01090006 CITYBUILDING DPI ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
7592 HOLLANDERRY PL TEO' S ROOFING 01090006
OWNER'S NAME: APPLICATION SUB DATE
FARKAS STANLEY R AND HILLARY 3 691 W SAN CARLOS 09/04/2001
PHONE: (408) 279-8797 SANITARY NO. CONTROL NO.
GOO ARCHITECfIENGINEER: BUILDING PERMIT INFO
to F BLDG EL PLUMB MECH
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�F- NSED CONTRACTOR'S DECLARATION
Zy 1 he allure that I am licensed under provisions of Chapter 9(commencing Job Description
mF with onID300)y[Di,Won3oftheBusinessandPmfessionTIC do,I...nse RE-ROOF
�K /y
L so C! an e Lic.a 1a��0�7/
O Dacus x_ Contracer
E
O RCHITECfS DECLARATION
• ; I unJemund my plans shall be Dred as public rtcords
, h
io�>f
o Licensee Professional
'
6-E., OWNER-BUILDER DECLARATION
—m I hereby affirm that I am exempt from the Contmc,or's License Law for the 9/
t?a following mason.sectimn 7031.5.Business and Prafcsaions Code:Any city or c...ty ,
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which r 9u res a perm n construct.al¢ p d I'h r rtW, any strunurt 0
C .pmr tq,a:,. cIreq ' meaPPl applicant hsigned So
the Contractors
L lChaprer9 'ff,{�r�s+", , Valuation
or mmanc ng th S Imo rn an (he
s 3 f m l sin enO io (Antons CoJ<) S 3 6�2 0� /,,,WrA y , I t l;:"
or Shut io as 31.5 f therefrom and the basis for the alleged exucant to Any violation
-ofSection I03L5 byatry applicant for a panda subjects the applicant to a coil penalty-
ofnot momthan five hundred dollars($300). 305APNy '_'t ." Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation. 1
will do the'w"rk,-and the structure is not mended or efficient for sale NTm 7rb14,,- . C
Business Tad'Professionv Code The CmMohu's License Law docs not apply to au 601 - ROOF TEAUg0jXg'1nspectiohs"''v t,
wnc
r of property Who builds or improves thereon,and who docs such work himself
ni Thoughhisewe employees.p bunkno truce somem meals art net intended or 602 - ROOF PLYWOOD NAIL
—o(rcrtd for sale:If,bowevec the Wildon — --is sold within one ear of . __..__ _ _-_ .._.__-___...
�Ofurdenorpro 603 - ROOF BATTENS "'` `
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completion,The owner-builder will have Ne burden of proving thin he did not build or i
improve for purpose of ale.). 604 - ROOF IN-PROGRESS
colaatwe lraw forecnyame a,ir ly i i 'ml worsen Cminortm
comtmn he project(Sec ]loan Bexeess and Pny who
a Cuda)The ConvectorsLicensIt
and-we Luodoes notapplyman ow,.unh a cormorants)
who buildsorimpmveamea the
-andLicense Lawucn pmjttm.withacommctor(sl licensed pursuanr to the .... ........ .. .._.. ._. . ._.__. . .._..__. . ...._..- _.--._-_._.____..- _ __._...__......
01 Commences License Law.
❑lameaempt under Sec. B&P C builds reason I.3 .- ,c ...
Oumei"'., .Dam . .
r WORKER'S COMPENSATION DECLARATION
1 hereby M.orderpen"Ity of perjury one T the following declarations:'
• O 1 have and will-maintain.Ccnifichie of Consent to self-insum for Worker's
�..i Compensation,as,presided for by Section 37M of to Labor Code. for the
_ 'performance of,he work for which mos permit is issued,.,
❑I haemo will " ui.Worker's Cotnpensutinn lnsuriitice.'as k,uied b"y 5ccl:
3700 of the r Code,for the perfomunce of She work for which this permit is
iso d M orkefs Co ipc sat Insurance carafe jand Pg ley berme
C er� Pelcy Nc a
qt TICE IFICA I OF EXEMPTION FROM WORKERSr
COMPENSATION INSURANCE -m .• .._.-. . _ _..... _.._ ._. ._ _ __.___...�..___ __..__.._._.
' '(Tniasemjnneetl nm W completed dine perm,is(Drone hundred dollars .,-4 � ' �'•' '•Ito { '`I Ir. �:
1510()orloo.)
t 1 cenifY,tlui'in the perfermantt of ntie u6rk for xhicM1 this permit is issued;1 - - :,1C.i Lp„- t - -
"fiall'net employ any person in any manner an es to become subject I.Ire Workrs
e ' "� - s
Compensaion Laws of Culiferma.Date`
I NOTICE TO APPLICANT 11:at making this Ceni ficote ofExemption,you shoo Ed
Q 0 become Subject td the Waders Cmnpcnaidism provisions of the Lm or Code,ytu must'
forthwith comply with Such provisions or this remain shall be deemed mocked.
Fy ' ' t "aCONSTRUCrION LENDING AGENCY, t t
a. lhreby offrm that She g agency pe 'c
of the work far which his t' ..d(Sec 3099 C C
� Q' -Lend¢ sNume' - 4 nt a nlendn a eel for s�.�, c.. ._ .__. ... . . .. .. .. -.. __ . .
Leader,Ald
U- t.l certify that 1 hove scad this application end sane therahe above information
coirtet.I agree to comply with all city and county ordinances and state laws relating
10,U to building construction.and hereby authorize teprexenmtivcs of this city to enter upon
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the bo e m ntioned pr party for inspectionpurposes.
6s (Wtg to ae'1 de Ify and kttph ml SmeCty
dice fCpnino against
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a lodgments c t d reuse hch y any ay against Said n ehc`e of thg t gof Sha tI TUNDERST SDg ANO wiL ormil. .Y M'ITH LN N-pOMCE 1EGULATI �° OIssued by: - Date
re of APP ican mracm a Date Re-roofs
•HA2AR S MATERIALSDISCLOSURE
. t _- '_Idnisupv,1wanepph ern dl .' dm,ovicd,d Type of Roof
as refined b theCupertino Municipal Chapter and Safety ._. _ --.-_-_- —••- ---
.. . ..-... ..
- Cade Solicit
j•. .ea.,..
4
May , ',.,ON�-_ ;. ....;u.'_( t. .. All.roofs shall.be.inspected-prior-to any-roofing.material being.installed.__.___..._
's -, •yWilltheeppllcamorfuture,building«cupantuseequipmentordeviceswhich If a roof is insielled'without first obtaining an inspection"Tagree'to remove
em t h bid s air cot ants as defined by the Bay Area Air Quality Management
District? „-.,all new materials for-inspection. Applicant,understands and will comply with
311, „ , oNe, -- all non- of source regulations.
"
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1 havgreagN cod materials qu ¢mems under Chapter 6.95 of be /
Calf aHeahh&Safety Cade Sections 550325533 and 25534.I understand that
ifthe Wildingsit c tly hoe a tenant that it is my mponmility Sonoaify 0d
occypanS oft onto ms which masa be'met prier to issuance ofe Ccnificae of
Occupancy' ....
—Iinature_of A(Sp ica P.
_ . Date
n�rnr.mnnraedag - Dae coverings t -- ...
.. All roof cover o be Class or better
' OFFICE -
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