE: � `^ ^_—�.r �.r SANI'T'ARY NO. CONTROL NO. : ' ARCIIITECUENGINEER: - BUILDING PERMIT' -INFO BhDO HLHCI'=PLUMB MELD I 1.I CI l-1 1^'I LIC12NSED CONTRACTOR'S DECLARATION 1 hereby union That I am licenwd under prnvixiore of Chapmr 9 (commencing - - Job Description is if "1141 ce a, of Dlvisi,n3of the Husinesv unJ l'ndcssiom CnJe. nnJ my license it is IlccIOOO - egF R-❑ �pfpF 7 TrCy+pmv 5r1FHIHRC`J 'lhJ TIAMI ' PUTOOSMELES ��^ CO l Liccnm• �Class LicA_I� i Dom _f�I,i ar ARCHITECT "S DEContCLARAI N— tea"'— 5Fi( []" v 1 understand _ypl fill be used publicrt d. VX7/ _ '29 - - - Y i Lc II f :I f1N NLR BUII DI R DECLARATION ' ' - - o I hereby ififflams that 1 min tocnapt from the C f t - Ijecus,Law for the fell,%Ing reuxnr. (Section 7031.5. Business and Professions Code: Any city or county which mquirc a permit In emsonat, lit, improve, denol kh, or repair any uncen e s prior in its issuance, also call the applicant Rattner pemtir 1. file a signed statement Sq. Ft. Floor Area. vamr 0 ' mattto ':I ect,,edp n rl foostsotooft C . Loch, License Low Cheat, 9. (fit g' J Sciatic 10914 f D": 3 t t Booand i f Code) or That heisexampt ihinfrom and the Mads for the alleged exemP t s, Any violation - $1.2955 ' of Sestion 103 LS by any applicant for a permit subjects the applicant to a civil Penalty ,r nmmrrcmanB�enandrcddeuar.(ssml. - AP Occupancy Type Cl,nuowncrefine pntpeny. ,tiny nnpluyces with w;ii their sole contpensealnn, i�7Qb��Y',rlt..��rf�.r' ,. ..n3'C�4d fL1/ 1. Sip, will do the work, bad the sni,mre is not intended or oliered'fnr side (Sec. 0144. Business and Pmfe,irn. Code: The Contractor's License Law does no, apply to an caner of property Who builds or improves thereon, and who does such work himself — ' ulred Inspections ' - or through his own employees. provided that such impmvements rue not intended or - — N — offered for sale. If, however, fie building or improvement is sold within one year of - completion, the owner-huilder will have the Fume, oI'pmving mm he did ,at build ur _ imp' I' p p su of ) - •— - 01 a: owner f the Present), am exclusively contracting with licensed contractors to ,gyp•/j —_ NMA l . M con wct the project (See 9014, Business and Pofesstons Cock) The Commnor's _ License Law does not apply to an owher,f pmpeny who build, or improves thereon. - _ _ and who tractors for such Pmjcd, with n'amnael (M licensed pars ntm m the Contrnem;nLiemt.al.n,v. — ' S O l ton exempt un der See, ,B& P C for tore reason 4 — N— - - - - 605 — FINAL REROOF' owner Date _ WORKER'S COMPENSATION DECLARATION _ - I lmrchy affirm under goody of perjury one'll he I'ollowiny declare iale, I have and will maintain a Certificate of Consent to self insane for Worker's - Comperoation, as provided for by Section 39W of the Labor Cede, for the performance of the work forwhich this permit is issued. ❑ I hove and rill maiamin Worker's Compensmion Inwmnc'. as required by Seniiat 1 3900 oI'the Labor Code, for rhe Ipedfammfee it mo wars forwhich this permit is issued. My Worker"s atlnn Irourunce carri/er�and Policy number am: - - lCnm u Cartier_aSLO Police No.:r Y� � CERfIPiiiCAlkl YN OIt EXEMPTION PROM WORKER.' COMPENSATION INSURANCE ., , - - (This section need not tm completed if be permit is for one hundred dollars J - ISIM)orless) I certify that in the perfomiance of the were for whkh this permit is issued I o shall not employ any person In any va row so is to h c roe mhjecgm rhe Workers' Contpunation Laws rf California, Date Applicant 2' NOTICETOAPPLC ,a ter ma Nis Cenilicmc of Esemption. you should bee,.... subjem ro rbc WorkeYe Compenmtion pmvisiore of the LuMrCNc, you must - forthwith comply with such provisions or this permit shall he deemed revoked. - ' Y • CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance `• of the work for which this permit is issued ISeo. 3W7. Cie. C.1' - Lender'sNam - - Lender'sAddress certify that I have readth': aillilection andrl Jot the above infonanall()nis t ^ cormel. 