02040039 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
10292 JUDY AVE . EL CAMINO ROOFING CO INC 02040039
OWNER'S NAME: APPLICATION SUB DATE
NANCY COAD 1650 S 7TH ST 04/09/2002
PHONE: SANITARY NO, CONTROL NO.
-408) 292-7644
ARCHITEC XNGINEER: / BUILDING PERMIT INFO
w ML i BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
i z- I hereby affirm that I am licensed under provisions of Chapmr 9lmmmencing
-yt with Section 7000)ofCoition 3of the ButanesandProkssion,Codanndmylicenm REROOF.
se Lim mu Tore rte e
So"�u ii""se cl�A ,� y f-- Li. 3 Z-- T/0 TAR & GRAVEL, INSTALL NEW TAR & GRAVE
Dat Commc r
Eli O Ice ARCHITECT'S
'DEC
10
<j I uMerswnd my plans shall be used os puhfe records
i�
i a o O Licensed Pmlcssional
Oat lam exempt
from
DECLARATION
tt:Z.� I hereby.!firm that 11. exempt from the Contractor's oniooe:Any
Law for the
t:Z. wde,follow ingreaea(Section ID3L5,Business
r.impove.de professions Code:Any city or county
Yq F p Po h requires n Permit re e arun alcor mpmve,demoLsh r ream!any statement
K3$ mat m t issuance,al reg m applicant for mchpermumfl L Joamment ..___. ...
(babes) p.id ithSection
eart to on7000pro ilinsnfthethemnor-I L C(Chapter9 Sq. Ft..Floor•Area I !! .nation
(co nog with Sen on 70W)IfD'vson3ofine Buq rtes;and Professions Code? gj_dY`� ... .1s ..1Jis. t +s, 5 -i'k'.�1,
or that he It exenipi therefrom and the bass for the alleged cibu on Any cadmium
-of Section 7031.5 byany applicant fora perminubjects the applicant ton civil Penalty s Occupancy Type
rof not more than five hundred dollars(5500). i umber rr•vr".
❑1,as owner of the pmpeny,or my employees with wages as their sole compensation.
-
will do the work;add''he'sm art.is not intended or offered for mle'(Sec.-70,pt' -- -
Bm inato and PmRssim,Code:The Contmcasr's License Law encs out apply m an 307 — INSULATMNired Inspections't %-
owner of property Who builds or improves thereon,and who does such work himself
or th2fgh his own employees.provided that such impmvemems ort not intended or 601 - ROOF TEAR_ OFF
offered fnr sale ho a the bullaing t p avemcnt is sold shin one yearof '-- -- '-- - --- -- _ - ------
It,
'completion.the ownerlald 'u have the bardenofprovingthat o did and build or 602 ROOF PLYWOOD NAIL_'"" " �' '•'�
improve far purpose of sale.). 603 - ROOF BATTENS
fico prop.an exclusivelycontracting d I' eJcontractors,rs 604 ROOF IN-PROGRESS—-
construct ii,, r h
th p j t(Sec ]044 Business d 1 r s ons Code:)The ve Bator s 1 I l � .
Licence Law docs not apply core owner of property who builds m Improves thereon,
` '• _and whosonuact.fm.mch Projmu.with..commnag),IicensW.pursuant-m.me_
..C .: Commemis License Law. . ._._...______ .__.__. .—__..
❑Iamesemptuader Sec." ,B&P C for this reason �w�AtlN"�p�� q�
7 ower n'Data LEm®
WORKERS COMPENSATION DECLARATION e R""
I hemby affi m under penalty of perjury neo of,R¢fallowing declarations: �t
❑ 1 have'und will trainmin•.&'Aificem'of Consent to sel6idiom for Worker'. MAY o 2 2002
i Compensation, ns-provided far by Section 37M of the Labor Code, for the
_ performance of me work for which this permit is issued,
❑1 hove and will dmmddmWmker's&maedddion Insurance.as required by Seniors 17
7700 f to Latour Cale f thme
pe f rcd f the work'for which this permit is BUILDING
issued My Wo k P C mpehs.0 n In con coiner and Pol c mbar re."
