02010131 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22121 LINDY LA . 02010131
OWNER'SNAME: APPLICA30/TION S}pIB DATE
WILLIAM HO 01/ 2002
1•PHONE: SANITARY NO. CONTROL NO.
8 zD ARCHITEC(ENGINEER: BUILDING PERMIT INFO
a U 5 BLDG ELECT PLUMB MECH
�U u u o LICENSED CONTRACTOR'S CONTRACTOR'S DECLARATION
z O
"L_
1 hereby affirm Nm 1 am licensed under provision of Chapter,9lcommensing Job Description
AML- said,Scene.1000)ofDivision 3ofineBusinesslandprofessions Code.amdmyIt,,.e TEAR OFF CAP & LAY TOPARCH
_xsM isimmnrareaan rife Cn3. f ISS'
z rc a License C s Lis.._
K O a.O Date Conwc r \ -I N A LE
w 3 u qR ITECrS DECLANATI0
F I undcrsm d my plans anal,he used as public rtca s
E
Ct, Sooi° FEB 0 6 2002
o OWNER BUILDER DECLARATION
m 1 hereby affirm that 1 am exempt from the Contractor's License Law for the $3000
following mason.(Section 7031.5.Business and Professions Cade:Any city or county,
which requirts a pcdmit to contract,alcor.improve,demolish,or pairs rrucmrc BUILDING
n 3 -p quires pp'an t filcasigned sidemen.
no madsorme c>msort tree he floe mchpator
mat he i4,licEnfui pu+yu@nl m me provisions of the Commcmr'a License Law(Chapter 9 �' C a- T' { Valuation
_+I�
(commepem&wish Semm�7oDDJ mf Division3 of the Buliness and Prole}stars Cade) v ',a �'3jF �.Y$�pgt!�'t!l1.i L,h
or that he is exIndlit therafroSa'and the basis for the alliged skemption.Any violation
-of Section]031.5 by any applicant for a permit mbjects the appllcunt to o civil penalty-
Wool more than Five handled doums($50d) 305APN NWANE Occupancy Type
❑1 nrof the property,of my employees w.1h wageos mer sole compenaton, 307 - INSULATION
_._-_- _.._ _ ..1 c�.�s.- . , .__ .____-_..
'wlPe the-work,and the ode:The
IC'ntCmmnd i or offered Law foes but
(Sec ]oib '"'-'-_ 601 - ROOF TEa-{akligLi Inspections "1!+
'Bas nets add P fesxwns Code:The C ntmemr s I.cense Low does not apply to an
owner f property Who builds or improves thereon and who does such work himself 602 - ROOF PLYWOOD NAIL
r th gh I"
own employers
ply s proded th such u h improvements ore hot intended or
-offered for:le wne el m building6, p ent ,atha m- Bey dor 603- - ROOF BATTENS :•5• .!
improve an,the erimserbda.). 11 have the harden or proving that heddnot b tm or 604 - ROOF IN-PROGRESS
improve for puepose oLsole.).
-li
❑l a he gphe p Sec.7 nm ex sines a samrommg with acen The Commerce'.
om era
c License
the project(Sec. to a owner o ono Professions Code:)improves
ves the o n, t
License Law does not apply man owner of property who builds or improves thereon, ''"`' "'" --
_ ._add.who ctor's tracu_fufsueh projens win.a.comracmr(s)licensed.Pursuant.to.me" ___.._.......__'_.._.__..._-.
Contractor's License Taw.,. , , -"_' -- - ----."
❑I am exem funder Sec:' TI'1:::....""'
n •'.:'; .B&P C forthisrenan jCl` ! ICLCI:J!o.!!1
Omer`' Dt td
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of peijery nhc oQhe fallowing declaration:
t•.0'•1 have mid will'rtminmin o Ccndeate'of Cerra,io set&insure for Worker's
Compensation, n-pnvidW for by Section-3100 cf She Labor Code:for the
permindattce of tne"wark for which this pewit is issued.1,„
❑I have_arid'wi1,maintain Workers Comkmeation InmmM' u rembed by Section
am work for which do,permit'_is
iss d t W rk C rope ton Insurer yr enJ Policy - he se.,
l W of the'tabor Code far the performance f the•wor {} p
s t RTIPICA
No
OP EXEh ON PROMWORKERS'ptt u i .f 9 t { 3 t t�V ti Ir.-l.L ?1 1'.i.,t ._..s-..,. .. '.,I t s L.... ...._.._..._,__..
