03020107 CITY OF CUPERTINO z# 'u«aa •y~!d> cfi* :���^ elx' vrd3i&
BUILDING DIVISION PERMIT WO,NTRACTQR T1,I<yURMA IQN:
BUILDING AOORa55: PERMIT NO.
22116 CLEARCREEK CT 03020107
ER•S NAME: PERMIT ISSUE DATE
JOAN HSING 02/26/2003
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT ,PLUMB Mac"
t�
maLICENSED CONIRACmR'S DECLARATION O
'r1 d 1 hereby afRrm dor 1 am licensed under Provision of Chapter 9(commencing Job Description
wlast,ction ) fDl,ii.n3oftha BUN ProfessionsCoce,andmylicensels
�❑ mmuromaaM e 3 REROOF
'0- seen ci Lr.•
Canuacmr T/O SHAKE/INSTALL PRESIDENTIAL COMP. SHINGLE
ARCHITECTS DECI ON srcltu LCC;S CONTRACTOR: FLORENTINO SERVICES
1uederausndmyplans NWIbeusedupeel =end, e
�] Licensed Profasalonal FINALE®
OWNER-BUILDER DECLARATION
.� I hereby affirm en I em exempt from cite Contractor's e:Any
law for the
In o fallowing nano.(Saban 71D1.5.Business and Pro(culuas Code:Any chy or county
$fLi which requires a permit to construct,a@e improve,d ormll uh,or rep Ir any structure
h, �^ poor m las lYYanCe,also mquimuhe applicent rmaaeh Permit to Nea signed saammcnt
ggg < that he is licensed pursuant to the provisions,of the Contractor',License Law(Chapter 9 Sq.Ft.Floor Area I
(commencing with Section 70DO)of Division 3 of the Business and Profusion Code)or
thathe is exempt therefrom and the basis(of the alleged exemption.Any visiNon of
Section 7031.5 by any applicant for a permit subjects the applicator to a civil penalty of APN Number e
not mare than Rw hundred dollars(6500}
El I,u owner of the property,ar my employees with wage as their wk compensation,
will do the work,and the sunwoure is not intended or offered for sale(Sec.70th,Business
w Profeulo s Cern:The Contractor's Litmse Law does not apply n an owner of Required Inspections
Propany who bWlds or improve lhermn,andwhodoessuh work himselformsough his -
owmemployees,provided that such improvements art motmended mo@red for ala 11. 3055 - FRAME
however.the building or Mprevemmut is said within one Sear of completion.the owner• 307 - INSULATION
builder will have the burden of proving dust he did ret build or Improve for purpose of
ask•)• 601 - ROOF TEAR OFF
❑1.as owner of the property,am excluivcly convecting with licensed eontrecmn te 602 - ROOF PLYWOOD NAIL
construct the project(Sec.7044,Businns and ProfeaNaas Code:)Tho Canusesers LI-
cuuso taw does not apply se an owner of property who bund,or Improves themon,and. 603 - ROOF BATTENS
who contracts for such projects with a eontnetor(s)Ilcenud pursuant to Na Contractor's 604 - ROOF IN-PROGRESS
LicenseLaw.
❑I un exempt under See. ,B&PC for this reason
or Das
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pedury oro of the following declarations:
1 Mw sad will msimam a Certificate of Consent to elf-iuun for Wmka',Campus- .
salla.,u provided for by Seedon 3700 of Ne labor Code,for W performance of the -
wofk for which this permit Is issned.
❑1 haw and will maintain Workers Compensation luurur e,u required by Section
3700 of she labor Codo,for the pcoormanee of the work for which this permit is lsaned.
My her',Compensation lasmusea caller and Pa n mberam:
.STATE •e^ vrab PolicyNo j .-02
CERTIFICATE OF EXEMPTIOWORKERS'
COMPENSATION INSU✓tANCE
ffhtssedion need not hocompleted ifthe permit isforo a hundreddullars(S NI)
m less)
1 cerdfy,that In the performance of the work for which this permit is ranged,l NNI not
employ anyperson In any manner an u m become subject o the Workers'Compensation .
Laws of California Das '
Applicant
NOTICE TO APPLICANT.IL aper making this Certificate of Exemption,you should
become subject n the Worku's Compensation provisions of Use IOM Code,you mesa
.J 0 forthwith comply with such provisioas or this Permit ahsil be deemed revoked.
z rCONSTRUCTION LENDING AGENCY
[•+ I hereby aRlrm that then iso construction lending agency for the performaras of
I>:> the work nor which this permit i,issued(Sec 3097,CI,.C.)
W Q Le lees Nunn
r7�, Lenders Add.
U O 1 ceNfy that I haw mad this application and mute that the chow Information Is -
Ifr eorteeL l agree to comply with NI city and county ordinances and rete laws miming te
O building convection,and hereby authmim representatives of this city to enter upon the _
W aMvo-mentioned propeny for Inspection purposes.
U n. (Wo)age to arc,indemnify and keep hafmku the City of Cupenlno against
tyT Ilmbilltles,Judgmcnu,cwu and cape
which may In say way seems against said City
V 7 in eansequmum of Os granting of this Permit.
F7 APPLICANyD BRCTA AND WILL COMPLY WITH ALL NO •POINT Issued by: Date
SOU EEO ATIONS.
02- "02 Re-roofs
S rtof pg�o u tar Das
x It' A�a 0US MATERIALS-
Type of Roof
"fired
u deRned by the CupeNre Municipal Code.Chapter 9.13,tab the Hulth and Safety
secuen gss3g(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yat [g No
Will the applicant or future building occupant on equipment or devices which If a roof is installed w' hour first obtaining an inspection,I agree to remove
I haurdous air conusminanta u deftncd by the Bey Arte Air Quality Management all new materials for ectlon.
District?
❑yes &u
Thaw reed Nchuardnusmaterlela rest ens undarClupter A95ofthe Califor- Q
Ile HcalNaSafcty a .S.cdou2555„g5533and]553J.lunnknsndthal(Ihe building '2^ 2(� -_ -3.
does not comen nwaJeoqR�pn4 met it is my respoulbillty redly one oceuP. of Ne
requlre t au ug he fdetpriorrolasaanca.facoelnu a y. -Signature of ApplicantDate
�3
Owner enc Gets All roof coverings to be Class r ”or better