01100091 CITY DF c DI
BUILDING CONTRACTOR INFORMATION:
BUIIDINGADDRESS: PERMIT NO.
10506 N FOOTHILL BLVD WILL INVANCOVICH 01100091
OWNER'S NAME: APPLICATION SUB DATE
r WILL INVANCOVICH 10/15/2001
PHONE: SANITARY NO. CONTROL NO,
COO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MECH
S N' I hereby atrLICENSED for liccenTssed under psDECLARATION EC ns of Chapte 9(=ammem in Job Description
>M w
t� withSection reandefect. n3nnneBuameaaand proreazionacfde.and myhoen,� REROOF .
fY4
is in effect.
�w< umm cmaa ere« T/O SHAKE, INSTALL 1/2" OSB BORDS/
Data cmarsem,
ARCHITECT'S DECLARATION 40 YR. ELK COMP.
-aj 1 mmisfand my plans.hall be used as public manors
i�
3 S ap o O Licensed professional
t�o LL OWNER-BUILDER. he CoATIoN
=' 1 hereby.!Gert that 1 am exempt from the C union Co a Any c Low for the
t?•0 following massa(Steuart 703 construct,
t,aft es and vet demolish,
Code:Any city or county
4 F O which q Perota ., a after,improve,demolish repair any sommum
m -pnwml I q th ppl ran,fw such permits fl ed utemmt.-ge ... -.
. a- that n I it n m m,lic n ns nine the Business a Coem) e, $ F,t Floor Area , $ ation
(commencing with Section 700QIfD"isn]oftneBusme ndProfessionscW=) 1'YT, ( K. , Ti 70
or then he is exempt therefrom and,he basis for the alleged exempu err.Any violation - - 1
of Section]031.5 by any applicant for a permit subjects she spplicanuo a civil penalty
of not mere than five hundred ablmrs($sW). 32P1tnb�r0 �, - Occupancy Type
1,az owner of the property,or my employee wile wages as their sole compensation.
' 11 do the work,and the swcture is nor numerical or offered for sale(Sm.7044:'
Business and Profemions Code:The contractor.License Law does not apply to an 305 - FRAME Required Inspections'
owner of property,Who builds or impmves thereon,and who does such work himself
or through his own employees.provided,hal such improvements art not intended or 307 - INSULATION
offered for sale.If.howevv,the building a improvement n sold within one Year of -
' compinion,the owner-builder will have rhebuNenofprovingthmhedidnotboildom 601 - ROOF TEAR OFF
distract
602 - ROOF PLYWOOD NAIL
f✓j 1.as owner of the pml><rry.+m excmvvely contracting with user d manometers to'. 603 - ROOF BATTENS
1 swet she Project(Sm.7044,Business and Professions CW=:)The Contractor's
License Law does raw apply to an owner of property who builds or impmve thermn, 604 - ROOF I N-PROGRESS
and who contracts for such projects with a contractor(s)licensed pursuant to the. '
Conuachres License Law. -
,lJle c to er Sec. ,B&PCfonhis rtazon,
ow
- W RK 'SCOMPENSA NDECIARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations
❑ 1 have and will maintain a Certificate of Consent to self-im.for Workers
Compensation, as provided for by Seclion 37W of the Labor Code, for the,
learmai cf the work for which Nis permit is issued.
❑1have 0d will maintainWwval"Compensation louncounce,as required by Samimn
37W of he Labs Cade for M1 performance of the ark for which this p(nim is
ssued My Worker C a i I ser d P l ry rah
Cari.
Polic
CERTIFICATION OF EXEMPTION FROM WORKERS' ' vf-a! Tit \ Jx'. !; ..�jii 5t OO`
COMPENSATION INSURANCE'
m fon need not he completed if,be permit is for one hundred dollarsa -
ISIW)orI.) � y
hat in the
y 1 certify awso Californa.Datcnngh azrto k fbecomehs 63 pfo thy��hsuld
shall I ra to _rformance ce i s issued I
Com
kmn
po sauon la
Applicant - - - -
NOTICETOAPPLICANTIf,after
on
okra th' Cm'Gcal<sfE
Z Wmram subjen to the Workers Compensation Provisions of the Labor Code,you muss
Z Q forthwith comply with such previsions or this permit shall W dccmed revoked.
r . .
h r
CONSTRUCTION LENDING AGENCY;'
a 'Ihmebyrkfor which
thenthem=iea construction lendingagency for the performaiicc ` t
of IES work for which,nit permit is issued(Sec.3097,Civ.CJ
❑ lender's Name'
.7.Z Lender's Address ..
U C) I certify.that I have fund,his application and nam that the above information is
14 [.. comYs.I agree to comply with all city and county ordinances and sum laws relating'
O U to Wilding construction,and hereby onhotisereprcsrnmtivcs'oflhiscity toenter upsm
the above-mentioned property for inspection props,".
F„ P. (We)agree,o save.indemnify and keep factories,the City of Cupertino against
h liabilities,judgments,costs and expenYs which may in any way acerae against said,
U Z City in consequenm the granting of this ce 's. l's
APPLICA N STAND ND WILL' OMPLYW ALL NON-POINT I /0 - /5
..S
soulcce �-,'3G DNS.
tCl Issued by: Datey — /5`
Si alum of App icmVConvano= Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
..
_Will the applicant finum Wilding occ pant ( or handle hacteduas material, Type Of Roof
as def W by Ne C pent o M n pal Lod Chaps 9 12 rad the Health and Safety,
Code.
ad S 1 255M) t]/ �. - r . : ✓.; . - .,
❑Ye Nn `All roofs shall.beinspected prior to,any roofing material being installed.,,__
Will the aPponta inantumbuilding mlby ue nays equipment or Marta which. If a roof is insfalled without first obtainin an ins ection,'I agree t6' remove
emit huallous av contaminants ss defined by err Bay Arca Atm Quality Management' g p
Distdero Yea a/ - '• all new materials for inspection. Applicant understands and will comply with
•. all non-point source regulations.
1 have read the hamrdm
ous materials requirements under Chapter&95 of the
California Health&Safety Cade.Sections 25505.25533 and 25534,1 understand that
if ih=building does not currently have a tenant,that it is my responsibility m notify the
wcupam of,h rc cra=ms w mus,bVroct prior to issu ie of a Certificate or
.` Occupancy[//
W t ' Signature of Applicant t Dale
._ wn=ruraumnri:W ag=es - Date I All roof coverings to be Class "B"or better
- - OFFICE _