01100011c
4:.
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
,WILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10643 GASCOIGNE DR.
ECKSTROM ROOFING CO
01100011
T OWNER'S NAME:
APPLICATION SUB DATE
DEVOTK PAULSEN
363 HARRISON AVE
10/01/2001
PHONE:
(408)378-1628
SANITARY NO. CONTROL NO.
Z ARCHITEC (ENGINEER:
C
BUILDING PERMIT INFO
p
ELECT PLUMB MECH
"F] L_ I t_J IJ
i LICENSED CONTRACTOR'S DECLARATION
Job DescR On
P
1 herchy affirm,l o 1 am I'memod underp.,nicum of Chapter 9 (commending
w sectio07010)of Di ,kno3nf:he BminessuM Pref,,own, Code. and Bay license
yin
REROOF.
full force vnJ It
4 ue,g
TO BUILT-UP & REPLACE
D e°"`Df Cnmraem
WITH BUILT-UP.
ARCIi1TECT'S DECLA A
i undernund my plans shall Fu used a> puhlic records
OLicensed Profedi... I
Qi OWNER -BUILDER DECLARATION
11 1 hereby affirm that I oin exemt from the Contractor's License Law for the
< following reason. (Semon 703)3. Business and Profession, Code: Any city or c.my
C which requires v Q<m o to consumer, uler, improve, demolish, or repair any structure
-prion. its iswvrce.vloanu,irenheepplicam for.ch proud.. filevai,ndsu.euem.
Y( \,. , (S F[ Floor -Are
�jyjy�a[ion
$41�"�
mat rte is licenled pidea(rtmtkrmv;ri.ns of me Cnnnarmrs License Law (Cwp.er9
iIconunencingw'ithSection7")ofDivision3ofthcBusinessandProfpssioncCaJe)'
or.hvi A6 is ezempnl.mfrom' and tnc bail for the allbged ekdnipdon.'Any violation
`(,q41,,,....L1.3_i4�!.ij-VcC�'S.7Lil\DT�:
- of Section r ion by wy ifiri dun. fore pvmit.bleat the applicanno a civil prnelry
h.fna.mtrcmanfivenana�amlara(s5oo).
37��i�u$tb�0
;:'.•..:t<^ Occupancy Type
° L downer of
mkt and he st t.'is ., .d I., sale (pevution,.
not ctor's ice seeLaw !oe sale (Sec. 7004,
intended
' will d. si and P if and the ode: The Contractor's License Law does not apply m an
' Business pool Professions Cale: The Comm
305 - FRAME Required Inspections"" • "^ E
arc
.wrierohh his em bonds to improve.at such improvements not intended
j or through his own employees. that such imp ar
ravemcns arc ria imm�dcd or:
307 — INSULATION l
building
oRmple for whet If. however, the building .r order emcm is what within one y
year of
_ •-, __,._'____`_____„•_.
- - "" '" "'
6 O 1 - ROOF TEAR OFF I” ""; ' °��
mprove fm,eowneebuilder will hwethe buNcn of proving that he did not build ori
improve r.r parpose of whet).
602 - ROOF PLYWOOD NAIL
.. __ , ... -
;Oras own of the prop tya n cxclusrvcly contracting with lc d helots t.
.. .. _.. .. _ ._.._.. _ .._._
603 - ROOF BATTENS i 'h -(s
cone) to p 3 not nod H. ro and ertyw oat Code) The Cesthemi'a
License law dims not urydy m an owner of property who builds nnmpcves thio
604 l- ROOF IN -PROGRESS ''' '
_rendwho th
.lonsuch prolens with.0 contuctogs)licenacd.pursuem.the'
«. ..._, .. ..... ... .... .. ..�. l..._... .. ..,.. _..__ _....___.._1
Contrwtors License Low.
