01070137 r
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10215 S FOOTHILL BLVD EXTERIOR SOLUTIONS 01070137
OWNER'S NAME: APPLICATION SUB DATE
ANTONUCCI DINA C 1771 SMITH AVE 07/26/2001
• PHONE: (408) 358-1233 SANITARY NO, CONTROL NO.
�o?zp ARCHITECT/ENGINEER BUILDING PERMIT I,N'FO
g U BLDG ELECT PLUMB MECH
dad C_ CJ I_I L_I
p an,�„m LICENSED CONTRACTOR'S DECLARATION
Ei o I hereby affirm slut 1 am licensed under provisions of Chapter9lcomnmectng Job Description
F 4 with Section 7") fDivision 3 ofshe Businessand Pmfession.s C°de.and my license REROOF.
R:an < is11 in and`°" S ue.x 7 035 REMOVE COMPOS . INSTALL 30LB. FELT
&
so°c c. °v1 — " IS 7/16" OSB & 25 YR. CERTAINTEED.
a O ARCH ll the u e UECLARA ION
— ? I unJcmanJ my plans hall be used as public mcords
.p�M
ai
a o O Licenser!Professional -
o y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law sur the
z following reason.(Section 7031.5.Business and Professions Cute:Any city or enmity.
E D which requires a"it no construct,Alen improve,7emollnh,or repair any zwaurc
i3 a. Prior 90 iswmme.alm rtyuims the applicant for such permit mfilan signed sen¢mem _ -
that he is licensed isurstiona to the previsions of the Contractors License Low(Chapter 9 : Sq. Ft. Floor Area k _ $70
of
(commencing with Section 7000)of Division 3 of the Business and Professions Code)
or that he is exempt therefrom and the basis for the alleged eaem'ption.Any vi.foram " ' '-'
- of Section 7031-.5 by any n,op ieam for a permit subjects the applicant o a civil penalty
t Of not more than five hundred dollar,rssum. 3 4 2 Rb tWT646Occupancy Type
❑1,as owner of she property,or my employees with wages as their vole compensation. 1
will'do the work,and the'amunure is nor intendedor'ofsmd'for vole(Som.l81'Business sitd'Profecaions Code:The Contractor's License Law does not apply to an 305 - FRAME Required Inspections
w r of pfopeny Who Wilds to imon
pmves there ,and who does such work himself
0
or gM1ti. oOn employee.he adlost:pt improvement, t'intended of _, .._ 307 — INSULATION __
off d'f .51e If h h ti Id' g p t'. . Id ih "'_ ""--"'-' - --
601 — ROOF TEAR OFF
completion,' the h Id 11 have the b Jc f p g that W d d t b IJ '
impvef° °rp° fool ' 602 — ROOF PLYWOOD NAIL
— — —
❑L feepropeny a lycontracting 'ml :<d contractors t 603- — ROOF BATTENS ' -- -- t'' ----
construct the preject(See 7011 Business and Professions Code)Tim Contractor s
t
LI La does t apply to net fp pony h,holdseemcn. 604 — ROOF IN—PROGRESSand h.contracts fm.,mh.,rvjccrs.wjth,a commumns) licensed p am.tothe
Cimaract.,s Lutenist,Los.
❑I mr,commit,under Sese. t 't B&PCfee this reason i0r Dir-7",
Owner
Dam /
1 •-. 'WORKER'S COMPENSATION DECLARATION Q/
• !hereby ufOm under Penalty of oeriuiy one of the l°Ilnwing dwhrmions:
❑ I base and will hadmairt a Cenificmn
a of Coant to self-insure for Worker's
Compensation, as provided for by Section 37W of the Labour Code. for the
'perfoonance of the work for which this permit is issued..1,
1:11 have and will main tin Worker's CmnPensarlon Insurance,as roq.imd by Section
3700 of the IrWr CWe,for the performance of the work let which this permit is
issued My Workers Compenmtioa Insurance r and Policyntimber are"-
Camc�/�'Ffci-AL Po1 cYM LGG 7o S4744 - r- _. -- _ -. -.. .� __. .__._.._• _
CERTIFICATIONOFEKEMPION FROM WORKERS' - s.. !,a �:.... ...-. a `'
\ .1 '
-.. „ COMPENSATION INSURANCE
otinccd not be completed fshc pemit'r for one fiun7md dollen `I `t C 1 :.Is
(s1w)a,less) r
'nh II fm`nto m IY that the performanceof the work for which a prior t issued.I - LY s .l iL' .I U_s.,Y" •• _ --
an ns to beco n b7em t the Wo kers I
Co pews nfaws ofC if aDatet
._'APP!team.
become TO APP the AN Wm `.a(tcimirkt am Certificate of Labor Co . on
Z 'foromewnimply the workers Caron or thin PmnsmhsMeeomed!Cnok You mon
z 0 fanhv ish'cnmply with inch provisions or this permit shall be JcemN m°Ied. '
—
'1 J- T ` CONSTRDCTIOLENDINGAGENCY
lw 7 t 1 hereby hiiiem t rh construct 1097 ng ab y7 performancethperformance ,
oen kf he Ve hlct : sued(S 3W7.Ctv C) '
.0-Q I comfy that l hose mad this application and state that he above information is
correct.I agree to mmply,wirh all city and county ordinances and state laws relating
-':O•f� mbuilding mnsutininn,on7 hereby nmhnrizc reprcsemaives of ih,t,ity roemerti,mi
;)W-;4 thealovot rainnored-Property t inspectionp ren. .
t,0. IWl gee uis 'dm-fy dadk ph 1.' the 6ty m
Cperino agotnm
,yliabilities.judgment, t. nd expemses,Ohnich may in any way accom agains said
U Z City in cminualiumne of he'gmn"ng of thispe m t '
APPLICA UYDERSTANDS AND WILL COMPLY WITH ALL NON-POINT"
sol GULATTIOr t M'I+t Issued by: Date
St n r re d I¢ant/_Coor . yDmc r -. Re-roofs
HA7ARDOUS MATERIALS DISCLOSURE -
I3neeapfolieanl«comm _ Type.of-Roof— .
as def ed by tIcCuiooMuoi,pa,Code.Chp,c,g,,',aniline H ahlb andStifin,'
Cride.Section 25532(a)!
r
') _._All.roofs shall be inspected prior to,any roofing materialbeing.ins[alled.
WII rM1 ppl r rr t b-la' y e p, t sn equp nt°rd ee hrn� 1f a roof is installed without first obtaining aninspecnon,hagree to remove
em t hazardous onananas eney the Bay Arca Air Quality Management
Di""" o dfid b oY - all new materials for inspection. A Leant understands and comply.
will cote 1 with
"`-'' - - - iilf ori-point Source regullat)ons ,,,IPP - _ .
t
h e d rh h ra ti - t I r 4 t d Ch pt fi 95'f th I 7'
Calf Ull'alb&S-bnY Coile.Sn,limil 2550525533 and2553J1 understandthf _
rt
fihbmld ' i wh
in ' pa bltyt e
patfY
�cmfeem rcquirm t-which muo be ,F t k Ce
faorcmof
c
P y
y Z Signature of Applica t _ _ Dale
Date All roof coverings to be Class "B" or better '
OFFICE-
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