02050059 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
818605 ADDRESS
AVE COSMOS ROOFING PERMIT NO 02050059
C`Lf_bY6ENGO 1901 OLD MIDDLEFIELD WY AUgCZTeg TL02
U n1�2
(415) 493-6373
PHONE: SANITARY NO.. CONTROL NO.
G re0 0 ARCHITECIYEoGINEER: BUILDING PERMIT INTO
BIL
DGELECT PLUMB MECH
__1 II u u
sF.. LICENSED CONTRACTOR'S DECLARATION
Zip IherebyeRcn that l am licensed under provisions of Chapter 9(commencingJob Description
In t:w with Section]000)of Division J of the Business and Pacessions Code,and my license REROOF
,an,
r ,. T.0 TAR/GRAVEL, RESHEET OSB & 2 154FELT
;0�6 I,-., I F Lic a
73LL a - SDCLAIR ADD 40 YR ELK PRESTIQUE II CORP. SHINGLE
,a O ARCHITECT'S is, cA,t
so
g 1 underhand my plans shall be used as public rtcoNs
i_p O Licensed Professional
T OWNER-BUILDER DECLARATION
m 1 hereby effete on I am exempt from the Contractor's License Low for the
C?a following moan.(Seaton]onstruBulinus and Professions Co de:Any city or county
FF c which requires o permit ro construct,ober,io busts demolish,or repair any structure -
e5m ..thatho licensdpursin,to the provisions
o ter Contrch actors
License
Lawdhaumrn, - 2 1
- Nmheiovings_etlpuisbinuothepioDiiision3,eCammnnesLindPronwonsCode) S FL Floor Area:- - ,�, ation
a Division 3 of Business and Professions Code
(Chapter 9
(rommenring with Senwn,]Igq) f D' 1 t {�r : 1 i.Y.'9.E ON ./c 1'a„)f.i. }.I s C s
on is exempt,any,dm'andor permit subjects
to Anylpenaon
of Section]than five
dollars($500)
xubjecR the upplicammecivil penalty
or not more than five handred daRnra(slot), 375rYMI3i$ttb@l0 • , i Occupancy Type
❑1,as owner of the progeny,ter my employee with wages es their sole mmpense,inn,
will dothe work,and the structure is not intended or offered for sale(Sec.nus,er 305 - FRAME c� n i s r
'B.daeidand Profession,Code:The Commcmr's License Law does not apply to tea 307 - INSULATI ONuired Inspections
ownof property Who builds or improve,thro nn,and who tloes such work himself
or throw h his own employees.provided that such improvements are no,intended or
car of. -,. _._.._____
completion.
ompld on sthe.IChowy4e;the ll have t or urden of
n sold within neje y '”' ' _ '(>O 1 �"_'- ROOF-"TEAR-'-OFF-_-- ,�� -, -
t'a
oprove forJhe own.fWilder will have the burden of proving that he did not build or
improve for puryoxe of sole.) 602 - ROOF PLYWOOD NAIL
- ._.. _.... --603 ---- ROOF- BATTENS' -
-- -
_ pLusowner rojecp(See.7
ani
licensed cmaconstrucmrsin !l;t:;;;yq.,• �. ,,
License,w project(sec. to a,owner
and Rotesmb Code:)The ve statue, 604 - ROOF IN-PROGRESS -
.
License Lew docs not apply. on owner of progeny who builds or seimproves thereon,
_and.who os Urats..forsueh.projmts with.v cammnortq licensed.pursuen'.m the ...... ... .. ....._.. _.__.,�.. ._... _.._. _......_ .._....._....... .,... ......,. .. ..: ....._. ._..
C mructor's Lic<nm Lmw.
