02040152 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7552 ERIN WY OLD COUNTRY ROOFING 02040152
OWNER'S NAME: APPLICATION SU DATE
URGUHART THOMAS AND MARGARET A 387 UMBARGER RD #B 04/ 292002
'HONE:
(4 0 8) 362-1111 SANITARY N0. CONTROL NO.
O z ZARCHITECT/ENGINEER:
O O BUILDING PERMIT W PO
z-' BLDG ELECT PLUMB MECH
y a LJ C_I L J L__J
2 LICENSED CONTRACTOR'S DECLARATION
ZK- tlOn
mIhertbyaRrmthalamlittnscdundcrprovisionsolChaper9kommmcing REROOF Job Descrip
Ew wah Section 7")of Division J oflhe Bminexsond Promrfc" ,Code.au
nd my luen
xs= isMmurnrtemee araC 3 / REMOVE 1 LAYER OF SHAKE, INSTALL OSB,
a c< Liam Claaa Lir.e
uo ' u Date o emamm° 30# FELT & ELK 40YR COMP .
C ARCHITECT'S DECLARATION
Y I 1 understand my plans shall be used as public records
z p p Licensed Profc.uional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 1. exempt Iron the Contractor'svCoa Any a Law co the
c'Z 0 following re>a anon to
7031.5 Business and Professions Code:Any cm or county
zF O which its iirn n perm.ra conswn.alter,improve demolish,or repair any stammer,i 3 x priori is ss arc 1 q he PPI cam for such penmu fl a.grrcd t roma t
Nathe s1i. sedW amledK ofO o sof the he
B.,irrx Lear uLo (Chep 9 S Ft: Floor Area �J.r1
Icon g 'Ih Sation90D0)oI D' n3of the Bus nasand P f bsCod 7 , ,�v lt:t�9'1 ,.,x '! 1 ', t i'._Ll' $7 Y190tlon
or that he is cxcmpt therefrom and the basis for the alleged exemption.Any violation '' -'
of Section 70315 by any applicant for a permit subjects the applicant to o civil penalty
far not marc than five hundred di llam(S500). 3 59PTib113r0e0 0 Occupancy Type
❑1,as owner of the property,or my employees with wroga as their sole compensation,
will-do thework.-and the structure is not intended or oRered-for late-(Sec:
rBusines,and Pmfessinnx code:The Contract.,I License Law docs am apply to an 305 - FRAME Required Inspections'°)='
owner of property who builds or improves Iheeon,and who docs such work himulf 307 - INSULATION
or ofpciiod h his own employ's provided that suchimprovementslaofare not intendedor or _ _
completion.
for role w how thewill
building e ire en of Prov s sole w thm one yea of - -" -TEAR -- -- -
601� _- ROOF "OFF
compleion,the If.
bu Idcr will hoc the harden of prov ng that he did not bu Id or °�'� � - '.J-..<0
improve for pimpam.fsale.). 602 - ROOF PLYWOOD NAIL
---- __ _.......603 --ROOF _
coLasowner pmpcnyomadusrvdy of Ii Code
Idmntmaorsm ------
conxwcllheproject(seo.]03a Business dPrurexs�onsCnee)TneComment's 604 - ROOF- Llccnle ICw dace not apply t en own.v of propcny who builds improves thermn, IN-PROGRESS. C cC'
endxbo c' mcs fosuch projects with acomaors)licensed
pumuam.m the ._ ----------..- ......... ....... ..._ ......_.. -...--:__-- -
- Contmemrs Lcense Law. ,. - _.__..._.
❑I am exempt under See'-' ": ''r.. ;B&P C for this
__ ' own Dam-
:r
WORKER'S COMPENSATION DECLARATION nII
- _ 1 hereby aPrm under penally of perjury one of,the following declarations. �' �r
ED
y. 1 have iM will moimiin 4 CcnifSection Conant to uLabor for Worker's �o o�
sf o notion; m ark providedforby Section J]00 nr the Labor [Mc.-for the MAY 0 9
pcdormonce of the work for which this pcnnil is issued.
