02060010 CITY OF CUPERTINO " -
''.-BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21534 'CONRADIA- CT , .. ROOFING-KING INC. 02060010
WNER'S NAME: - - .. APPLICATION SUB DATE
,LINT DAVID W AND JEAN G 692 KINGS ROW 06/03/2002
. �" �• PHONE: SANITARY NO, CONTROL NO.
(408) 293-3618
qO ZO ARCHITECTIENGINEER: BUILDING PERMIT INFO
kL'kL"' BLDG ELECT PLUMB MECH
�� I.D LJ L-] I_-I
LICENSED CONTRACTORS DECLARATION
CSoZ r' 0. ;hepljy.Sl6sm thetlaml ensN un rpmviaonsafCh pmr9(commencing Job Description
F ;tidh3eeuo 700Wq(ONtmon7bfthe�Bu as And Preflo. Coda and my license INSTALLATION OF .SKYLIGHT
Ince w.#
Li nu ¢.11.'
Conwuas
'S D or
RA IO
ARCHITECTN
t—m 1 understand ery plans shall be used as blit records
3a"p O Licensed Pour..to.]
OWNER-BUILDER DECLARATION
r "4 or 1 hereby of irm that 1 am exempt from the Contractor's License Law for the
N < -following reason.(Section 7031.5.Business and Professions Code:Any city or county' $500 5 O O
n'S which requires a Permit to construct,cher,improve,demolish,or repair any stroctum $
wit
�.._poor to its issaane"so requires she applicant for such Permit to rile a signed statement -
tbat(t4is.li�n(cA pursu.milm��l1ttec pmvisim,of the Contractors License Low(chapi _ I r Agree/ M1, T a Valuation
(<dmmeeicimyaioI�Section,%OOrflr ofDivisionJ of the Rosiness it Professions Cade) fjs�'� Cj •4V Uf31�•.1-�:x xEl r` -
or that he 9s e'iemAi theYYefoi sad the basis for the alleged c ortiptioh.Any violation
-of Seetiam703 I;S by any epplican for a Permit subjects the it,lieant to a civil pcnlry tmDbe� Occupancy Type
ofne,more man five hundred do[ma($500). M
50n). 101APN ftATION ''-" • ' Occu enc T e
.01 as tvi of the p parry r my employees wall wages as their sole of m ...too
will d`the'wick,mill the'structure'is not intesdeabr offered for sale(Sec 7094; _- _ - - -
`Buim as'and Perorations Code:Th
e Contractor's License Law docs not apply to an 103 — UFER Required Inspections •l
owner of property Who builds or improves thereon,and who does such work himself
or durough his own employees.Provided that such improvements are not intended or __- 1024 - _ _-REBAR_„-___
-;g@rca'PoTieIe:If,however.the building oTimprovemem is sola'withinoneYof' '.n
completion,the owner-hulde,win have the burden of proving that he did not wudor 105 - ANCHOR BOLTS -
improvefmpurposeofmle). 106 - SEWER & WATER
q-- of Water - e o^- --.... 202 = .UNDERFLOOR PLUMBING.. - -
y 1;W.owner of the prnpenY,am exdusivelY convociing with licensed contractors m
conslmct the project(Sec.7094,Business and Professions Code:)Th Contractor's
License Law does no apply to an owner of property who weds or improves mcrcon, 203 — UNDERFLOOR MECHANICAL" . ...
,and.who eonwgsauch,Prol«ts wire a con_vect a)IscemsedWnua.LmtM. 2'O4 "= UNDERFli00R FRAME. -
ors License L+
l O I am xetnpt prior Sec B&P C fonhis reason
o nlr'+ q✓s `sp;te .''- 205 - UNDERFLOOR "INSULATION
.J ." W RKER'SCOMPENSATIONDECLARATION 3O1 ROUGH -PLUMBING
1.
302 - TUB & OR SHOWER
-1 hereby affirm unde5penalty.a Pnury one of me foowing dmlvmions:
ell303 - ROUGH MECHANICAL
Cl 1 ha.e'dnd'will"numnmin''a Cmilkete'bf conkeat to relf-inure for workers 304 - ROUGH ELECTRICAL
Compesuatios, as provided dor by Section 3700 of the labor Code; for the
performarce'of the work for which this permit is issued.. 305 — FRAME
❑I have mid will ininin worker's CompNisaiion'Irispstince,'all required lay Section
306 - HOEDOWNS
37W of she Lalsar'176dc,for the Pentecost of the-work for which this ,rinit is
307 INSULATION
ckarliCima
Ise M MY'WCPRTIPlCAT10N10F EXEMPr10 FROM WORRERS'I're * ..._.. .. . .."-._ . _..__,..« . .....:...,:...,__ :�...............- .
v u
s.
f.1, � IO XEMPTO : 3Q8.. -: 3SHEETROCK
r COMPENSATIONIN$URANCE „< " •' x '"r ' t36'9. BXTERIOR-' fATH I
_._N TNSURA .. - ........ -_. .............. 1._.._
310INTERIOR_liATH
"rr is
iectro+"need not be cmrr ied if the Permit for one hundred dollars '.