ALker
°l vicesrnntlmder Sec:',B'&PC forthis retrain)
l�:t'1::1Si!ti`Ii`0/!I�JZ,
d ..,, • `•taco
w
' WORKfR g COMPENSATION DECLARATION
'
I hereby affirm under penalty .f perjury one of the fall 'ng declarations:
° 1 have ind will melniain'6 Cenificete of'Cdnsrn.'to sewn.. for Workers
o t o Provided far b Sen o 3 f the lab. Cod fm Ne
/
pe .he rk for whish N s perrtut .s ssud
'^
V/
O I n e end 11 mann, n Wo k s Compensation]00
I
required by Secoon
37 f Labor CMe (o
m .he peRormame of th work f h h to s pertnn Is I
= Y1
t d M���Wysk7ys..0 m t I taro wn MP l y bee -
FUNDS' 467-'�J UIV1T Ootki
s� - -_.;. _„.,.... - ••..'-
'Caner 7/?/C P.hryN
d-Aht L:>Y, -. av(. `•��
v]t
CERTIFICATION OF,EKEMEf10N FROM WORKERS!•,
k +�\�-�• 4 .;ra ! 4 _
COMPENSATION INSURANCE”
f'..�
....._... _....._,.. ._., ___ ........,. ..._..,.,.........1....__._.__ __ ._..� _ ._.,_.._..._.._
'3
pined late rmit ,rein.
(TTterc,a°n n¢J n. be con pe isfw one hundred tlollan
��• 'v'I l• "! \)CClljl.l (, Ji.
f$1001 I )
't' i
n rI pe
y. y p h rmantt n the work . hich o s t I. ns d I
._. ... .............. ..... .«... •`4 5 f - ....
Ii "(jlal. tl It 1'In.
employ me b )cot t the Wo ken'
h.:, per,on n rot mon ere m tics
.,.
La, rynfC I fn Date
1
. .:,
�. ... .-
Applicant°
.. .._ t ... _...._ .... ... _... .. .. ._
rI:NOTICETOAPo after this Certificate cof Exam tion,
g p youphoulJ
r becomeh the WoT:B:
Compensation CWe,you'musf
his provisions)
ttheemead
comply with tehpsCoions or
fonhwilti comply with such provisions or this permit shall be deemed mvaked.
S "' ('(t "' � CONSTRUCTION LENDING AGENCYof
'I hereby which th t th conn .ion lending agency for Ne fierfonnantt
.. ..
Is
weak for which this permit Is issued ISec:309]. Civ.. I
� 'Lenders Name.' •e .._reit, :__..�__�:.,.. .,..::
Leader's
'Lender'. Address -'
•- f 1; • '!'wit
s; I certify that l have mad this applicant. and aa. Rut Ne above mfr mune n is
'correct.
1 agree to comply with all city and county ordinances and state haws soloing'
to building conseualon. and hereby authorize representatives of this city to enter upon
_
• the above-mentioned property for inspection purposes._-,
We) vg¢e.o save,-itocmnify aM kttp hvmlds du City of Cupertino upina t
7 liabiT es, judgments, coos and expenses whichmey in any way accrue egainn said
: Co consequence of the gaming of cis permit.` ,'
a 'A I.ICAN7 UNDGR. ' WILLCOMPLYWITHALLNON-POINT'
,r
Issued by: Dale U
DEC n .' 10 0% C�
Si ... tmr'of ApplcamA7m,mrto. "j [" ""•:'d- ";'' Date ..L" -
'HAZARDOUS
Re -roofs
^,l MATERIALS DISCLOSURE _ ,.,
'„; Wlhthe applies or or futureWoking..Pa t . rc handlehainN maenad•
Type of Roof. _ •, e. - -., -
as defncd hythe CoNn:no Mu c:palcod Chipler912, and the Health and Safety”
1
°vG` °No k t
.—All.roofs shall be inspected,prior.to.any.roofing material being installed,_
n.
n • Will the ipplitionor future buildine.ecupantuse equipment or devices which
d
emit herald... air ecoammums d define by the Be, Area Air Qwaliry Mumgruem
_...
If a roof is in'stalled'witti'out first obtaining an inspectio`j agre6toYe-move
Diane. I
.
all new materials for inspection Applicant understands and will comply with
3q DYcs u;. - °N Y- r -r.
v , .. • .' .I.
.
all non-poini'source regulations.,.-'
s„ Ina e'read 'thc under Chapter695 of the
num,
aty, Coos
Ce H hh & of ey, Cod 5 .ionsk 1, m , it is end 25534 1 understand that
505. n533 a
B bis ld gat snotc ayh veamanhat. my. p. biny to notify the
f.pa t of tM1' equirtme u whichList be m . p .r. ns dee f v Cenific.te of
s z. _ _ _ _ �0 /O �/O
N�IfI�atX"�,
ignature of Applicant Date
All roof coverings to be Class •'B`•or' ,bettei";
wnertraatn.riaetlagem`,.` " '. ; " ;. D.
OFFICE _.. .. _ .. .. _. _ .... _ ...