02030001 CITY OFCUPERTINO
]BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20324 GILLICK WY J SAENZ ROOFING 02030001
OWNER'S NAME: APPLICATION SUB DATE
HIRAI FRED M AND DONNA R 1592 MONTEVAL LN 03/01/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 997-3422
n ° ARCHITECTIENGINEER: BUILDING PERMIT INFO
kkkk F BLDG ELECT PLUMB MECH
CLARATION
.y('.f 8�
LICENSED
liLunie.4° i» nImoebyafion thmm licensedderr provisions oer Csla
per 9(commencing
REROOF .
Job Description
In t. dpmfoCodndmylicense
Imf f IF Gs�e
oVLiom, c
ARCHITECfaD ArRN l
- ej I undcmanJ my plans shall be used os pub(¢rtcoNs
p O
Licensed Professional
-o, OWNER-x.r.,n RDRCLARATIOY
I hereby affirm ohm 1 1. eumm from the Cessions o License Law for the
t a
following uiresa(Section]onstr Business and Professions Coda:Any cloy or county
E F°
which,1 requires a perm o t Construct.n .Iter.rt far u demolish,or ropes any swoon $19300
3 pct ti to swsedpuf q teeth apphamt foe Contrach ctor's License
aw(shaptero ion
- that hq+I . dpui nttdthe pbauontofoheCnmucmrsL<enseLawlChapmr9 sA,v„ pC�,r ♦ i s'- Va]Da[IOn
leo so exempt
ti lomla) fDlba aloof the1,9 nc iumPuor An,
Indian he is exempt theiefrdm and me hush for the vll<geJ eiemptma.a ny v olamn '
--of Sminn]031.5 byeny.ppliunt for spermia subjects ohe applirnm eo v dvil penehy
throat tmre man rive nanarcd emlarc(trot). 3 0 SAPN K'IE ... Occupancy Type
❑h vs owner of ohe property,ur my employees with rages m their sole compensation, `
wdrness a work.Professions ode:Theuntmorek.ntr intended d er ffareda Law does nod.apply toa n 6 O 1 - ROOF TEARqu i'� P
Business and work.
en the
Code:The,Contractor's License Law does not apply to on ria eetionsl"• t,t -'
owner of property Who Wilds or mrPmves thereon,and who does such work himulf'�
or through his own employees.provided that such improvements are not re itintended or 6 O 2 - ROOF PLYWOOD NAIL
copdfon smelChowuilder will
gorirden of prove sold he
nee year of"-----'-' -03 --"-" "- -' _ '_' _- .,,: _ __ ."_- _ ------
completion.
-_-
cdmpleon ma owner-builder w01 nave me burden of proving mm be and not Wise or 603 3 - ROOF BATTENS :` .. .'
improve for purT.m of sale.). 604 - ROOF IN-PROGRESS
❑6 as owner of the pmpeny,am Business a d isusingProfessions
with odenude Contractor's is
_
construct the does
no(ace. to a,owner o and Professions Code:)The Cnnwceon, t ,
and-we Law does nm apply man owner th property who builds or improves thereon, 's
.
Comments
contracts or such Pmlecu.wim a cammnnds)lice,sud.pursaam m me .. ._.........,_. _..__ _ ... _.. ._. _. . .. ._..___..._i-_....__ -.._.c._ .. ....-_. _....__
aw.
01 ma
pt mile See., m
°loth exempt under sea 1. ,:'',B&PC fnnhis uason FIN"
_ Owner "Data '
WORKER'S COMPENSATION DECLARATION
I from,affirm ander pan any of Pe,j.,abc of he following delamtims: MAR 1 5 2002
° I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cale, for the BUILDING
_ performance work of me for which this Permit is issued,
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the Performance f the work for which this perdou is
iss d MyW ke'sC opensau
C7lnsumnce< a 3peoSPolc dPtol Sy 6brobe r
... �... .. _,.. - - . .. .. .... _ . ...
SA .$., [ lt..st'I. 1 p 1Y i ..� ,r♦ t. o. l v','r:
x CERTIFlCA ION OF ON FROM,WORKERS'' x.
e
COMPENSATION INSURANCE
dhis."C'umineed no'be celmplatedf the pernit is for one hundmddollars
(SI W)nr less) ,
(,1 certify that in the perfomunde of me work for which this pc
shall not employ any person in any manner an as to become subject to the Workers'
Compensation Lows of Celifemia.Dae '
NOTICE TO APPLICANP.Work IL ager ranking this Crain s o of Exemption,you should t
Wcomeh comino the Worker's Compensation previsions of me!abed Code,you must
F CONSTRUCTION LENDING AGENCY „ _revoked. .. -..,....^. .._. .....". . ...... _ .. _... ... -. 1...__. _i. ...It. ,•
1
Q forth ime y itha such Provisionsoh pe tshallhda W
F I moeby a f.I ,there -emoomelin.lending ixgency I the pet n a +,!
of'hework rod hhth'pc t' scd(Se 309] C'v C)
Under',Name ..•. .._. _ .m... i..._ _ _
:D;Z LenderiAddreis
'V 0 Iccnify that l have read this application and state that the above information is '
ca'abo 1 agree to comply with ail cloy and county ordinances and slam lows relaxing
cl, g ria extort ndhercby.mhnd e nt erdina c sari tel smlation
�S'W the abo c mem o ed
pend for purposes.
(We) gm suite: dm fy and keep
hams s
s the Cupertino
tZ) liabilities,judgments,costs and pontes hick may in anyway sc against said
U zCityncronsequence
of the granting D WI permit. " 6 L-
PPLICAN7 ER STA SANG WILL COMPLY WITH ALL O POINT
toad _--- - �� . , �('3 /-oi Issued by: ate
S' mumofAppliant/Con m�'"' ` ' - ' ` -:: Data Re-roofs
! "HAZA DBUa MATERIALS DISCLOSURE
rune o furore building occupatn port or handl heiadous mm al� Type of Roof.
upcntnMunicipal Cod Chapter 9 12 and the Health and Safety
Will me app(
asdcfinetlb the C2(al .i
Cdd °`Yes 2553
_All roofs shall be Inspected prior to any roofing"material being installed.
.,Will'he applicant of future building occupant use equipment ode ces ntchl If a roof is installed without first obtaining an inspectior,'1 agree to remove
.then r.m t veonummnt
s ss donnedby Bay Area Air Quality M.hagcmc ,
°Nn all new materials for inspection. Applicant understands and will comply with
> smct
all non soarce regulations. ,.
` I he'read the hazardous materials rt uortmenu utd r Cha w 6.95 of the
Cal Tom.ing dos et at Cade;avee.la 25s05,25333 and 25534.I ity n,mmd that
pence ofliry noonday the .__. .... .. . _ .. .. _ ..._._
if me building docs not cumn0y haveamnmt;mat it is my rcs - - - -
c' an,of me re uiremenu whic muse be at prior to issmnFabf a C.ertincam of
` In'! " Signature of APPlcan[ Date
. . -
owneanmedaeda rot All roof coverings [obe Class'—'B"-or
_B"or better '
_ i:. ...
. '. .. ...OFFICE4.
-
. .. _.. .,