Ll I am exempt under Sec. "r t 1 t"l E&P C for this reason "i"['r
Owhn" i:.... . ....:nam
WORKER'S COMPENSATION DECLARATION FINALEO
�e•..I hereby alTno under nearby of pc jory ane of,the following declarations:
( ❑ 1 have and will maim m a Cemficam of Conscn,to self-insole for Worker's
N7u. Compensation, as,provided for by Section 3]00 of the Labor Code, for the O 8002
performance of,he work for which this pc�r ii is issued. , MAY a/ 0 L
I havicaml will ma ,a W A Coinpersation laimance.as required by Section
3700'of he Labor Cade for,hy perform ce of me omk'fimrwhich his pemii is BUILDING.
1 Wrack
rk Is'Co n a,on 1 sum c c e d Pol y mbar ere
..... _.
tic
CERTIFICATI - ._..BUILDING__altyN,. 57/ -0/—//'7�' z r i, +.rt l r ,t
N.OF EMPTION FROM WORKERS, s a. Sl. id.l,r � x.?'�I'44 ,� Ce i. .:
COMPENSATION INSURANCE '
" t (Thsaec,ionoeednot be'campleled if the permit is for one hundred dollars
00)nr less.)
1 c<n fy that.in the performencb'of the work for which this pe ii is issued,I ;(, (; ,r Z, Yl, " '
shall no,employ,any.lieraon in any manner,sa'its m become subject,o the Workers'
R : .Data'
Com elation Laws of California
j wi P ;. g RI'a
ti fonh th complytO1h,hWml,r'Csiris or
vImn . of Exempt 'yo shoulJ
Applicant
NOTICE TO APPLICANT If 0 vk ,h Cnifica
O shot[ the Istio Cod you mus,
bed teed revoked.
•`<'CONSTRUCTION LENDING AGENCY
a ; I hereby'(rich thanker nstiu t u 1 ding ag<ncy Tor the pert rinance
W:Q of the work for which Nu Penn ns asued'(Sax 309'/,Civ.C)
Lender'sName. - - .._ ._ _ .. ._ .__ ..._. .___ ._ _ . ...
�' Lend
D Z Address- ({
V 0 Iced fy thin l h e read ih a applicat on end stet that theno.information s
ta''tr cone, I grey th comply as. th all city and county onfiricances and nam laws rel t ng
Q V to Wilding consimition,and hereby euthanae ropreumatives of his city to enter upon
,.W he shave mcmi...d property for inspection parposcs.
0.t (We)agrte,o saves indemnify and keep barnlesi the City of Cupertino i,mma
W liabilities,judgments,costs and expenses which may.in any way accrue agains,.said v V
U: City in consequence of the g t g of thisarmit:
APPLICANT UNDER N AND WILL( IPLY WITH ACL NO' 0 1
- SOURCE RED[JCA S 5'; Issued by: Dale
9g.n..
_ Sigwtu a of AppheanUC np chi. Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
asdefinedWlli,he a'"licaniwfurore buildin -u[m l store or handle hiedNmis material
ro e wit Type of Roof. _
by the Cuperfinct Municipal Code,Chapter 9.12,and da,Health and Safety
Code Sancti 255331q t ' i t ;', s. Iv.3 It 'c? ?:'p', i.p e'.,
All roofs sfiall.be inspected prior to any roofing material being installed.
wtnmegppiea t r, buJaiegecaapa,use equipment nen If a roof is installed without first obtaining1 a ree.to�remove
em,hainormsa c atter n, as defined by the Bay Area Air Quality Management an ins Pecticin g
!� Dfs'ncP all new materials for inspection Applicam.understands and will comply with
ace pt m s req re
j
s hch
mun_be rip orm¢nloom n
all" o -point'sour-ceeItons i
I hi vad,he hazardous materials equ is uderChapter 695of Ne
CalrmuHeaIm&snyCode,Swims25505understand and35534 I ,
,f,he building does notcurrcn0y have a¢nom thetnhis yrcspansbl'ytoami ,a'
fCnOcate'of '
LLL
Oc
_S 9 OZ _Signature of AoTicant _ Date
All roof coverings to be Class B"or better '
_..
.. .. . OFFICE-. . -
.�.