01090028 CITY onemERTINO CONTRACTOR INFORMATION:
PERMIT
'BUILDING ADDRESS. PERMIT NO.
20635 KIRWIN LA CAL-PAC ROOFING 01090028
t" OWNER'S NAME:. APPLICryTION S B DATE
MASON HU 36 RAILWAY AVE 09/ 06/2001
i PHONES (408) 369-7444 SANITARY NO. CONTROL N0.
O m z ARCHITECDENGINEER: BUILDING PERMIT INFO
�n as,0• - BLDG -.ELECT PLUMB MECH. ...
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z wim Sectinn7LICENSED CONTRACTOR'S DECLARATION - ]Ob Description'y.� l nercbr amrm that 1 am Eeenxea unser vm.ixiaia of ensurer 9 uammendng RE-ROOF
wt-w 0W)of Doision3 of Nc Business ant Profession.Cale,and my lianu '
' is in full force Ana�m
a a Liccnsc axi Lic.N_f] 6
O i O Dam - Can
me a
i Z d.Ia ARCHITECT'S DECLARATION
u O i udcm
nund my plans shall he uscd as public victims -
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Licensed Profess I
yrR 7 ;yy OWNER BUAnjan cobalt,
lt,ARAnON _Lima
- - _ f r w •t .. .. _ .. ..
• NTrrtr!dtaf l am- 2mpt( m Iha Convect -L anti cul -
1-z� Tol {,..I5atirocad 5'Bsitcr,i�d Pe. new' Apty 'nyuIdettamr
ea x-C ('vliicl{-rtgmm.n permit ne centimes alcor, mpkve demolish or repair any-structure
i 3�.poen t ' c L eq the'PPI am fuuuch pemsiuo Ele a vgiied siammem. - - - .. - - - - _ _ __ _ _____.- _ __
mat ha sl'ttb dp tient pkv. as of the CommemesLicense Law chaper9 s•7! ! a t Valuation.
ao� -mgwyhbai7troBJaro�x�m3dmeBuxmexxaodnnrexxanxeaae) t,,j1;y a3.§Lt3'1R8j( SPP �6T6,gjs.j V,/'j(.?:�t
ur Nafhe'i's exempt tlicrcfidmn and the basis lin the alleged dcmptiun.Any violation
-of Sccrion 703 k.5 by any applicant for a Permit subjects the applicant to o civil penalty
iafartmnrethadfive Whifteddollars 0500r. 30El%PN *qVtRE f':r Occupancy Type
❑Lax owr¢r ofin<pmpcnY.or mY ernploYees wiN wagesss Ncir wle compensation, 307 - NSULATIONI'
_ wm'do Nrwmk,'and'the.waure"is'not intended!or-.,rcered for sale ls«rTBu.- - 601 - ROOF' TE18SgtGiE�'Inspec[i0ns
'Rosiness and Professions Cade:The Contractor's License Law does not apply to an
owner of prnpery Who Wi1Jx m impmres thertan,vrW who dies such work nimxelr
602 - ROOF PLYWOOD NAIL
or through his own employees,provided that such improvement am not intended or
iaRcr}d dor.vle.1(,M1ewever,the Wilding of iinpmvcmcnl is stilt within tine Year of - -- -" "'
completion the owne,-wader will Wsai dne burden of poving that he did not Wild or 6 0 3 - ROOF BATTENS -:.kc:..,' �.,:<:r •:,
improve fmpomoeeof alA.). 604 - ROOF IN-PROGRESS
q ,. ❑I. oxmrddie (Sec.r ani Business a dl Preftin8 withedledsTh c Conn
"- .comtmcr de,pvyect(Sec.lou.Business ud Hofm,ons Code:l Thc Connector's
i ' Lima.Law Areas Am.pp,m.. r of p per who build,ca Ap ar a heaven, 1 .O
-And❑I t 'J See
such pr 1 r int van rl.)lic nxal p t.to the _ .- ..
01 ho exempt
nfor !/
i 7.
Cmracm' Cc .eL
r Oam U' Dom u
WORKER'S COMPENSATION DECLARATION
I hcmby affirm undl of perjury one of Ne following dedamtlmns:
d ❑ 1 have and will maintain,C ificam of Coosni m self-macre for Worker's
erg, Compensation, as provided for by Sectio 37M of the Lab, Cole, for the
p+Mormam e i the work Car which IK'per i issued.
