01010026CITY NGmy SIONo
BUILDINGNPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
1.031.2 E ESTATES DR
HOMEGUARD INC
PERW,
I]. 1@@26
OWNER'S NAME:
DAPAGIAN RODNEY E AND ELIZA
ET 51.0 MADERA AVE
APPLICATI N BDCTy'
PHONS:
-.
SANITARY NO. CONTROL NO,
(408)993-1900
• ARCHITECT' ENGINEER:
BUILDING PERMIT INFO -
BLDG ELECT PLUMB MECH
O I� IJ
LICCNSCI
r I herchy al rad that Ila CONTRd under ....ilio.... RATIof ChnNer 9 (commencing
0
Job Description
with Section 7111X1) fDlvisinn Sof lire Business add Professions Codc,smd my license
iafwlrnreeaneAcr.^�_— ��q ���
License Class �•—^--rr•7�``11 Lic. X_ //CC��
'
OVERLAY COMP TO COMP
--dam`
Uafe Commcmr
ARCIII"I'ECr'S DECLARATION
jI undmomtd my plans shall he used as,amid records
'
i Licensed Professional
DECLARATION
OWNER-BUILDERim
..excitfa Law for the
I herchy s(Bmr. thus 1 um exempt farm he Gnnlon, I:
followingarena(Semon 7(13Lo Businessane Co A.,
Code: Anycity
m.deionc
i whim, stmumy
isunpermit to nmewn,pplicimprove.h rapine any mmcture
arca
its Carmich,
s
plat eco,od amsoregnithopt ppla,ffilesneho,clue mtilc x,ignNswatent
hosts is
(flathernectio eimeprf
of Cnmmpnesl iemmo L:ssiom; pod)
S Ft. Floor Area
q'
ua tion "
Diviroof
(commencing exempt
Section om and
and prion. Any
Ithe basis o The alleged li Code)
thcnimm enJ the basis for the alleged exemption. Any miolmioa
or toms. 7
$4 5��f
O
31crept
of Secdom than Tiby m
the doesi vntforarc0). subjects the applicant maciril penalty
or ret lin°a man eve nmwad dmlmm (ssoR).
- APN Number
Occupancy Type
❑kasownerolmeprollCamyemplyeeswithwagesaxmeirsteatoptammion,
36907021.'00
will to the w(rk, call the .elmclure is not smarm or nRead Ibr rale (See. 7044.
Required Inspections .
Radicals and Profess inns Coda The Comr cou a License Law docs not apply m an
corwrof notal Who build, ar imPmvc, dons., ad who does such work himself
3@5 — FRAME
or through his non employees. provided that such improvemenrc ts anot Intended or
offered for sale. IL however, the building dor improvement i, sold within one year of
307 — INSULATION
completion, Inc ownerhuildcr will have the burden of proving that he did not build or
improve fill purrynecloda),
601 — ROOF TEAR OFF
111, usnwacroihepnmarf..tin:excluotelyco..reatingwill lieemdedcmnmclorsto
602 — ROOF PLYWOOD NAIL
masrvctw
the pmjea (Sm. 7(94, ImAnea= and It fcaer°ns code:) The Cannot lnr'.
dom
License Lacs not apply an r re
owner of pottery who builae or Improves thereon,,
. 6@3 — ROOF BATTENS
and who cmnmtara for ,nen project, wire a contmctoex) licensee Par, On
Comcmrs Liman Law.
6@4 — ROOF IN—PROGRESS
❑ 1 am exempt under Sec. If & PC Ibr this rensna
Owner Date
WORKER'S COMPENSATION DECLARATION �
I homily Cartoon under. penally ofP jury one of the following declarations
/�
❑ 1 have and will maintain a Certificate of Cnmcm to ,Lithe, for
/
4.0/
Sare
Oomoicanu ions, a provWm fin by Suction J7tln of the Lnbnr CsMe, fior the
for the
porfnrmwuro of the work for wnicb Ibis or it is isxncA.
atr
/
❑ I nave and will maintain Worker's Compensation fral mace, as required by Section
3700 of the Labor Code. for the Performance of the work for which this pemut is
ismed. My Workers n Insu ace carrier and Policy number arc:
qCompmeadi
carrien�{LF L(g Kli aY No
Cut IFICA'I'ION OP 8%EMPfION FROM WORKERS'
COMPENSATION INSURANCE
..
(This section need not M completed if the Permit is for one hundred dollars
($100) or Ids)
I certify that in the perfornanum of the work for which this permil is issued, 1
shall not mnpluy any Carson 'fit any manner s° as to become subject in the Workers'
Comlrcmat inn Laws of Cali ban in Dam
Applicant
,
NOTICE APPLICANT` IC ufmr making this Ccrtihcare of Exemption, you should
become subject o the Workers Compensation Pm emions of the Lids), Cale. you mull
forthwith comply xith ouch provision, or this pemoilahall he strand revoked.
CONSI'RUCT'TON LEN ANG AGENCY
I Term, from shut mac is it gonane lording smoey on fire pcffimnanre
of the work for which his pennh is ismed (See, 31X97, Civ. C.)
Lender's Name
Lender's Address
1 certify that 1 nave rem[ this apI licinum and nae that the atone information is
a
correct. I agree to comply with all ci ly and county onto maces and state laws refiring
to building Conon colon. and It,, rhy aummi o tcpre,ematim, m'do, city to ether upon
the share.rm•m finned pmpeny hit mspenion ambo ,,,
.
(We) agrce to dove, indmnnify and keep harmless the Cityof Cupertino against
'liabilitin, judgments, casts and expenses which Co., in any way u mue against said
'
CirY in con.uyueree the grvni og oft' nit.
AI'PLICA UN AND A' IL COMYLV WRH AEI. NON -POINT
SO EO' TON.
"
ISSUCd by: Date
—0-L0
-'cr
Re -roofs .
s1 C� raga Pan
HAZARDOUS MA ERI S DISCLOSURE
wnlbe appheaal nr wre nadamg «ap:rm sracahamim naardnas rmredal
Type of Roof '
as do Inert by the Cupertino ciPal CMa Chaprer 9.12, and the I leahh arta Safety Section 25532(x)'! no
°Yt, N°
All roofs shall be inspected prior to any roofing material being installed.
Will 'ln'°Pplicantit, Cable ha°mngneaalntm use equipnlemmdedae, which
haeuNuus
If a roof is installed without first obtaining 13 on, agree an inspection, I to remove
emit air mnwmin,lply xs d=tincJ by the l3ay Areu Air Quality Menagenenl
Dixtrice \j�
all new materials for inspection. Applicant understands and will comply with
1 0y. NO
all non -point source regulatio
I have read the h riankl lx materials requirements under Chapter 6.95 of the
\
California lleahh&Safety Code, Sections 25505, 25533 and: 5534.1 unJenlanJ thvt
'\
it the huilAinocs ncrmrcndy hnvcamnimt. that It is nxy r=,rynnihllity mnolify tlm
- id
I L
- D —D J -oo
rc ,ants ren n rig m uwancc ill' a Cenificmc of
t
e,1`W
Sig azure of Applicant Dale
rooe.edag=nt Date
- All roof coverings to be Class `B" or better
OFFICE