01010075 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: PERMI"1'NO.
21144 LAURETTA DR EXTERIOR SOLUTIONS 01010075
OWNr:R'S NAME: APPLICATION SUR DATE.
LIU TOM T AND CHRISTINr S 1771 SMITH AVE 01/18/2001
IONP: SANITARY No CONTROL NO.
(408)358-1233
O z Z ARCIBITC171INGINEER: BIJRJANG PERM1'IINP()
i.
a Oi
AiCH
aO .
ELECT PLUMB
LICENSE[)CON'rRACfOR'S DECLARATION Job Description
G I hereby uRrm that 1 tan licensed under previsions of Chapter 9(commencing
—r at with Section 700ll til llivi,ionl of fl a Bu,inc„atm P ..I ,Coda.i In,,license
�J ,.n1.111cin,andelrcetc.�4 Lie.. } 1�3s REMOVE ONE LAYER OF SHAKE, INSTALL 30
adN Dale_/ - - commeTntree 7/16" OSB AND CELOTEX PRESIDENTIRL
3 114 - AR� CRITECI"S DIicLAR�'rrON ���0�'
1 understand my plan,>hall be used as public¢coral
c p�p LicrnsN]I f,,ornal
OWNER-BUILDER DIiCLARAfION
m I hereby anion that I um exempt front the Contractor',License Law for the
C'L•�, following n:wun.(Seclion 7031-9.Business and$lot ..:rens Cute Any city oou
r cnty
Sxtj which retinue,. xiondr.coromm,nine, tip delool,sh.or repairan,structure
wFm pnorr t ancer,dw,expire,therilplalicandf h pronfir it)file a signedrtement
a--
It.,he I I.....ed ru"hardI the provikarn,ol1 c r t `. License n (Chapter9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Dimsion t of the Business d P ..
d. ' Code)
or Ne he ,exempt door d the ban f Ili alleged exemption. Q.Any violation - 11 J
COO
lir S0.ainn 71031.5 by any applicum Ii,r a permit'em"Os the applicant ut a civil penally
of not move man five hrmdmA dollars($500)
APN Number Occupant
C1 1.usowner of the properly,or my entployces with wages as their sole cora nation,
will do Ilse w„rk,lam Nc.varum i,tmr i o, led ,,of rred tar sell,)sea.7044, rter�,, ����tt
Businm,and Pro(en,ion,Colic:Tire contraetm License Law docs not apply Io an 3265402Ntdk�IHY:d Inspections
rrvr of.prnpeny Who builds or improves thereon.and who diva such work himself
throngh Ale oro mnploy,,, povidcd Ibar Intel,in,pawcmen,are nal in en led re
onared for,ale.B;however.the building or improvement i,.till]wimin line year of 305 — FRAME
n, x
completion,the anenbuilder will have the burden of proving that he did not build or
improve ire„m vororx°101. 307 — INSULATION
❑I.as owner of the pmpeny.am exclusively eonvaning with licensed contractors to 601 — ROOF TEAR OFF
1-iusVad the pincer(Sec.711,14,liminess and Profies%m,Ctidcy The Comraetor',
ce e Law doe,t�ot.,,lym anowar,ofilo,herty who baudx or improves mercon. 60'2 — ROOF PLYWOOD. NAIL-
and who contracts forlicensed such protea,with a conlraetorbs)liceed pursuant to he
Commcmr,Lieen,e Law. 603 — ROOF BATTENS
❑l ant scull under See. ,11 k P C for this«nxon
604 — ROOF IN—PROGRESS
owner Die
WORKER'S COMPENSA'1'I(IN DF:CU\RATION
1 c r I vshl under a C,,lty ofpepnry one ofthe fallowingdedaretiom:
] have aid will trovided a CatilS a rl Cunsem la Latso ec lire file 'e
Corapource i it,he provided for by section 1issu of the Iab,r Code, lin he
performance of the wort for which Nis permit is issued.
ave and will maintain Worker'%Conrpenmtion Insurance,a,required by Section /
37 Ml of the labrt Gde,for the per(nrmanee of the work for which his panel)I,
ismmd.My W�oorrrkcr',,ro timet n l Ii'cc artier and Poly numlvr arcs Q
ctaemr: 2titr nrlDNrn11.1
�OTENIVI ION IApeJg&3 20(
COMPENSATION INSURANCE � r T
(This section need not be completed if the permit is for one hundred dollars
($1111 or less.I
I certify that in the performance of the work for which this pmol)is issol I
,hull not employ any person in any nwnner to as to Nuorne subject to the Workers
Ca v'roolin I Law,of Cabl....I. 11"a
Applicant
NOTICE TO APPLICANT If. dura making Ilii,Ccnilicale of[Ne rn'rion.you should
ba I,,,I,hject to the Wnrkah C.... euuon provin ionxof the Labor Code,you nm,I
Q O onhwilh comply with such,loonion,or his pnair shall bedermed revoked
.moi CONS IRUCI ION LANDING AGENCY
1 hereby anima that there i,a ttnuamclirn lending agency for the performance
of the work for Is hich this permit I%issued(Sec.3M.Civ.C.)
�.[a Lender's Nome
`I Lender',Address
U0
I cenify that I have mail this application and%late dva flue above information is
W Pn ncel.I agree I,,comply will,all city and manly ordinances and'tate law,relul ng
Q U at building construction.and hereby amhorire representative,of this city m enter upon
the tMvc-menuonerl P,.,rly for inspehnn purpncs.
phi ran,vooi,and e, and keep nnrndes,v the C'ny of Culvnin in%t said
Vl liabilities,creenno,cmc,and exp use,which ma In why accrue upuinnt said
U G A,I'm con uenee of the gin' an
AI'I'LIC ONO o U LI. 'LV fill .NON-POINT Issued hy: Date
SOIL ,
s-no rol'A,liwanvContractor - - - Do,/ Re-roofs
HAZARDOUS MATERIALS DISCLQ IJR17
W5111he.,Iicam mlbmm lmildingovcapanl dura handle Waterloo, lateral Type o(Roo
u dtlined bathe Cupemart Municipal Code.Chapmr 9.12,and Inc Health and Safely ,
Code.Streit 25532(,"
0\'ef ''" All roofs shall be inspected prior to any rooting material being installed.
w'tu me:mpliranl or mrrtm baBdi'roue=ar;tm rt,ccgt'irrm'tlordcvicc%whieb It'a roof is installed without first o raining an inspection, I agree to remove
emir nnrudous air cumaminumn ns JdincJ by the Bay Arev An pualhy Managmncm
r,aie,3 all new maleri• . for inspection. plica understands and will comply with
oyes. r o all non-poi s rce re rulati s
I hove read the hararduv mmeriuh n trimmed,under Chapter e95 of the
Cmllbmin llealth lie Safety Code,Sectio,2555 5533. 255311 understand Nm
If the building a not currently hale;t moot yy "y.m nucify the
ce,ant of c r lir r c n1'a Cenilicat of
S' n' re of Applicant Dale
r amnodaed%sem
All'roof coverings to be Class "l3" or better
I m '
OFFICE