01110065 F
' TY OF CUPERTINO
BUILDING PERMIT CONTRACTOR INFORMATION: '
DINGADDRfSS: PERAfIT NO:10�FT BAKER DR CAL-PAC ROOFING _ 01110065
WNER'S NAME: - - APPLICATION SUB DATE -- _. ..
NAOKI & EVELYN SHIMAZAKI 36 RAILWAY AVE 11/ 14/2001
PHONE:
(408) 369-7444 SANITARY NO. CONTROL NO.
Qp .ARCIIITIiC'fIENGINEER: . . - BUILDING PERMIT INTO
z W. t...__,:1. - BLDG ELECT PLUMB MECH
'¢u.
s.z¢m
5_ 1 LICENSED CON-FRACrOR 5 DECLARATION t ]Ob Description.
N f:i hC an,alTWnm 1 ml cn.dunclep i n.of Ch pf _9(o mencing ,
E� ,tinM1$cCh s7000)opQpts on3 of th BL51 ers and Pmle- ons Cod ' ❑my
license
REROOF
mE tn:I qI(lyFe amt eryen !`.1 C. '{ GII 7..11 f -
ppu Lenu Clan l.J Lica b0
3Dam Comnaar
IL a.O G ARCHITECT'S DECLARATION
5 und<mand mY plans snag be Bud as puhlic rtcoNs -
wrE .
x o c ucena<d rroreasiawl
OWNER-BUILDER mDECLARATION
L' f naso atlinn that 1 1. exempt from he Coli.i,C s a:A.,c Law for rhe ..
c.Fp z<' whichallowre requires scroll)t mals.consumer,alta n and Proreamoli Csde:Any eay or<auure $117 5 6
o which reyuirc>npermit rerestheaper,improve,n Pearit1 or firepairanytWment
w 3cc
c. prior to, tkc 1 q to applicant for mcM1 peon uo fl g ed statement
vu pidis.liatmod parscutimm the firmi,brioof the Contractor.License' La (Chapter 9
cimureasin,withs la )000)ofDivision 3ofthePrf. 'onsCode) �i39`b Y+V•Y1PJ,.'nVEhe]Y r't Valuation
o,that be is exem t thcrefmm and the basis finite aIle cd exem'ion.An
P 8 P iv 1penaan
of Section]031.5 by any applicant for a permit subjects the appticanno a civil penalty
of..,more man five hundred dollars(S500). 3 0 5PN PORAME Occupancy Type
El[:as owner of me propen,',or me employces with wages as their sole compensation, 307 — INSULATION
-win do'tho work,and the'srmpme is not intended or offered for'cale'IScc.7Ula, 6O 1 — ROOF TET iw
'Business and RoC
ressions Code:The Contractor License Law does not apply to an AFquHl7alinspections .... .. - _.
alio,of Nope-Y Wh,Wilds or improves ibercon,and who does such work himself
or mrougn his own employees,provided mat such improv-ements are not intended or 602 — ROOF PLYWOOD NAIL
bfrcrcd'for sale:If.Koweverahe buildingpr"- '---603---
_._ _
ar imen of prove idd-wi did not ld r 603- — ROOF' BATTENS-
n —
eompletion,pm,i f,ith,erwinnavemebumenarprovingma,n<eidoatbuseda, 604 — ROOF IN—PROGRESS
.. inp,ro,e red pumas<arsme.).
[. Ol vdner of he op., I ely ractng with
to ficenosi comu,atim,
commuct the project(Sec.70,,L Business and Pedress ons Code)The Contractors
License Law does and apply matiownsor.fitimparty whobu Ids on, mProse,thporn: .... ._. . .. ..__. ._. ... _.. _. _.. . _...._ . ...._. _ __ . ..
li
_ .
