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00080143 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: HUI LDING ADDRESS. PERMIT NO, 1. 00080143 OWNER'S NAa56 - AVPLICATION SUB DA'Z'E 0A/:='j 12L71iLIO ONE: HURRAY ROBERT SANITARY NO, CONTROL NO. C Om C ARCHITEC-EMENGINCEIC BUILDING 111iRAII'I'INFO w- BLDG IiLECr PLUMB MECII dad 7 N z LICENSED CONTRACTOR-$DECLARATION Job DESCrIpl10I1 O G_ 1 hereby arfnm that 1 am of H under provisions niPIc of m Codeupter and mmuccoog cense FHI-J with Scmiomentalof Division 3ofthc l{usincssand Pntlessions Code and my license is In full force nnJ ctt t. X00 _pp 39 ? 16 a fi o d Date_—&> — Commcmr s REROOF 3 W n ARCHITECTS DECLARATION ' ¢.C g I undersand my plans shall be used as public records. �r 6 z Lcn i< sW I'rnleaslnin] ea a OWNER-BUILDER DETI CLARAON '-�r 1 hereby,(Sect that n I aamm nusin sfivern an the C%sins Citric: License law for the (•,Z a ,doming moron.(Section 703 L5,1t. om,v and Pv,derios h,or.Any city or county FF O pate, rtyu ire.,..leonit mum,the ober,improve,annnr.h,or repair any structure Co prlarm,licened pwrle,mb,the proski iaun for scM1pmmiuoienseLw(Cacnwm dam Bothe ening wit mtmuamfolic of Divm.of the CnramcmL.Littn.elaw(Chaptar9 anmmencingxtimsmion]alBlrroivi..iondonhna.nte,.narma.annsa,del Sq. Fl. Floor Area Valuation or that he is exanrt therefrom and the basis for the alleged exemption.Any violation or Section 7031 by any applicant for it p,mot w ihwct¢the app,varl to a civil penally of ren mme non five hundred dollars 6500p. A PN Number 0ccupaI1Cy Type 0 h as owner of the frmpeny,or my employees with wages a,their sole compensation. will Jo the work,and the ammure is not intended or offered for sale(Sec.)114,1, 'n Ho, oil Pmfo..ions Code.The Contractor,Liemnc Law does n apply to a Required Inspections w e,I pn,Pe 1,Who child, repro is thrrtt nod woo docs such work himself or through sal own employee..provide)that such vementcmcnl,are not marched year or olretw for.ale.H.however the l have t or improvement is sola he did one year or 305 — FRAME nm...c for the m ore-builder rill have the harden of proving that he did nil build ur fit prove rm purpose of.m,.). � 307 — INSI.ILRTION 0 1,as owner tit The profcrcy,air exclusively contracting with licensed coalracloo.to 601 - ROOF TEAR OFF .nmme, he projee,tree]a,1.nosiness and Profession.Code:)rhe Contractors ROOF PLYWOOD NAIL Lr no se Law does t aptly ro an owner of yropeny who brick er iecmve p ,thereon. 64'rT1_o — inW who contract, for such projects with a eoorastogsl hecrwcd proarm to the 603 — ROOF BATTENS contramorn License Law. 0 la in exempt timer Sec. ,B K P C for this re'son 604 —' ROOF IN—PROGRESS Owner Dam WORKER'S COMPENSATION DECLARATION 1 hcrehy ailuro under hettulty of Isc'riory one of lot following declaration,. 7 1 haveand will maintain a.Certificate of Corwin m self-invert for Worker's Compensation, as provided for by Section 3700 of the Labor Cale, for the perlitrntaneeolthe work for which Ilik iscrntit i.kmod. /v X3 have and will maintain Worker's Contpen,mion Inwmnce,as required by Section v ]lMl Xof the Labor Coi for the performance of the work for which this Permit i. i.encd.My aN�'�nrkcr's Cu��''``ns tion In.urmtce carrier una Policy number arc: Camer_7CR�l Policy No.:29C ©O HVS - CIiRrIFICAI'ION OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section recd not he cnntplcmJ it the pmmit is for ono horded dollars 1 pm)nr lro.l - I certify that in the Performance of the work for which this Permit i.,issued.I shat[nal employ any Person in any manner so as to become subject to the Worker.' Cnnipensmina law.or Calihsrnia.Dula .1 APPli'rat NOTICE TO APPI.ICAN'E If,after making,his Certificate of Fi rnvxinn,you should hott me subjeco the Worker'%Compensation pmwision,of the LaMar Code,you must O 0 forthwith comply with such pnwi.inm nr this permit shall be deemed revoked. 7 F•' V] CONS there1CTION LENDI NG AGENCY vat mfmt this there,.anwed(Sec. lending agency for the Performance Lender work for which this permit is Issued(Sec.1(07.Co.C.) 0. Q Lender's Name � z Lmmu's nddre,s V 0 1 certify that 1 has,mad this application and ,am that the allov iorom ion is R. t.. correct.1 agree m comply with all city and county ordinances and nw' ate la ,relining O U to building construction.and hereby numodre representatives of citym enter upon Rl the aboveim,Nonea PoTeny for inspemion p.I've, y (WO agicem save, odanmify and key hnmdesv the City of Cupertino nguin,t N liabilities,poloci m..ends and ex ar,s which may in any way accrue again,,said U z City in consequence of the granting of this perm it. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: `•' Date �H SOURCE REGULATIONS. y' signamreofnppLenJCommnor Date Re-roofs Will he applicant orlfcam building alepaDISCLOSURE= le baradem.material Type of Roof as def red by the Cupcnino Municipal Come.Chapter 9.12,and the IIcahh and Sam, Code.Serdnn 25532(aT! En•, El No All roofs shall be inspected prior to any rooting material being installed. Will,he applicant or future building occupant use equipment or devire.which If a roof is installed without first obtaining an inspection, I agree to remove emit haoudou,all emounlinents as definnl by,be Bay Arca Air Quality Management Distdefr all new materials for inspection. Applicant understands and will comply with Dye, 0 N all non-point source regulations. 1 have read the hazardous materials requirement,under Chapter 6.95 of the it he Health&Safety norCare.llyhmSection,25505.t itis ym,c W.londer.wndthat /A �I� D/ ^O iccupanilofthe requimmrriv ahich mustIt,the et 1,nls to responsihillrymnrnily the MMM///lam" s� ^-'ll occupant of the re(�ypaulr/e�mv{n1h wlhich��v�l M:met prior,o is.nnnm rd a Ceniticam of Occupancy. _ZIP Signature of Applicant Date ownir tnmorirea agentDane All roof coverings to be Class "B" or better OFFICE