...../ t ... ...
Cnryt at... Fo /
J� .................
COMPENSATIONINSURANCH'Je sls
�6Y"o �
r TIFICATION OF E% MON FROM WORKERS - : I,,Vs.'•
Benton neNombe cnmplercd ihhe permit'.,, . ' ...•._._. .__.. ___. ...__.. ._ . ..._-
P
isforo,ehundreddollars -' '\ls .-, �-i'. t . 'U!: I 'r4'
(S 100)or loss) -, r ,
Z.
I" r,yoy noun m perforin ce e r rk f r hew pe tis issued 1 ,ip._
shell net intim L w,6f tdil n any m.nner zit is m besome suh3ed m Ih.1 ikers -
Aopp at ' '` ofC II Dae ""'
Applaud, n: ,. ... :
NOTICE TO APPLICANT If,after mnsatio this C isions of the
Exemption.ewe,
you should
become h comply with
Worker's Compensation this provisionsll theemed Cade,you must
z Q fonfiwith2omply with such provisions or permit shall be deemed revoked. -
`� "CONSTRUCTION LENDING AGENCY ^ '
a ' Ih reby off atm o nsVucuo le d'ng agency fo the perfrtnance t:
of the k for which this p,mu s issued(Sec 1097 C C)
WQ ..Lender Nm '.T. _ . .....-. :_:. _... ...:_ •.. 1 i a-4 -...:,._11j-1:- _. .. ..... ......... . ....._ ..... .. ._ .__. __... _
z
<cmfy mm I ha e rc d m s applicat on and swm that the nbwe informaion is
(r+-L.1 c'oriea.1.gree no
compl,with 411 city end aoumy ordinances and state lows relating
PxU to building manm find and hereby mddmxdrepresenmtives of Nis city to enter upon
,.W the abnvemmmioneo Property for inspection purposes.
,a (We)'agree to save:indemnifyand keep warless the Cityof Cupenin6againat
-V] liabilities,judgments,cost and expenses which.may,in any way accrue against said
f..) City consequence of die gram ng of Ni permit -' n
AP LICANT TINDERS N A\D WILL COMPLY W7THIALL NON-POINT ! ( i
s JRCF u t x N.". o-L Issued by: Date
arc of APPli VC manor, "'" Dmef' -
t HAZARDOUS MATERIALS DISCLOSURE t Re-roofs
s ts, Wll lh'bppl'dant rfmure hu ld ng mcupam mae orb ndlchatord us met Tial Type of Roof _
as defined by the Cupernfird,Municipal Code,Chapter 9,12,and the Health and Safety
Code Section 25532a), n I s 5.411 ;:}sI
roY1� ❑Nn`l; l. - _ All,roofsshall,be..inspected.prior to.any roofing,material.being,installed----------.._-
Will m, pp�matr future building ocernause agapmentordev«;which If a roof isinsialledtwithout firstobtaininganinspectionteLagree'.to'remove
nt dfne0 by the Bay ArtaA Qual ly Manngemem
nhna:ora en all new materials for inspection. Applicant understands and will comply-with,
Dst a
` r ❑v ❑Nn :,', all non-point's`ource r gist ns.. uc',.'
`4., tI he a eat the
aft
mrdous'ma!a rcgmrcmems under Chepmr'693'bf me
Cabfo re.Heahh&gafny Code,Smuons 25505 25533 and 25534 1 undemand that U
Jshe builtlI does did darentl'haveamakil that it responsibility to notify --
I Y Y W _ Y Yttie
q sxuen f e Cenifeme of
Oec pant of the rt(firemen h u,t be mit pd r i lgnatU 6f Applicant _ Dale
r, or.umana ;gars, Data, . All roof coverings to be Class "B"or'better '
-OFFICE'