02060100 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
eTJI LUNG ADDRESS: PERMIT NO,
21681 COLUMBUS AV MARCO ROOFING 02060100
OWNER'S NAME: APPLICATION SUB DATE
ISHII YUSUKE AND YUMIKO 43230 OSGOOD ROAD 06/17/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 656-6400
G O ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
I'--1 LJ I._- 1=J
Z 5 y i LICENSED CONTRACTOR'S DECLARATION Job Descri [ion
OZ- I hereby affirm that I am licensed under provisions of Chapter 9(commencing P
F_LAs with Section 7000)of Division 3ofrheBusiness and Professions Code.and mylicense REROOF
�H�J sin Intl torte an eq�4 LiOA c�o 29 fo f T/O CALSHAKE: RESHEET 1/2 "CDX &
O m 6 Licenx
a°i y D9C ° cDECLAf $ PRESIDENTIAL COMP . SHINGLES CLASS "A"
ARCHITECrS DECLARATION /
,g 1 understand my plans shall be used az public records
dO O Licensed Profesai.nal
OWNER-BUILDER DECLARATION
I hereby mb.Out 1 aexempt from shma
e Cuaor'a Lt...Law for she
C Z a m following reason.(Section 7031.5.Business and Profeaion Cash,Any city or county
E t=-❑ which requires a permit to construct.alter,improve,demolish,or repair any structure.
--Prior w its issuance,also requires the applicant for such permit to file a signed statement,
shut he,is licensed pursuant ra)hp porlil ons of the Comacmis License Law(Chapter 9 }G
(commcncip'ggwith5mion,�000)of DivisionJof the Bnim and Prpf�sa' ns Code) l' JI�YO::-ls`A ilii,Fr-DrItl'3:#Tial li. $gg��luation
."hot he it Lienipf thcrtfmm'ar,d the basis for the allegdi cemgbn.A^Y violation
_.of Section 7071.5 by any applicant fm a permit subjects she applicant to a civil Penalty Occupancy Type
'�nf not more than five hundred dollars($500). 3 5 6 APCi-NJatff`6g5 .,r,,
111.as owner of the Property,or my employees with wages az their sole compensation. 112233 I[lL.SS..77• v VV
will'do he rY and the structure Is not intended.,'offend for sale(Sec'101 ---- - --- - - - -- --' --- - - - - - - ,-
B nd'Dofcss ons Cndc'Th.Conuacmr s License Law does not apply t 305 - FRAME Required lnspectlons'1� 'i+ +• -
orr of property Who builds or improve,maim,And who does such work himself
through his own employeesprovided that such improvements are not intended or 307 - INSULATION
"-:offered for-sale.If;hbwevec the building or impionrieni ie sold-ulthinone year-of -""_-"-- ----' '"`" " '- ---' '--- '--'--------'--- ----- ----- --- -- -
---
completion.theowner-builderwill have the burden of proving that he did not Wild or 601 - ROOF TEAR OFF " ' >o- •
improve for purpose ofaale.). 602 - ROOF PLYWOOD NAIL
rope-- --- --------- ---'
Chas_..liner of the n,am eacwsivel contracting -------- ---- "
1IS,r r swithucen.ed,Contractsm 6.03- - -ROOF`BATTENS----,--------..1::;-ri --
cicense Chep sectISalytoa ownBusieroaMProwhonCale:)TheComnmors 604 - ROOF IN-PROGRESS
License Lew dines not apply m mj owner of property who builds or improves thereon. "•
. d :. and.who„commas forsuch.pmjcas with a.convacmr(5).licensed.pursuant m the
....._.. -. ____..._.. _ _.rope_.. _....