.,
Ud`1h)4lbwifmilnmioW kcN CWripuidatimiun m ce is rcqurcd'by,Section A
.3•t 3700 o6rhelLli1x lNe (o rhe perform ntt of the work-for which this panni is
issued My Workers Conapeonallo.linsuorWit c mer and Policy numher
ArLi'FJh-t•'-PdicyN 113-00 'tie-o1 er7�•tys :a:,' •l;l ; N.
1 t Tt+CERTIFICATION OF,E%EMPTION FROM WORKERS(a
-_ COMPENSATION INSURANCE ... _.._.. ----_ - r. .._ .__ _ .__..._...
a" x(Thn sttJnn necJ not be eompletcd f the perm i is for oss hundrtd dollars f ' --- _- "y, - l -'
ISI W I or less.)
rce
1 i I comfy mai in Ne pert imnncA Wthc work for xhmh th pe t s issued,I •Y , j v; 1.[;•{'I-� rn
All bm employ Any person m any manner w vs to become subject m the Workers
cam Eon Laws of CaliforniaDa
. te'
" n�a .. ... .. .. .... ..... ._
AppliacantNOTIC
-became TOe,1.he ANT:If.after Connilakalising nsCmA the
Latioroda.Imuh..d
O O
became b u the W ch Cis nsrt onProvisionsll the tabor mod uu must
0 1 comply with such provisions or this pc t shall be deemed revoked
�(J) •°' (CONSTRUCTION LENDING AGENCY
a'> - ' I hertby affirm that fliemis a construct an landing agency for 14,erramnaiiila ' it 1 '' It
of the work for which this permit is issued(Sec 30 C) _
•�.Q Coral 's Name"-'o._'..,c... .- 9].Gv
�.z
Q
I certify that l have mad this v application and state that the above Information is -
rn„
W-'e. `areae I.,am to exal ly,withall,city and county,eminences and stale laws rearing
[� tobuilding construction, dh byethin cop sentai es of ths ily roe t,upon
} ryt the above-mentionedWmpery( peer, purposes.
F„ y (We) greet mdembiryand keep h .le. the Cly (Copan o'against
OfA liabilities.judgment.,costs d expenses wh ch may in any way ecemc againsi said
.z City in consequenceof the forialing ofths t
APPLICANT ASTANDSAND WILLCOMPLYWITH LNONPOIN'T Issued by: Date
-SOURCE noiss .„ q.6-67
.r . .
L-
C naw + 'p" ZARDOUS MATERIALS DISCLOSURE'sF Dam 'I Re-rOOf$"anal
uNur tipplivara or folumbuildhing6ac.pam'dons or ImadlebLadvise,ma a. Type of Roof, . :-..-.. ... —. .._, ..-..,, _
As debited by the Cupertino Milme al,Code.Chapter 9.12t Andth Health and SN iy s4 it •y t,' r Siv e'•S�. r f )„ ky j ' '.I ' t ,
Cod 25572(a1 d 'et`'Y J x4 _ 1r - _
All roofs shall.be inspected-poor to any roofing material being installed._..._
„1 Will m applicant humor do Idma occupant t equip a .:men If a roof is installed without first obtaining an inspection;I agi'ee`to remove
emit hanmous air conmmmant as defined by the Bay Area Air Quality M age'ant
Dirtier. - . _all new materials for inspection.. Applicant understands_and will comply with
A n °Y )N all non- of o ice regulations:
4� 5 I P
1 h r J mh hvamous t' Is myu a vie t'under Ch purr 6.95 of he
Cahfim a HealN&Stir ty Cm1v,Semians 25505.25533 and 25534 1 understand Nm _
frhebuilding drcs immly hive a tenant,that it is mviesponsibiliiy to notify the
occupant of1Ne'qui rnts which must helmet prim to issuance of a Ccnirium of ^O
°"Jp°""'' d - attire Applicant Date
- ..
admen ee a ril I Date . All roof coverings to be Class "B?' or better
t
OFFICE __ ..