01110099'OFFICE-- .. __.... .._ _.. __: --...
CITY OF CUPERTINO -
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BUILDING DIVISION PERMIT
- :CONTRACTOR INFORMATION: "
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BUILDING ADDRESS:
PERMIT NO.
22253 N DE ANZA CL
R E,ROOFING & CONSTRUCTI
N INC 01110099
OWNER'S NAME:
APPLICATION SUB DATE
RAYKOVICH, PETE
108 OAKLAND PL
11/21/2001
PHONE:
SANITARY NO CONTROL NO.
I
(408)925 -9995
u ARCHITECTUNGINEER: -
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Description
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I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
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with Section ] IHI[ ) afDivisian3af the BusinessandPmfessio�nlsCodGe .aGn`.dmylicense
REMOVE EXISTING 1 LAYER OF ROOF INSTALL
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Li<enselClase and ec4A 2
7lY �� 1
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Lic. p t 1
ASTM FELT AND FIRE FREE RUSTIC SHAKE - IC
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Dale
HITE 'S DEC
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1 unJersmne my plane shall used asp I' s
Licensed Protemional
OWNER- BUILDER DECLARATION
-
1 heteb affirm that I nm ex the Co,mdsCcs License Law for the
y
a
following reason. (Section ]11311, Business and
trim s.r Code: Any city memory
E S O
ova, demolish,
wh 1 q pe I t c .wet all p den of, h repair any structure
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prior to its I requires the ar. such file a statement,,
-
b . S Ft. Floor Area a uatlon
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rapt h I tl pars a i m to Provisions f 0 Contractor L L (Chops 9
Law
(cote rw g, nhSe t fDivo 3 fm Business dP f amasCohm
,7000)
that he basis
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or n exempt th reform and the for the alleged edempuoo. Any violation
- of Seminar ]031.5 by any applicam fore permit subject the applict nno a civil penalty
of not "lore than five hundred dollars ($50t),
umber ..,...,� Occupancy Type
❑ 1, as owner of the property, m my employees with wages as theirsole compensation,
5
will do the work, and - the 'structure 'is -not intended or' offered "for 'wile '(See 704di,
PIP A. - -
Business and Professions Code: The Contractor's License Law does not apply to an
307 - INSULATMpired Inspections " "' I -'•'' f.
owner of property Who builds or improves thereon, and who does such work himself
., through F emplye p n„p„ cot � mgea r
'',
-..- ROOF.TEAR OFF
offered ldnmr
building mpm vi Id within a., year of
ote dion,sole wee'
. the owner bu Werw will have the b Nan if Driving mat he did not build or
._... _._...._.._60.1_.. -- -.. .__._..... _. .....__... __. .. .... __ ---
602 - ROOF PLYWOOD NAIL " "
imp rrparposeofsl)
BATTENS
fthe property m-
Dlducr
lydcontracting with licensed omraetones
_603 _ROOF
604 — ROOF IN-?LIL,
he
cnnstrueLaw project (Sec ]044, Business and
ure Code) The
therom,
- '
License
License Law does apply to an owner erty who
property who builds or improves Thereon,
ves
.::.,
-f with
and who contracts fLasuch prolects.wilM1.a <ontmnorts).licensed pursuam m me-
Ce woof p
Cirri x<m r ndcrS "` ' B &PCformtr sons.
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Owner - Dm
WORKER'S COMPENSATION DECLARATION
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Vito
I hereby effort under penalty ofpepury one of the following declarations:
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❑ 1 have and will maintain a Ceni6cate�of Consent m self -immure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
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performance of the work for h h this perrti l is issued.
'
❑ I have and will maintain Wo ke Comp¢ li Insurance, as required by, Sect o
37W of the Labor Code for the of the for
performance work which this pnm t
My WoyktT'i Compensation Insuran r and Pol cy n tuber
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L. IPoI ITV b (
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Cain r .1'N cy No
- CERTIFICATION TIFICATION EXEMPTION FROM WORKERS',;
COMP SATION INSURANCE,_
,.:. • � .
.,p, permit is for one hundred dot
act need not be rote lncddthe tars
_..__.._ .. ._.. ..._.. .__...__._ _.._.. ___
($100) or less.)
ten fy thai in me Performs ce bf 0 ork f r hsM1 mis pe i _.
d7
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shhll note play any person to any manner so as to become subjeut m the Weekend
Comp¢ damn Lawsbf Cahfomta Dam " :
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Applicant .. ,. .. -�. •,,, .. ,.
NOTICE TO APPLICANT tf B .king th is Cnfcam of Exemption. -y should
m
.. _ .. .. _...
s bj a the Workers Co a smion p tons of the Labor Code, y u must
Qbecome
fonhw Ih comply with Such Provisions m this perms small be deemed revoked,
t-i
CONSTRUCTION LENDING AGENCY
''` I h by affrin that the a constraction lending agency fo the
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rr
pet-finnimince
which this permit Is issued sec 3097 Clv. C)
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- Lenders Name
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I cenif that 1 pplic t mad mate Inanh abo e' fomtation is
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correct Fagree to,comPly with all city end county ordinances and Into laws relating
to building hereby dmha:ize
construction, and reprcaetnetives ofthis city to enterupon
tbq above- memione0 porpeny for inspection purposes.
we kgiee to save; indemnify and keep hasmlees the City of Cupertino against
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'udgmeme, costs and expenses which may in any way accrue against said
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i"
City n con re of th gom ing of NIA pe t " `-
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APPLI' 'D AND \' 1PLY WITH ALL N N-
sou EREI T s-
Issued by: Date
�1 2llo
PP nUCn t t Date 1.
Re -roofs
S MATERIALS DISCLOSURE
-' wit me i 1 t r mm bola 1 I
pv g o ups t a re handle h a s s me
Type of Roof...
a: defined by the C p nm Municipal Code Chaps 9 13 and the H hh a d Saf ry
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Coal Section 7j5321
�� A'!", 11 e
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All.roofs shall.be in spected prior to any roofing material being Installed.
teed �1C81
r,. it tit or future bolding ac e m use equipment t a ana wit nt
mith vad s ontammat defined byte Bay Area Quality Bement
.
If a roof is installed without first obtaining an' ins action•,' I agree to�ramove
p g
Dia' oY
all new materials for inspection. ,Applicant understands and will comply with
_..
_
]lit ❑ -point source regulation".,
not as requirement ode Chal ter of he
q
It
Health & Safes Code Sections 25505 25533 and 25534 1 d
Y and that
-
Id doe note ea¢ne t mm t t b tf the
myrespo by9 Y
hch
...�,� /I ....
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0 ce of which most
9u stbemct no roissu fa Cc m r of
p
_' • L I 0
Oolifo
` .. cue
. -gnatu pphcant Date...__
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All roof coverings to be C ass "B" or betters''
'OFFICE-- .. __.... .._ _.. __: --...