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02040148 CITY OF CUPERTINO BUILDING DIVISION PERMIT CON'T'RACTOR INFORMATION: BURRING ADDRESS: PERMIT NO. 22106 DEAN CT CASTO ROOFING 02040148 Oa1'NER'S NAME: APPLICAION SU DATE THOMPSON RICHARD AND RACQUEL E 1938 OLD MIDDLEFIELD WA 04�262002 PHONE: (650) 961-8922 SANITARY NO. CONTROL NO. 0 0 ARCHITECT/BNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LJ Z LICENSED CONTRACTOR'S DECLARATION lob Description i=0 ebony aRrm,M1mlam oftheasines pod Profsof sins apter Code9(commencing REROOF WITH HEAVY SHAKES w C. with Nation]000)o(Division 3 of,h<Buziness and Professions Code. dm license m g= is in Full fMc d CI{e_t. o:,scJ, < License Cla.. l:�-1 Lic.x > O� 3 Daw � 'CNL TTEiontna S DECLTIOFI NA. n u I uAdmsmnd my plans shall W used as public records an O Limr,ad Pm essmnal MAY 0 8 2002 x e" OWNER-BUILDER DECLARATION A,=w I hereby aRnn that I am exempt from,he Contractor's License Law for the F ta Following reason.ISec,ion 7031.5.Business and Professions Code:Any city or county �* xF O which requires a permit to construct.alter.imprme,demolish,or repair any structure p�' y 11 0 0 0 na- "prior to its isamnce,also requires the uppli4am for such permit to file a signed snmmcno - C7 -- thSLDIN t he is licensed puisu5n7,o Jr ,provs4ons of the Commet.ea Limn.Law IChaptcr 9 ,,.,. p1frnx�1 e,,.�., - (marrencim,wish,Saaw.:]000)of Division 3 of'he Business and Professions Code) � `' 1"'3'3-1/V9�9oS!�'�i i:J ;�. �''„ Valuation x.e.' O'Sec he'7031 rape m.y.pom and the basis for the alleged eiemptirm Any violation ' -a/Section]OJ I:S by eny applicam for a pemdt subject the apPlicanrm a civil penalry-, !ofinet more than five hundred donna(SSW). 3 0 6PN NPRh F 1•`q <''' Occupancy Type ❑Laswrnerofffi r" eny,ormyemployeeax5,bwagesasthd...1,compensation, 3 0 7 - INSULATION will,do the-overK:"and the structure is not intended or offered'for-sale(See-7[Fal,-, Business'.and'Prefessions Co601 - ROOF Tde:The Contractor's License Law docs not apply,o an Elt4uiak14nspect10n5" v SL:t r:'L. owner of property Who builds or imprmcs,hermo,and who does such work himself 602 - ROOF PLYWOOD NAIL or,hrouggh his Assn employens.,provided that h improvements q intended or to(fcrea(or sale If,howevertobola _. - -- g pro vigtha anon -)ear or 603 - ROOF--BATTENS mompinion the owner-builder will have the burden of proving that he did not build or ,....•i' prove for purpose of sale.). 604 - ROOF IN-PROGRESS - - 0 1:as ownerpr the progeny,am�IalBuss n Business d Praaisi with licensed:)Th C contractors,,o G I! .:!I L construct the project(Sm. appl IDU,Busies and Professions Cade:)The C memo's _"" ?�: License Law does not ki,-suytuan owner of progeny who builds or improves thereon, Vi it .and who.contnet fa-mch.projat withCon son LicenseLow. n , ._ .. _......... _........ _ OlameAp, dergee , - B&P ...___ C fa this :. .: Owncr'.,.; .' ..