1 agreet comply with all city and county orshorances and slate la . calming ' tobuilding constructio, and hereby cauterize rvpmscbuuissof this city ie enter upon the aMwc-mentioned pmpeny for inspection purroves. - (We)agrecmmve,indemnify and keep harmless the City of Cupertino against , liabilities 1 igloo i. t, d p n,a, which my in any way aaxntla limns said - City in c ocalle,tscal the gamor, ol his Permit APPLCANTUNDERSTAyyPP�fAND WILL COMPLY WITH ALL NONPOINT SOUR T. REG TION. - _ Issuedb ` - Date /'J Y �" / I —0 1 t L� y(a. Sig (Apple fit/C mon r Data Re -roofs HA9ARDOUS MATERIALS DISCI OSURE Ildeappl'eul rfalowbu'ldg mat xanorh Jl la anions nutcrul _ t Type of Roof as defined by the Cupeoinn Municipal Code, Chapter 9,12, and he Health and Safely Code, Sensor 255321,)'1 ❑ves ❑No All roofs shall be inspected prior to any roofing material being installed. Will theapprcam in more battles aircraft use wuipmcntrrdavicea wbiclt ' If a roof is installed without first obtaining an inspection, I agree to remove til hazardous sur enmarunumsm Aodnnl by lire Huy Area Air Quality Managcmmm ntimtO - , all new materials for inspection. Applicant understands and will comply with vca 11 No all non -point source regulations. . 1 have read the bzamous mamrialx requirerrmnts under Chapter 6.95 of the California Bestir &Safety Cade, Sections 2550525533 and 25534. 1 understand that if rh FJldl e l : t nrlyln I- Irl t t': ry .P l ftyt ffy rhu p /�- /� owupea of the requi rc is whishnuxr be mrpvrtn's. mu oft Cenil cam til_ Cie G l ((�f ' Def agcy' - 7 r( -Oa S' ture of Applicant ., Date _ All roof coverings to be Class •B" or better Gw oraalifi lagent - Data r •. - kirncc � - 4 0 z U r - L CITY OF CUPERTINO F RN'fakTIPN'� BUILDING DIVISION PERMIT 1�. CONTRkiCTOR1N. " � , " " 19� i � . , , ;'. r 3.; �' .1 A — BUILDING A�Dg Arolli FR ROOF 11 Wp�T 1� X) , V MMITNCQ10-07".5, OWNER'S NAME W TR AND DEAN K JgT E APPLICATHM"JAIE/2000 05/04/2000 ONE MW 69:51 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am liceread under provisions of Chapter 9 (commencing with Section 700l Division 3 of the Buntmastund Professions Cods. and try tire... n 1 (41 -7 License Lia. Lic D. Caribbean, ARCHITECT'S D2CLA 1 andmitarul pbui hawed as ImbinTI:' 0 Licensed Professional OWNER -BUILDER DECLARATION from Commi License Law for to 1 herby niffirm that I am exempt the following memo (Section 703 1.5, Business and Professions Code. Any city or county which requires a Permit to construct, alter, improve, demmi ish, or repair any structure prior to its issuance, also requires the applicant for such permit to rite a signed sumusbut that he is licensed part re the pasovia.m. of the Commerce, License Law (Chapter 9 Sq. Ft, Floor Area VaOMO (commencing with Section 70031 of Division 3 of the Business and Promotions Code) 12,955 or he, he is exempt therefrom and he basis ban the alleged exemption. An, violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penaltyOccupancy A Pg T�pe of nor more in.n five hundred dollars ($500). 