00110140 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: !,
BUILDING AV]1(IfS3 ELDERWOOD CT J P ROOFING PERMIT NOL710101.it
OWNER'S NAMES. APPLICATION SUIT DA"'
HARRIS 974 KINTYRE WAY 1.1/:_9/2000
OKE•
(408) 252-0372 SANITARY NO. CONTROL NO.
,
aOO ARCHITECf/ENGINHER: BUILDING PERMIT INFO
F'.mFc� IILDG• ELECT PLUMR MECH
FF�j LICENSED CONTRACTOR'S DECLARATION
Z o'�a'a I hereby affirm that l am licensed under Job Description
p b—p Y Provisions of Chapter 9(commencing
pmC wimSection 7UfaUofnroi.ten: it it,Bteine..and Prot c,,im,.Code,and,,,,Icn+e SHAKE TO COMP
a y is in full force and a I,rt 1
�ie License Class c�
36" Date.A1 — CDDCCs,T
F` ARChalt he use DECLARA ION
1 unJelsnnJ my plana.hall be used as public rccoNelit RE ,
Y
i O O Licensed Professional'
OWNER BUILDER DECLARATION
1 hereby uffimn(lot, inn,sena..from the Cnn,crnt Co License city
, for the
t$re which
m, u- (Sea 7031.5,BI mese an il Rofe. s Code:A y e ry r county
r�F C wn h Peru,"
rni a consumer. Imo 1 demolish. p any structure
i3m art I e a sits y ,h- Balis It hPermit l TIy Dune nen
math Imneedp Iasi t, m pro n nnec ,rse¢nala (clmlan9 Sy. Ft. Floor Area - VaIn.Y.(p$yt'
me that he is eamna nererrsont it tle basis la,ihorm
lc•ed��adi.... An,valali s ia•a�0
of Sermon 7031.5 by any applicant turn penal,subject.Ne applicant)a civil 1'emiby
_
of I mote man Use M1uimmd.wllars(s5o0). APN Number Occupancy Type
OLas oldneo of the progeny,or my employees with wages as their sole compensation, =+5929018. 00
will do the work,and the.striven is not intended or offered for sale(Svc.7044,
Business and Profession.Code The Contractor'.Livers,law does not apply ,,an Required Inspections
owner of progeny Who builds or improves thereon,and who does such work himself ,.305 — FRAME
sear through his own employes,.provided that such ituprovements am not intended Lir
oncred for sale.If.howroer.the building or improvement is sold within are year or 3tb7 — INSULATION
impletion,the tremor-builder will have the huNen of proving,hat be did net build or
tnprmelmparno.eofswe.l. 601 — ROOF TEAR OFF
01.as conical the pmpert,am exclusively contracting with licensed contmctorsm 602 — ROOF PLYWOOD NAIL
Liinstruct the project(Sec.711 ,Business aid Professions Cnde:)The Contractor's
censee Lar.due,ma Elytianowner ofpropenywinobuud.oritnpm.esthem r. 603 — ROOF BATTENS
and who contracts forsuchpnjeru w;tn a ron,meoml licensed pursuant m the 604 — ROOF IN—PROGRESS_ Ax
and whloc ntiactse law.01 am victual miner Sec. .R&PC ror this reasonOwner Uwe
WORKER'S COMPENSATION DECLARATIONI hereby uffimn underpmmlty it perjuryoneof the following Jeclara,ions: ��
J I have and will maintain a Certificate or Conant n alf-insure for Worker.
Cunnpcnm,lon, as prnvidid Tor by Section 3700 of the Labo.Cndt far the
pe formm.ee of the work for which his permit is i...vd.
0 1 have and.,It maintain Worker's Compmn.sadna Insurance,as squired by Section '
3710 of the Labor Code for the rad mmence of the work for which this pa t is
issued.
-
ssued May-Workers Congemation Inwemce caustics and Policy nnummber am:
. Carrier:_.r.,fJ- r�f F%FMPI'IO I'N —00CERTIFICATIONOF ,
COMPENSATION INSURANCE
(This sermon need not IN completed if the permit is!Drone hu umd dollars
IS I IAP or less.)
I vanity that is the performance of the work lar which this panni)is issued,1
shall not employ vny Jerson in aa,amnner sen as to barman subject In the Workers'
Compensation lows of Calif rria.Dale '
Applicant
NOTICE PO APPLICANT:IL alter making this Certilicale of Eannp,inn,you should
Q 0 become subject tithe Writers Compensation provisions of,he LaMar Cale,you mina
torthwith comply with such pnwisisnu or this recruit shall he created revoked.
a VJ
CONSTRUCTION LENDING AGENCY
I^^ I hereby aRm,that them Is a cunstmeion nding agency for Ibdpeformance
W of the work for which this person is issued(See.3097,Civ.C.)
4 Q Lander'.Name
itis z lander..Address
U O 1 rectify that l bare mail This vpplimmion and state that the ahmve information is
Pcorrect.I a to coin II cit I snmv
0 f"s 1.buildin gomauction,andihereb ymorimrc rcammnes of dui.chem enter
-
r, -rerns you p y Pon
�s W ,he aM(We)agree
fee b ass,pumac for inspectionfyunkeep
p lna tic '
L (Wjudgnc,o.cost and expenses
hi lunatics,in an Cha it Ceproarm,against
i nt akol
wid
Z) liabilities,es,rean¢,roses rac inof which may in any way n¢ruc aguinm sail
C,1 z City inCANTlUNDERSTANDS
ND of,he granting of thispermit.
APPLICANT UNDF,RST NDSAND WILL COMPLY WI'fll ALh NON-POINT 'Ol r�,[
�S P Rlk�aL�ATIO' Issued by: Date
Fc_ — �' 000
gnmrc of Aaphcam/C ame6r Dam Re-roofs
IIA RIWUS MA'tL9B UISCLOSURF.
Will he applicam or fume l.,dding overrun.,am or handle Intonation.maledal Type of Roof
as defined by the Cupertino Munalpul Calc,Chapter 9.12,and she Hvahh and Safe(y
Corte,Section 255321x1'1
11 yet, ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfmure Wild,.,oeopem Liu:egaiparm or devices which 11'a roof is installed without first obtaining an inspection, I agree to remove
nit husnrdous air ronmminxns as defined by the Ray Area Air Qathly Management p g
.Arita' all new materials for inspection. Applicant understands and will comply with
°Y` ID No all on point sour re ations.
I have read,he haramous materials requirements under Chapter 6.95 of do t
California Health&Safety Care,Sec,iam 25505.25533 and 25534.I understand Thal p `
i f the ho ilding does not currently haven teMm,that i,is my m.poic,pil cry ecu anti fy the W \� �����
occupant of the requirements which must he met prior m issuance of a Cen iticam al V �)�
era an Date
ignature oflicant
riQ n tis orrsedsig t Data All root; Brings to be Class "B" or better
OFFICE