02090030 CITY OF CUPERTINO
BUILDING DIVISION PERAM CONTRACTOR INFORM ON: \
BUILDING ADDRESS. PERMIT NO.
10151 S DE ANZA BLVD SECURITY ROOFING INC 02090030
E APPLICATION UB DATE
W'
Y081Z MONTE AND THERESA TR 406 EL CAMINO REAL 09/x05/ 2002
HONE: (650) 595-1213 SANITARY NO. CONTROL N0,
a.O O ARCHITECT/ENGINEER: ` BUILDING PERMIT INFO
he BLDG ELECT PLUMB MUCH
N<J o u u ry
y i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that tem licensed on er provi'b"' f Cnepmr 9(commend" Job Description
with Section 7")ofDivfsfon3ofm=B zx.Z11rofasoi°nsCoOe, ad my license REMOVE EXISTING 4-PLY CAP SHEET/
< E mlru and �et-. �9 INSTALL NEW 4-PLY CAP SHEET
a:asad:� Lose O a O Dart tract cFINALED
u 3 t=y , � / ARCIi1TECES D RATION
IOndlestaM my plant shallbe used az u he records
pO Licensed Professional - OCT 0 3 2002
is:
m OWNER-BUILDER DECLARATION
°- I hereby chino that I am exempt from the Contractor's License Law for to
w'"v
fall g reason.fSection 7031.5.Business d Professionso Code Any city or county
3_
which a permit t t alp demolish.or prny structure
to .s Irre:thpptf 'uhpcmit rite statement,
-n �'� NG
matoI n Ldp rxuhitotep I ons of the Contractors License Law , xl- o
mu � } iHq. iG,tFlr-ArWoValuation
aef thfroiand the bass for the allegs"sorption Any violation . xar
of that he is .
.....
of Scotism 7031.5 by any applicant far a permit s.bittb,hc ap ----a civil pcnahy ,,
of ArtmrcAPN Number nthanevehundreddo[[...a50% , Occupancy Type
❑1.asowner ulthe pro'
peny,ormyemployees wiinwagesaameirsole compensation, 305 - FRAME
'will'do,he work]°nd me swmo t is not imendea'or offered for sale(Sec:76 , _ 3 0 7 — INSULAT I 'I�:S'
Buxides.i and Professions Code:The Contractor's License Law does not apply to an QAuired Inspections� - `
owner of pmpcny,Who but ld%(it improves thereon,and who does such work himself 601 - ROOF TEAR OFF
or through h pl er .p 'd d thus n p tents t i Jed o
cBaeaf ,th IThr- m Thad g improvement la tfi6'one Wild
of _ �""' -- - -
602" - ROOF PLYWOOD-PLYWOOD -,I• �"'"
•
improve
Con,the owner-builder.). will have Inc burden of proving that he did caw bu Id ser
improv=far purpuxeacal=.t 603 - ROOF BATTENS
_..._..__604------ROOF- IN=-PROGRESS'-
❑I,as owner of the property, exclusively Contracting withlicensed contractors to - 1
coruwa the project(Sec.7044.Business and Profess ons Code)The Contractor's :,, r. a-, i a •• ,:
- - License Law does nm apply to an owner of propeny,who builds or improves memon, -
f' �C ._and who-osmrmn.fm.zuch Pr°l«¢.with.amntra=turts).limnscd.pursuant..m.thc. .
Contractors License Law. 0.W I .+o r ,
._.� ❑I am eaempt under Sec'.' '.... 1B'&PCfonbis rcuon 1,"?