0 1, vi owner of the Fiction, army employees with wages as theirma compensation, Inspections will do the work. and the summons is not intended nr offered for sale (Sec. 704, Business and Pratessions Code The Contractor's License Law docs not apply to an owner of Who builds or improves thereon, and who does such work himself Aruired property or brosam his own employees. provided that such improvements are not intended is offered for sale. If, Wastron, the building or improvement is mid within one wor of completion, the owner -builder will have the burden of proving that he did not Wild of Improve for P.,.,a mfwl..). licensed IS C1 1, a owner of the property. am exclusively contracting with contractors to comantact the project (Sec. 7044. Business and Professions Carl The Commcmr's License Law does not apply to an owner of property who builds or improves; thereon, a' .oil who contracts for such projects with a connotations) licensed pursuant to the 11 6 Comment's License Law. l— ' E] I am exempt under Sec. . B & P C for this mown 605 FINAL REROOF Owner Dole WORKER*S COMPENSATION DECLARATION I hereby offlan code, penalty of perjury one of the following declamokiml: ❑ I have and will mosecon a Canificith, of Consent to wif-imar, for istmoolie Compensation bas provided for by Section 37M of the Lidice Code, for the performance of the work for which this Permit is issued. 0 1 have and will maintain Worker's Compensation binsince, an textured by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Comp scum Insurance carrier and Policy number am: Came, — Policy N., or 21 -2 1!z it, CERT1 C N OF EXEMPTION FROM WORMERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for an hundred dollars 001 or lem.) I cand, to., in the paltiormaree of the work for which mus permit is owed, I shall not employ any Forms in any inabour m 10 bub,x to the Workers ;'�; Compensation Laws of California. Data -if"ja Apploan I --:: NOTICE TO ,,LTC �.m, me �Ih,�Co�fflcum .1 �Exa.lwn, you should I become subject to the Workers Com,pubtalian provisions of the Labor Code, you must fardowilh comply with such provisions or chis permit shall be deemed broker. CONSTRUCTION LENDING AGENCY I thereby affirm that them is a construction lending agency for the Performance aid. work Far which this permit is issued (Sea. 3097. Ci, C.) Lender's No. Lender's Address I certify this I have mail this application and state that the above information is correct. I agree to comply with of city and county onfinconan and state laws mining to building construction, and hereby intuarise representri afthis city to enter upon the idisax-inartiosited property for inspection purposes. (We) so= tosove. indemnify and keep oundects the City of Cupertino against I liabilities, judgments, costs and expenses which may in any way acerse against said City in myrat"inance of the gribuip, of permit. APPLANT UNDERSTA�P* AND WILL COMPLY WITH ALL NON -POINT Issued Date I, by: so VE ued � %=NT, 7-i(..0 0 Re -roofs Siga.&A,basontiscmiumentr Data HAZARDOUS MATERIALS DISCLOSURE I[[ the applicant or from Wilding occupant sume or handle housedem, manswund Type of Roof as defined by the Cupertino Municipal Code, Chapter 9.12 , and the Health and Safety Cade. Section 255321x1" oyes 0 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or boom building occupant use equipment.,, devices which If a roof is installed without first obtaining an inspection, I agree to remove nit hasnowits air contaminants an defined by the Bay Area Air Quality Management 'istrim? all new materials for inspection. Applicant understands and will comply with 0 Yes 0 Na all non -point source regulations. I have mad the hureardous, materials requirements under Chapter 6.95 of the CadfificonoitHealth & Safety Code Sections 25505,25533 anal I understand that if she building dot at ea..tiy have a tenant, Our it is my responsibility to notify the t tomipsom of din ousibersoma; which must be met prior in issuance of a Certificate of occAancy. . '7—recure of Applicant Date �1 coo All roof coverings to be Class "B" or better zee ,:nl Us. O.,zf, ruffirria Vrrm,=