..
a 'who o wcB.fuchproj a with a comvnor(s)
---
pcenud pursuant m the
S Cinctrap
amara Lmende Law. .-
'"' ) pIa, e'—s d $ec - ,B&PCT this rtaaon - -
k 11
WORKER S COA1PENSATION DECLARATION
I hereby affirm under pnmlty of porpry one of the following declarations: 2 02
JAN3 �
❑ 1 have and will-mainmin a Cmifcam of Consent ,o zdf-insure for worker's
Cornpcnsmlon, as provided for by Section 3700 of the Labor.Code, for the
pmfmmence of the work fur which this permit is issued,
1313 1 have and 'll nm Wak Compemalion Insurance
3700 or he Lib Code f 'he pari...roo T he rk fo hich th npermit Us BUILDING
issued My Workers ompc t -runt r d Policy -
[ 11 ( ter❑� 3 o U ,+000a7sb
Cariic S-1G e fQfa.4 Poli<Y No. �1 Q N - ___ ._ ....:..
'CERTIFICATIONOF EKEMPCION FROM WORKERS'i.
.. ..._.. ,. _ :.'_COMPENSATION INSURANCE],:""', ' r
o t..ti . .
(This uciion need not 6c camplemd lime permit is!or one hu„tlmd dollars r.
151001 or less.) - - ,
1 pertly has in t T%pnarmommuce mann the work for which subject
a issued;l u - •- _ ........ s'• —'-
shah not employ any'penon in any manner m as to become sunjcn,o the Workers
Coinpenzaion Laws of California:Dam
NOTICE TOAPPLICANT.If, fter making thCcmfj ameofE p,o
you.Would
Z becnn n3 a 1heW k C p at p s tl. \ .
,f rhe b Cod y ' runt
n
z
Tiptoedr.mPl, - such p sir m, p red,mull b<dca d e'akcd.
O
Z .. .. _..._ _. ..._ ... .. . . .. . ...... . _
F h ' `'11 -r CONSTRUCTION'LCNDING AGENCY
CL h mby R that them i constructionlending agency,fo the pe f,r,iance'
of the work for which fin perms in ssued w' ISe<3097:Civ.C.),
Leotler's Addrtzs �
.k, '.1.:.:'•.t" ._ . .
r i Y h c PM a d m city
and 6ba and ordinances that a bo - ( fo is
Q [{. tobuil Ijcoint mP1Y' Nall ryandtmPreordmWesoa l cityI Ifoe
.V the imm ng mucid pa,and hereby a ectuiu rtpossemevves ofth i city m cnmr upon
Ls7 he ebovwe)air.iniproperty foody and
keep
'impose" _
�:.6r (sx'c)5groc It sore.indern ape anJ kcey narmlcIs the City df Cupertino against
_N bilis j dg ms,cosi d cape s wh ch ,' any slay ac gainscsaid
V Z City in consequence of to g in, f this perm t •
APPIACANTUNQERSTpU AND VILLCOMPLV f`H'ALCNON 016'- Q
SOURCE REGULATIONS .11 IY / Issued by: Date
ignmumor ApplicanVCnntncpor t. °• ^s /
. .. HAZARDOUS MATERIALS DISCLOSURE�'•�' " Re-roofs
tonin pph< t n f, 'b ld ng pant tort 'n dl<ncomandoonestion.1 Type of Roof
as def ed by he Caromp,Mal Cade Chapter 9.12.and the Health d Safety
Code,Station1 3553 1 ..
❑Y r 1 N
._All roofs shall be inspected prior to any rbofing.matenal being.installed.
W llth ire oft buildingal occupant.Aequipmento devices If a roof is installed without first obtaining an inspection I agree'to'remove
cmiStridulousted at ud<f cd b,the Bay Area Airp IryManagement
District', f\ryas{/ i all new materials for inspection. Applicant understands and will tom 1 with
oY all non point S rte gulations, - p Y" -
1 h e d to h aarh s' Is mq m m ode Chapin695 of the _ -
C, In m a Healed&Safety Cod Seldom 3505 25533 ad 25534.1 understand that '�e\1
.ftp bu lA 'n ,c t1Yn ,nano lt . yresponsibilityt notify the
upa,ofmquirimum hit arta.be me,pot, span fisc nficate
'Occupy cY t .
Signature of Applicant . Date
Owner_ur tumhunica age., Done All roof coverings to be Class"B" or better '
OFFICE .