01030006 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINOADDRESS: PERMIT NO, a
10785 W ESTATES DR EXTERIOR SOLUTIONE 01030006
OWNER'S NAME. T A Q SA-0 C. APPLICATION SUB DATE
FFP4E1{4T JOHN 1771 SMITH AVE 03/01/2001
PHONE: SANITARY NO. CONTROL NO.
(408)358-1233
Gp-JO AHCIf1'rl?L'1'l1iN(ilNliliR: - BUILDING PF.RMI'I'INFO'
Ivi BL ELECT' PLUMB MECH
,ak t✓� o u �I
Z S N= LICENSED CONTRACTOR'S DECLARATION Job Description
°a_ I hereby affirm that I am licensed under pmvi%ions of Chapter 9(cnnnnencing - P
l:,Hk with Sectio.70 NB of Uivision3ol'thc liusiness and Pmlessinns Cole,and myllcenm
nmufn,a;mnemet. q_ I. .»_i �l03$, REMOVE ' 1 LAYER OF WOOD SHINGLE.
Eo u is in fall
coo, �.
SmCnmcmr Fyrp.,.Ql�
sLL� ARCIIITECr' DEC ARA'I(lN StAt�uTganLti INSTALL 30 LB. TART 7/16" OSB A 30 Y
I uwersnnd my plans shill he..wd as p.nhe reenmh
'`—co Ltren.ed pmfe.mnnal CERTAINTEED.
OWNER-BUILDER DECLARATION
I hereby mhnn that 1 It,cianni fr...a the Cnmmcmr'.Licehue Law air the
it z< litllowin8 rahmtt,Genian 911115,I{urincha unit Prnfessloms Code:Any city nr county
f q which mryires a permit to conswn,alter,improve,demolish,or repair any stnicmm
i3� prior to its i"mence..Fmn,,do.the applicant bonsai permit m filensignedstatement
that
he is licensed punuanna the prow"inns of the Cathartics License Law(Chapter 9 .S FL FhFeer Area pp__ Valuation
(commencing with SeOmm]WBof Division 3 ofine Business and Professions Code) q' 40,4E
ar that he in exempt therefrom nnJ the basis for the alleged exemption.Any violation ZD
of Secnion 7031.5 by any applicant horn permitsubject the applicant to a civil penalty
of not mom than live I..aimed dtmam($501)), A Number _ /OccupancY TyPe .
❑l.asownerortbe propenri nnny cntpinycev who wagm ns their sole cnmpem:nion, 2
will do he work,and the rmnure is nut intended or mTe..I far sale(Sec.9044 -
Business and Professions Code The Contractor's License Law does not apply to an Required Inspections
'cher of phourow perty Who builds or improves thereon,and who does wen wink himself
or -
n mm.gn hisnwn employers..prosdin that such improvements are not intendedecar or 36923031. 00
offend for sale.if,owner
-mul a the building t e l impmvenman is that within one your or ,
completion,the nwnenb wile.).
will have me NINen of proving Pm he did not buildor
Ell.a,e wn par nhr Fampee.>. 305 — FRAME
❑1,us owner of the property,am Holmevely d"mowing with liremcd nCounelom
enrmmn an paw oejen(ser.yto a owner of and erty who ctdeo iThemproves ves tmnac, I NSULA'f I ON
Lim whnseo
contracts
ot applyfor such
tun nwnrnd a contractual
win halide or seimpmves thio the 01 ROOF TEAR OFF 57/
and who Livens for.wch pmjcers with u rnmranurtA licensed pursuum m the
oIam`exe pht`underkSee, .B&P C for this reason 1 .1 ROOF PLYWOOD NAIL
Owner Date E, 3 — ROOF BATTENS
WORKER'S COMPENSATIONDECLARA'nory 6�0�+ — ROOF TN—PROGRESS
1 hereby affiant under penalty of Fc jury one of the following decimations:
❑ I have and will muinmin u Cenificme of Conserv In self-insure for Worker's
Compensation, as provided far by Section 17M of the Luhor Code, for the
perf namr,e of the wick for which this permit is issued.
av -
he and will mainmin Wader's Comped,und Insurance,as required by Section "
In of the Labor Code,for the performance of dw wnrk far.)men this pemtit is
A
0p`
Iya d.M,Wkis�R,p,, li�nitt�� cooler and Policy nmbhu
uer e:
a�itiFiWG +S %C`cmcl7 .
Curden_t.V$.- co. Policy N.,
CE RI'I 10CATION OF;BX EM"IO �L34eg���/ .
' N FROM W R ERS'
COMPENSATION INSURANCE
(This Icellan need nog be impturd rd if the Permit is Annie hundred dollars
($100)or less.) -
I cenify but in the performmtee of the wnrk for which this permit is issued.I
shall and employ any person in any manner w as tit becmne..hien m the Waders'
Campensmion Law,of California Date
Appueaat
NOTICE TO APPLICANT,If,anernmking this Ccnihatteof 17 ptiniyoushould
-
bo,mor nmjr,l to the W..on's Cnc ircoha0on F, info nd he Labor Code,you n not
Z
0 forthwith comply wim,.rh pr.,i,ion.nr this permit Shull bm
e retired revoknl.
CONSTRUCTION is
construction
LENDING AGENCY
' I hereby%firm that Vert is s chroman.lendingCo,agency.) for the performance
W of Led work for which this permit i,issued(sac.309'!, v.C.)
Q Lender',Name
z Lendeca Address
1 cenify That I have read this application and sola thin the above iaft urnunion Is
kT t-, correct.I agree to comply with all rily and eountr oNiinimns and state laws relating
Q f, mbuilding corowction,and herehy authorize represemmbesof this city to enter upon
W rhe shone-men ioned property fur inspection purposes.
0, (We)agree toime.indemnify and keep hacule.s the Chyof Cupeninn against
Fr [n liabilities,mlgnsenm,costs and espeme.which may in any way wrote against said
U z City in cnme,Wh, enfthegmmin• d i, n
.-r So, ICA U lEN ' WITH ALL?ON; IN'/ SSDed by: e �4
Sig ApplicaMCnmmator Ll n:e' Re-roofs
are HAZARDOUS MATERIALS DISCLOSURE:
N511 the applicam mfume buildingoccupant mireor handle hazaNnus,maim Type of Roof
I defined by the Cupertino Munici I Cale,Chapter 9.12.and the Health and Safety
Code Seniun 25532(x)?
0y" All roofs shall be inspected prior to any roofing material'being installed.
Will tma"b'salmfo...building occupant use equipment orderiew,which If a roof is installed:without tits[obtaining an inspection, 1 agree to remove
emit hazaNuus anrnmaminim; etmed by the Bay Arca Air Q nlity Manognoent g P g
Dison? all new mater' Is for inspecti n. f ant nderstands and will comply with
Ll yes vn all non-po' Urce re
1 have rwd the hazardoms materials requirement.under Chapter 695 of the -
Cnlifufnlu Health&Safety Cade.Sado,25505,a 5 3 and 25534;I undemm�d tint
iflnebnildingd of am ly m th rc,pnnsihilitY me tify the
,ce.ema of r' a ements w chat 'cure,of a Ce lean if V /
Occupanc y�
3 1 /� ign re of Applicant 'Date
o ger aamnrizalagent D All roof coverings to be Class `B"or better
OFFICE