(s100)oe le a) 311 - SCRATCH COAT
vP pYr.rx y .• ra ad.-I - - -3 - -ROOF- NAIL. . . _: ... - .. -
sWR not ire+mnf that me r a,mummer
dto a mi nth m�lra I AL EliECTRICAL ENERGY
Q PNOTICNTO PPPWIIhANTIPfnfterDmakfn�'hs�ertanmlxa meareeo ..- .- 5 .2__ _ _p UMBING -ENERGY___ ._ ..._ .. .. _.
hntt W to bac object so the
Compensationly
visions
so our,y0 ould
Z bed shlct16theWorkers C pent provision.,
sion.,ofthI,=Codk must x A A4 .ENERGY
.z 0 ....._ _ . . -- ._ 04- - , F ILD -ENERGY;- _.... :.•,r . .:
hCONSTRIICTIONLENDINGAGENCY _ 05 N - IC Lr
l^ I hereby afpsM thvnhe v n i- t o d g agency f th perf.Tance'
7,t of me work for Nehmspe i, lssue4(Sea'3097 Civ.C) � - S 'I'- r
G I', ' heMer N m .' •' r ._ . .. _ ,,..._..i. -. �- __ - __-__5_ 6_ _
�,z L'eraer5Adercaa - 507 - FIN IN r,
U , r nMu•r, , a ,t .. , 5' _ 508 - FINAL. M .. . AL' V
s a 1 ten fy�hel I W e reed this apphau nand state mm the above
..It..is r -.
fzt (.w i!Unen 1 ogres to cpmPly wtM all 'ly a d co ntr nknan«,anQ.atme la s miming
enter upon 5 0 9 — FINAL GRADE r
O C.) io bis id ngc nt'ctio nOh by umh xe p 9enwuve of the ty m
�.'La7 ,the ebo a me t--W p perry f-inspenron Paryuus. 510 — FINAL PLANNING
'n--iL� I We)+gree io'a e and<mnify and keep naemT's Illi Cny of
coagato s
rr-W liahlm )udgmentx c sss and expense h ch m X ^^^Y. 4Y o tree against mid 514 - FINAL U C WORKS
V .Zi Cit rn conequence of the mn'vg6hhis'permit - •' T
AP LICAvru.' ERsr .D ANDWn:Lco�fhivwitNatY.NfS`pro Issued by: Date
sandle pphcpm(Commeor, . " rDare
HAZARDOUS
MATE ALS DISCLOSUR - Re roofs
, u
lit the apPlentmfutue<huildin c'p nt afore or he
adlehazardnummanvl . Type Of Roof_ _.. - _ ._. . .......... . :._- � ....... .
la'defirood by me Cal o M n c(sal c.Clarifier 9 13.ant Health and Safety ) f \ t
Code S u n2551 lal - t 1 1 - t �A
o
emtnuallo anntatre nt WaeB by meB�f,AeeaArQaltyMaceIa _ speetedpnst-obainingaingspectialbeinginStalled „_, ._
r All roofs shall be.m
W 11 thpapplic nt rfumrc w'Idingocc p t rem p t a via: n h If a roof is installed'without first-obtaining an inspechont Iiagree.to remove
D t et _ nt all new materials for inspection „Applicant,understands and will comply with.
t.. ❑Yes ,t t t ,,; :i all non=point source regulations: :, In •• .
if th pan,of the cc I men N mu t be met n ems under Chapttt.b ro of the
n
Occu c rmbmimhrc 'm Sl3 send 255J4 (understand that
luave
d the
-if theP,Wm d«s Safety
d h q is and
25534hliuytonmifythe
Cal fo I Healrcih&Sefe�sCode Sections�,2,5505 25or to issuance of a Cenihcatr of
Y
eeanant theist
P P
Signature of Applicant -
n5r P aathon:ea agent,' , ., , Dat. , All roof coverings to be Class "B" or better
-OFFICE