❑1 have and 11 imaho Work - Cotnpmxmiin 1 s rma,a req red by Seci n
3700 of the UIxaFCaje,for Ne Performance of duc w6H,for h ch thu,pemut Is ed My Wo k/ Com section 1 mote c nd Policy n bar are BUILDING� /.::
Camey 1 �r-Po�fgn /�'y5�la s ._ a- , - - - �.-
_._ . __.
'
_COMPENSATION'NSVRANCEr"-'-' r
ITh uaton need of bee mPlcmd if the Permit is for one hundred dollars " v'1�' •' I' AY:" x `TI l � -.�__..
- .... _ ..._ ._..... ..__..__-----_.............e..._... �..�...
1 Cannily that JI performancef Ne A fah ch th pc us sued'I i; t,; . : 1
ihall a ploy any pc y c so i hecomd
cans b)ev t the Workers ,' '
Compensation Laws of Cal Tom it Date n '
-'Applit.._.: '.._. :_� `, ..
I NOTICETOc,mrdm ANT If after tame glhis CeniOcam of Exemption you should
-' ---- -
bdd'ome s bl t io the W k t ComMn t n prgvs ons of the Labor Code.you must
i
0 Q fonnwM comply with such provisions or Nis permit shall be deemed invoked.
.._ _ _._ _. -. .. _ ...._ ...
i' CONSTRUCTION LENDING AGENCY -
'"" I
bomb' j•aR lh t Ne a construction lending e
g 6encY for the pert rmance ,
r oldie abbhNspertn us ssu d(S J09];C C)
dttNu
Lis
.7 z L de sAdd s - • .... ._ ...__ ...-._.
U O _ .. - -c.-: ... j _.. -....
Ic<nfylh"hverdWs appl 'ton and tmina,the above information is
IT+ F cortca 1 eprtt
'a
'amply with all city and county o d nc d stat laws relating I
u Io build g onsmmtumiand hereby aahoriie reprcomaives of this city to mom upon
�e Ls7 the abo a toed property far inspection purpous
E.c (Z) Mjudgrcnts.eve, and dy mtl keep halmiss N'City of Cupenloggaioa
h liabilities.judgments.costs and exPe wh ch may n y way aceagainm said
V.z City in consequence of theg Ing of the permit •
PLICANTUNDERSTANDS AND WILL COMPLYu car Arsons I %YTTHALL 1 ♦POL\T
Issued by: Date
.iB.::r i°. PP�cmV ontn2mrc,
HAZARDOURe-roofs
S'MATERIALSDISCLOSURE l l
'i;'WIINe epplicanPor boars ldingorc pat tore or Hanna na,;mmaterial ., ..Type of Roof:..... ._._.
es defined by th Cupcmw M me pal Code Chaps r 9 12 and the Heahh and Safety - - - - - - - --
Code:,s❑cYon25532(q .' ;Z ... -- r..
Allroofs shall be.mspected prior to.any roofing.material,being installed—
gain
nstalled— _
' worn pplcmt f t�renulding'ccupa t uequpm t rdc areswhich If a roof is installed without fug first obtaining an'ihspe Ftion;Yagree:to'remove
mit haurdo s c t m a t a d f ed ny Ne B y Arca Au G a ry M game 1
D strieiP all new materials for inspection._A Applicant understands and will comply with
4 'a❑Yesi .'.e t '. .., i - pl?l _.
all non-paint source regulations
o _ ,. p or m usuenc o f C n Bc �e ::
tan
i 1 ('r •• .
f Ne 6 Id dos nes-urea tl ha c lenmt dw t s res n bd 1 Io f at
tn t
Va iraments W h ua be t thhe
< «<u m e H IN&S fn C de Se tions 25505 2553)aiq 25534 1 u dersde of
he x read Ina.huardms mete elz req rtme u u dei[ha¢ li 95 of
y
B Y
_Signature of Applicant
D
,. -- — ._. _ ate
G i1Cr a Ih m ..-. - .
g_.
I.
y. Date,,,
All roof coverings to be Class "B or better
--OFFICE'—