�.. ._,.._ COMPENSATI INSURANCE s y+i
Je.1'<(1hii�uci]obreeAn°tDe'complcieJ ifthe permit is for onehundrtd dollen t ' +•''1 'I'''f "'�tt:":�i ll•.`Cl:�::(: s ,
($100)or less.)
1 I certify that m the Performancebyaof . work for co.which bipermit e Issued"I "
shall nor employ ws of Caon to any manner,m as to hc2dme aub3en tri the Workers t t.
AComp,ltrsmion laws of Califnmia.Date
NOTICE TOAPo the Wokers after makt this Cenincme fE cm tion:yo......t .., t •U
z &come cubjen in the Woikels Compensation pronsmns of the Loner Cale,yau'muit
QQ loth 'ih r mply with such Prov s cons or rots permit>hall ec deemeJ voiced
h ) vCONSTRUCTION LENDING AGENCY - -
' ,hereby E that there . n t a lendingagency f th pe fo
Ls7 ti of th work fn which thpem, 'issuedsl 3097Ov C)
L'etl vNamc'• 'n .i. n_.:r.,. .a. ..:.t.:�.t _._._- -.,__..__" .._ ,. .. - _. _ ., .,._-_,.__ _ .t__..__
y�Q Lc d Address.'_. t ..._. _.
V.Q 1 certify that 1 have read this apps clan and ecu to that the above mrormm on is
•Correct:1 agree to comply with oil city and county,ordin^nces,xnd state laws relating .....
OST) to building con.aructiuq':mbem
d byautboriie mIc.ontatives alibis city a+cnterupon
W m b emend dprpctyf -.pelt npp IN",
N -
at em demn0y dell kipul, nip tithe Cty f&perbm Wg-mnst J
t;abilil,,e,,,3udg ms c J e parses h¢h may any y q.:g�intsaid
V. Cyyuence f the lo t gofrot pe t �c �'IP inNFUNDER5TAN AND WILL C6MPLYWnH ALL NOu'-POINT 1P 1 ( �V V
'_. s tk6e+Eagd , :1 .I i. Issued by: Da
Ign Applr,.dYCommcmrr .' to -
c
roofs
HAZARDOUS MATERIALS DISCLOSURE t
Will mePPlic b orfmurebuildin °eu om stemorhandl haz6uimenulTyPe
/
of Roof.
defin di.to Cupen noM
Codes thpICWe Chapmr9,2 aero Heahn ond5afety _ t _..-_
25N {) d f ''}' • : ns. (r .y+\nr•'!•1 {:- ] 3 ';1It
iQYes 1 _ ak T No ^.:("-.}<4 t t e t o l an
_, ,, ._e _-, --• ,•.All roofsstiall be inspected,prior to any roofing.rnatenal.being installed.., ,•,
wn to applicanto fm nuod gmccup n. eeq pmept device,which If a roof Is installed "without first obtaining an inspection 3 agree to remove
ems haboddlours ail contanninarts a,d Med by the Bay Area A r Quality Management
Dist at / all new materials for inspection Applicant understands and will comply with
C7 t
l Ye f�,. ••. •N°�- "Q . + .-' ''..--" all non-p -_-. .urce'regula[Ions _ _. ...- . .
a read he hbzhddres mchon rtqu rcmenta"under er 6.95 4.4h, -
Cal Toni Sgfety Codd Sections 25505,25A3 end 3553q t un
mlof gdoes urtently have a tenmLthm it is my responsibility to notify """""
pEcupudt of the require -Bis which must he.me,pd.,to i...d.of a Cenificam ofCocia -tY
w y ' • Signature of Applicant Date
o -' — PP .-.._.__ .- __._..
o rte rz o sag ,. All roof coverings to be Class t`B" or better'.
D c.
_OFFICE. .