01100014BUILDING DIVISION PERMIT
BUILDING ADDRESS
10439 HENEY CREEK PL
OWNER'S NAME
CAMIE DONALD R AND M K
PHONE
LICENSED CONTRACTOR'S DECLARATION
I throb, affirm that I am lacer,tdd and,, provisions of Chapter 9 (commercial,
with Section ]BOB) of Disitican 3 of the Business and Professions Code, and my license
is in fall force and effect.
License Class Lic. #
Date Contractor
DECLARATION
I understand my plans shall be used as public records
Licensed Podfa .... hot
OWNER -BUILDER DECLARATION
I hereby offuran hot I air exempt from the Contractor's License Law for the
prilown, .,at. (Sand. 7031.5. Business and Pri.colima, Cache: Any city or county
which requires a permit to construct, alter, improve, demolldr, or repair any $mucture
or
CONTRACTOR INFORMATION:
CARNIE DONALD R AND M K RUST 1100014
'PLICATION SUB DATE
10/02/2001
,NITARY NO. C
REROOF. Job Description
REMOVE SHAKE, INSTALL COMP.
r.,3q j4u, rioor-
a
El 1, as owner of the property, or my employees with wages as their sale compensation, -4 n r - FRAME
will do the work'; and the -structure is-n6t intended or offered for sale Sec. -704,1,_
(Basindsn'end Professions Code The Crannotator-a License Law does not apply to an :3 07 - INSULATBboired
owner of proolhot, Who build, or firoproveni thunuma, and who does such work himself
or through his own employees, provided that such improvements are not intended or, - ROOF TEAR OFI
:offered for arld. If Wvvavtn, he Wildmg_m_WqpmvcrhyRt,s add avithi.ond test, of _6'b 2 ROOF _PLYIW(56D
romplthion, the onner-larilder will have the burden of proving that he did not build or
mapow f _W- f I 1 603 ROOF BATTENS
K
kas owner of the picepor,, am exclusively contracting with licensed contractors to 60-4 __ ROOF _IN-PROG1
. ix -.e
marm 1h, prdjaao (Sm. 7044. Business and Professions Ccdc:) 'Hae Contra ctor*x
License Law does not apply to an owner of property who Wilds or improves thereon,
.ad who ma runs to, -,h ... -s wlm ..........ma n--,1 ...... 1.
I thereby offinar tradc' act, of
❑ I have ad
IS 100) carksa.)
I I ' � 1,11,"Ir"t1,
H Is Is C to this reason
�r.... . . ....
sa,
I
11AHIN WEC ARATION
yfnj my We of he following declarations:—
care of Con4ru'la self -insure for WoToct's
kation 3703�rf he Labor Code, for the
Penna is anneii,
OCT 2 9 2001
BUILDING
ELECT PLUMB MECH
I "', L)ccupa
z) NIL
----
„i.u4 1, ! . 1. V.I;
;
d-�,,
.ad amen that the above information is
any mcilittruds, and shamlaws reading
eprettmalvei of this city to enter upon
arly"as
harmless the City of Cupertino against
h may to any we, rcmo against said
mit 1. I I 1 .1 1 L' .1 1 111. , 2 ,
OMPLY
y'n ' L I id 1,
H A I�NON POf T
/O LA
Code, i,
IS DTSCLQSUj,
pint suna or Wardle lassamcnas rmdod�sd
Wpanr 9.12. and the Health and Safety
A. - / I
ar, ,
Issued by: Date
Re -roots
..Type of -Roof
c'Z1 tli 11
All roofs. shall.be,inspected-prior-tQ any. roofing. material-b.eing-installed.-,.,,,.
If a roof is inisiall6a�wrthout first obtaining an i*nspect*ion,,*,Lagree�tc;'remove
all new materials for inspection. Applicant understands and will comply.
all^....
non -point source reg-alud'on-s-,
1 A" let 41.1 wr� ;ji
Signature of Applicant Date
All roof coverings to be Class "B" or''better
r.
OFFICE-
�
""_ . *-
(Io -
i'v "
HvUoNTm-m.woRKERS ;-
IN INSURANCE . ", , , j
r
0, c"It ,,s-
Jifthe,parmitisfarronseloundraddollars,
...... - ----- --- ----
1ir
--- -----
it"! 1,
.1 v sidah this woonat as�ixsucd I'
the asmk far ,
i a, b3 Be .
t, 1 -.,t; �U
�1, so c..c sublee, 1. the Works'.
C, �j j'T
glhi,�Cegificale�fExemption'yousho�id:
pro
ton
his hot, shall W deemed resolved.
.ENDING'AOENqY
r
.ctioel an bathe domormace
.'rc,
d-�,,
.ad amen that the above information is
any mcilittruds, and shamlaws reading
eprettmalvei of this city to enter upon
arly"as
harmless the City of Cupertino against
h may to any we, rcmo against said
mit 1. I I 1 .1 1 L' .1 1 111. , 2 ,
OMPLY
y'n ' L I id 1,
H A I�NON POf T
/O LA
Code, i,
IS DTSCLQSUj,
pint suna or Wardle lassamcnas rmdod�sd
Wpanr 9.12. and the Health and Safety
A. - / I
ar, ,
Issued by: Date
Re -roots
..Type of -Roof
c'Z1 tli 11
All roofs. shall.be,inspected-prior-tQ any. roofing. material-b.eing-installed.-,.,,,.
If a roof is inisiall6a�wrthout first obtaining an i*nspect*ion,,*,Lagree�tc;'remove
all new materials for inspection. Applicant understands and will comply.
all^....
non -point source reg-alud'on-s-,
1 A" let 41.1 wr� ;ji
Signature of Applicant Date
All roof coverings to be Class "B" or''better
r.
OFFICE-