C t t a License Law. '-
OI ,.Pt wide Sa.
c- s” B&PCfar thin rmomIl„t,s-
- Q
I' WORKER S COMPENSATION DECLARATION ,I1�gp�f
-� have
d Kinn d K ItY of Pel rY rte ofaef 11 gdeclarano .-- ��s' -� p
❑ 1 have and will mmmnm a Cen rc t 1 Co "nt to self re for Worker's 2oQL
Compensation, as provided for by Section-3700-of-the Labor Code, for the �� 0 C
- Performance_7 , or to work forwhich_di peen t ed J
,J]IXh of theilLabor l'-Cud f the`peRormp` 3 f the work tar 8r-whuirad ich h thbpe`''i u
!'.a d.My Wrnkat C m t Insurance - - d Policy -hr arc n'1
w I'Mis,N .: 3'7/ �J1LDING
.-........._ _..._.__.. _-.._....
aI1 CERTIFIQACOMPENATION IINSURANC WORKER$(} 1., E "-�'I, � axlf i?-f �t�aT,\ ;\l y,1S.` ' ' �• '
_ 'COMPENSATION INSURANCE""�
s ,
...._..-.. ,... ..-_"rope... ............_.....-.-,.. __.. .. _ _rope
_.rope. ...... �....,.r_-._.-.............�_.�.._._.___-rope_._.-.rope_._
(This'xcrion need not Ine amn,ied if the permit is lm one hundred dollars
IS IW)or less)
. S -. _:c - - .. _.:: - --:_..__ ... _
1 c afY Ih a the perf ance f th k f which th Perim,'n invited.I ) ♦ < .: t.1; - -
h II n.I employ any person in ny ma Int as to become aab3ml t.-the Workeri -` 1 `!-
Connknaasion Laws of Calimmia.Dine ,
..Applicant . .. , ... . .. ,. .,,.
........
Z become subject to the Workers Coniparnation peavinionk of the Labor Castle. .0 mon
Zf6ruadldi comply wish such PmvisiOns or thin Permit shall be deemed invoked.
of th I he for which this'the coalman lend - -- - - -
CONSTRUCTION LENDING AGENCY
> - g agency the pert mance ,
� permit s steed(Set.7097 C'v.Cl -
y;G
L7;Z Larider”Address
I en fy drt 1 ba ad do appl c t n ad Itme that theabove nomination is
so
mply,with all Ctyd, mY ordinances ❑ rate l scion,
ng
r w so bubld g co t eJ p pcdty by
f bo p x t I o f thistyro pen
[. CL (W) gr! m indemnify and k keep theCtY fCDei .g m
V] liabilities.judgments.costs and expenses which may in any wayitknme,Again t said V Z-- City q ce g f
—0APPLICAM1T UNDERSTANDS ANDWILL Permit.
Y%kTf"AlXNON L_
OI T' t UA
soukcE RLGm.Atlons ..��, y ,. G/� jz Issued by: Date
Signature0(APPI¢ant/ContmcmoYl-�-;7--7'— _, ; Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '.
. irAII the xpplicaam oI tuil linsa t. indla: is minimal
TrYPeOTf.R♦o'lofs the
Cuiie Municipal Cud Chapter9.12,and the Health and Safety 1
by25 -532y)
_... ..- -._... . .. ............_-,....-., rope
._...._. .. . _rope - .._.
4p
_ Al] roofs shall-be Inspected prior to-any roofingmaterlal being,installed,
"
Will he eppl I lir t n ie g rpt use_q p nae w eel which
byth-B Bay Quality evicesManagement If a roof Is installed without first obtaining an inspection-'Ilagree to remove -
emlh N ammo t dfnd
°i" et - _ all new materials for inspection, Applicant understands and will comply with
❑Y i -- ..
all'non-point source"regulations
'1 h rc d ih hA'.
x rd m roti I eq ,rcments under Chaper 695'of th '
Cal fom a He Ith&'S fety Cade S coons 5505 25533 and 2553) 1 understandthat
dtheh Iding tirosnot cu dy ha atuna t Nat t
in rape ibthsym notify the - �_-1 --ter[— -
mcup t f th ,untent ms x Inch must be ®D rid in a oLa Cen Fcate of /1' — (I
Occ P y,� - 10
- fS� :� gnature of Applican Date _ - -
m own .ra.th.rxeeagc I 3 )
Data All roof coverings to be Class "B" or better
a
._-OFFICE. ..._... _. rope __.. _.._- - -- - - -'-- -- "- - - '