�..:�.,di :Date, WORKER'S COMPENSATION DECLARATION I haebyeRrmundcrpenh f g y o perjory One-fib dcclarationx: - O 1 had'e and will maintain.0 Ccnifica,e of Consent to self-insure for Worker's i, Campenami,m as provided for by Section'3700 of the labor Cade. for the performance of the work for wnich,his permit is issued. ❑1 have and will mainiaio Workers Compensation Inimm.Fe,ei;.j.hca Ey Scefiion 3100 of the Labra Code foe t f the work'fo— which Kelt `— suermit is d MyW Co nsa,on I L7,k! mance r nE Policy ter a.pe 4Yt!^ Poli ON _ Z 00 P. it' •' •r:. .. .... _. . . ;_11 _ _ .: .. c �t CERTIFICATION OF ONRROM.WOR S--S 1 r ,. 's , I ' a ^•� COMPENSATION INSURANCE' - '-' � • t fliton need not he completcd R on the permit is for e hundred dollars . ps. : jk. ..._ Italy or lax) t , ..... _ _... .�__�,._..._....._ .._._,._�_.........., .� ,( I ttmfy dot n N pe,fo ane it h 'Ark f h h,h pe - ed.1 shilI t mP1 y .y pc n any m 'er so t be me b)<aJ jlre Work<rs Compenseuon Lives of California Date -A,licar, .._... .-.._.. . . ...-.__--. .. .. _. _ NOTICE TO APPLICANT If haft r , NSC rt( , ofE p, youshId Z bati6nie sub] t the veMmeA Cou pori,ionjofme Uttar Cede you most - �;f..R-, loon N comply with such provision,-1this Permit hall e ded ok d. '--'--- re .. _._ .___ 'CONSTRUC710N LENDING AGENCY '. „ r , _ _ .... .' " I batch ri yAM.'that them a constructionlending agency for the performance' t of Me Is fee which th,p h is j.6 a.309)'Cv.C. - "' y:c UntilNme._.c. _........... ........ U!0 17. I cai fy that l have ad this inlific.1mo and state that the abovc,nformaion is 0; corrin 1 agree to comply with&I c,y Add county,ordinances And state laws relating s ,.0 to building construction,end hereby emhorixe rtpicainaMisa Df this city to enter upon �sTLI the abovo-mentioned progeny for inspection purposes., , .Fn:G IWb(egree to save:indeinhify and keep hamJcss th.1 Cary of Cupenino egainx, -lp liabilities,judgments,coat end expaas s which may,in eny way,accrue against said City mconsequence- of the granting f this Ferran. . .. APFLICA\'TLSpER$T \T9S ANiD N'p,LCOMPLY wTTIl hO\P 1 s P u'Ar0 �} Issued by: Date tg,a rc of pphcon owacm y / HAZARDOUS MATERIALSALS DISCLO '': '' Re-roofs Yfll'the iPplicm,t a f rare build iiy annpant stere hmielle ha 6ii mmenal As dcfindd by th C penmo Ma pal C de CM1 pre 9 12 d the H ehh aha Safety - 'Type Of ROOF_ .. ... .. _ __... Code,Statism 25532W `,I h c.; , e .5 atti __... S\ ppoccupant p ` All.roofs.shall,be inspected.prior to any roofing ina[enal being installed.._. ,�.r wmme Applicant orf ort budding oc pin,n.equipment m devices wnch, If a roof is installed without obtaining an'inspectioti;-I agi'ee.to'temove - nhersrdousair e tsmna, mde0 dbl,h Bay Aha Air Quality Mgement' Ya all new materials for inspection,;,Applicant understands and will comply,with t � �ho all tion-point source regulations ti '1 1 has.read Ne hazardous m t ala rcqu remit under Chapter 695 aP4fie '� "1"• ' ` ' C61/ora a He IN&Sarny Code Sea o s 25505 25533 end 25534 1 understand In,, it 6A bu Iding doer rnu Ally ve mom that it A.artrcspo tb1ty to notify am pow 9 to Issuen e of CenificeR or J- P Y . m o e rc ,rem nt; h mus,be m t or �^ Signature of Applicant P^ - Da ..-. -.. to n r r too app_gent r - All roof coverings to be Class "B"or better `' 'l . .': .`, - r: -OFFICE-...