.. :1
Own
el•. •r 'Dote
-'< '•WORKER'S COMPENSATION DECLARATION
-�� - IherebY.aRrm under pewltyofpcdury one oflme.followin84darati°ns:-
O 1 have yid will'maintain is Cen;fic5m of Consent to self-insu,for Worker's
Compensation.-as provided far by Section 3700 of the Labor Code, for the
perfamampi of the%ork for which rhes permit is issued.,, ,
01 hove and will inintaiu�B•uikcr i Compensation Insurance,as requited by Section
3700 of the Labor Cob:for the peifmmmice of the work,for which this permit is
issued.My Workers CoWpenkodion Insurace carrier ad Policy ranother arc., %
Ca ttJIC�C !s, , Pot cam(.' "I D�1310Zi -- - l .-.,_...�_.. ... •- _,. _
......_ ".. Y. __.
I ( CERTIFlCATIONOF EXEMPTION FROM WORKERS " " f.i)1 4_`s.s l� e.<�i. :y f`i_i;•I sq,�:, � :�;'Y: �'l"" 1'1
COMPENSATION INSURANCE "a• P "
-,�.-..i-.�.0...........: ..... .r _.n..._+..
io`n nccil'noi be Nomleied if the
p permit is for one hundred dollars ` ,-'• t`i G;'li)i' r .'..i:'c'i C.L.:OI;LnCi T::I:r
' "t(Ifiis:ect
•(5100)°r less.) r ( .
pert,f)mtnaa sin acarto rkf hchrl permit s .s dl „+I
'enzll t employ anYof r any mann n ai m become mbjcct m the Workcn C. Lfs l' .'
Compensedon Lows of Calif°mia.Ohte;-
.Applicant.... ., .. . ,. ... -. ..
`NOTICE TO APPLICANT 1.atter making
.. .I_ Certificate 1 E p you should
Itl
zhm !' the G wpons of theLM CW yuo' tOph uhetumPr 'm
- - - ,
is peoppit short he
- -' -----"'-'-
� `" i CONSTRUCTION LENDING AGBNCY doomedresulted.
,
a. ' ' Ih by`B"' thm tb strut Ica g'agen<Yf th performance
W-Q -Lend N fu h eh th pe i s. cd(S 3097 C'.'C I
ti m k
.7:y Isnd r Add .. !'•L' t .
��, It carr moth am ppT t e t t m me nu r at
[L Fs cam t l g m e mply th all c ty d iy N' a c I t t rel!ng
�1 orb Id ng t C dh by' tti p idt e.of lh cetyl
[r-,VrteEs1t AtHhaPebpiWlb t C(W1)emggU.•N
(reDmmEds,R'.p c TpAte N gtyd,edSfm oA dpyebpn w�cacdit ILk,cnL ehep�pCoOhnh 1 t
ImPlLzeY s n Miuh'nRCH iAy L•�fLI c C NC/,O3ca-LNmet upon
sipa`r'"
t aidV z cas
,
80 it ULIS5OYT
0IS,S'U.'e;d'aeby
e A
D'
*
_
came of p1ic AC RC-roofsHAZARDOUSMATpx CO
Will race a�f=stnorri Wildingoccupant
ccutstorc n dlen adm mateal Type of-Roof_a def of byh (rt M
n22rec wIP ] aoa dl Healthd5 fnycm sosJpo
UY=
_
All roofs shall-be mspected prior.to any too fing.material,being.installed.-...
Will'he prolit econ t r mrc bu it pat equip l devices can which If a roof is installed'Without first obtaining an ins ection," Ilagree`to'remove
e ;i ha aid t t. . def by th B Y A A Quality Management g p
.°Writ,?Ytt -_, ,I - „ all new materials for inspection. ply
-Applicant understands and will cont _with,_
all non-point source regul s t
of I
have read the hazardous material requirements under Chapter 6.95 of me -
Celifom a Health&Safety CM Sections 25505 5531 d 25534 1 understand that
if the bmld g does n=Iya,� t that us Y iesponubdny to mufy and --- - "'dr,Wof m requior t poort tremor%ofil CenRcxteof. .. _ _U Z . _ nature of Applicant._.._ ._ ate.. __.
:E' n or aumorizNe cm".`) - "-
g All roof coverings to be Class." 'or'better .
" -.' .. ... _ OFFICE
t Hof