01050006 .ICITY or CUPERTINo .
- BUILDING DIVISION, PERMIT CONTRACTOR INFORMATION:
UI
BLDING A DDIOS. 2' ILUCILI—E AV if 91—IM ROYAL ROOFING - FERMI'r(vo. 01.050006 ^.
owN1:R'sNAnu:TRRMMELI_ CROW RES. SERVICE 1.345 VANDER WAY - APPLICAIIONS05jI I/200.1
• PHONE: , '. (4.08)279-2332 • SANITARY NO. CONTROL NO.
COO ARCHITEC UENGINEEN: - ` BUILDING PERMIT INFO
U BLDGELECT. _PLUMB MRCH
LICENSED CONTRACTORS DECLARATION •, « '
Z- — Ill h alfa lie,,1 .•J d (Chapter9( ,a 6 Job Description
'F- 'wnv t ]Ian ID 3atlife B u fp t,add a,yhaense " : RE—ROOF REMOVE .SHAKES & INSTALL 1/2" I
< y,� s full fn IcB `-4— 35-6 IIYALEY ,
gg _ 'q , „ R•fAINTEEA' SHIfdC,LES.
t7i 3 a y Dam . . Ct nmcwr_fL^ p—pyT—
K as 6 La �� ARC,I'ECT'S DECLANArIr�RY�
t a O g y .I fnden,and my Piens shall M1e used as public ovead,
JAN�1 eS 2( Lex002
A
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uC1 , OWNERBUILDER DECLARATION
I marelly ffma 1hat,1 am exempt s theC i a License L for the BUILDING '
FZ�,: toll 6 �(4.tt,]11315 Business 11 2s ,'Cel repair
aay structuflabbyre -
2€C wh 1 q ¢: pe ra t, construct, her,improve,roundish, y mudum
3 -that
h n mqu c.the app)cum foe Cont rmB t file a'ago d:t cement
min 1 dp . y n p arnxanbecatntmna :I el (chmpler9 ` Sy. Pt'•Flooi'Area - Valuation,- -
(enasng w'th Ser-unn]aN11 of Dlvx u,3nfJe❑us'v.•ss anJl,fessm ax Cale) - y .f
of that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Sit 7031,5 by any a,liaanl for.permit subject,the applicant to a civil penalty -
ofaaname man Five laabad danam(S5(g). f APN Number Occupancy Type ''
❑1.as owner of the military,or my employees with wages as their sole compensation. 1 F.PIP17134 `Of
will It, h k,and th ultnote is no,imended or o0cred fnr sale(Sce.71144. -
Bu m c and Ime,xi .is Cot Tha C..mmcarx Liferive I.w dax oat apply man Required Inspections
ow r of propery Who builds or improves thereon,and who does,fall walk himself
r through his own employees.provided mat such improvements am not initiated car 305 — FRAME
offered IDI solo.If,Imwever,the building or impmvan rat ,sold within Ona Year of •- - n, +
n ampleion,daeowner.bunderwillafetheburdetor .proving 307 — INSULATION
improve for'ptupoxe of sale.). - _
s. 601 — ROOF..TEAR. OFF 1 ., ' +..•'
❑I,a,ownaallifepoisonv,amex�lmsdvelyaalttrnctin8wi;hreefxedcoal rnnarxto 602 — ROOF PLYWOOD NAIL
cm-tract be ponder,(Sec.](H4,Business and Plot.s ion,Code.)I'he Committal's
ucame,Law does naapply,nanaware,ofproperty who build,orimprove,thereof, 60', — ROOF '.BAT.TENS
and who'etmmm,fnr amlt midst.wuh a ommnor(,) licensed Pn scant In The .. r-,k_ -
cammnnr,Idttmxelaw .. - 604 — ROOF .TN`PROGRESS '
0l omcxemp,under Sec. .Il&PCfor,his reason
Ovi Date
.WORKER'S COMPENSATION DECLARATION
I reach,dlinn wnl.•r.pcn;J,y of Fe,jary me—I aha tldlawing Jcclarmions: I
0 I have and will maintain a Cerificme of Consent ,o xelf-inmm far Walker'x
Cumpcmalion, u, provided for.by Section 3700-of the Labor Code, for the .
'x performance of the work lir whtoh this permit le Issued. t
{'{��I have wd will maitnain Worker's Compensation Insurance,us required by section
Tx11I of ma:Lahar Cada•fir The performance of Tho work lou which Thi, annit is -
„sued My W�o�rkers Compensation Insurance carrierand Policy number am:: C
Carlegr�,L„EsfiCN.k`Q�Q'nlicy No.:
CERTIFICATION up EXEMPTION FROM WORKERS'
COMEHNSAT1ON INSURANCE -
I flag acetum need I,,,he en;npla ad it the Permit ix for enc If I...I dullnrs-
(SISE less.)
I candy mot in the perfomuaiac of the work for which this parvo t i,i.. x -
shall min employ uny'per,nn in Iury manner so ux m Ireconm xdbjcct m the Wnrkeri _ - - - " .
Comperea,inn Laos of California.Dam
NDI PfipbCIS TO APPLICAM':If,agar making Thi,Cn.....ac of EsmnPlion,yon xhnulA
lasubjectnt the Lot's C ;Pensau...P s of the Labor Crxtc you must '
O
fial ith comply with such provisions,r r the Numil shall he deemed rev lml. -
-4 7 '' CONSIRUC'I'ION 111-NDI NO ACENCV -
�•' I M1 mby affinn that there t construction leading agency for the performance
F>a of the kfor which,h:permit is issued(Safe 31197 C. CI ,
Lender,Name
7 Z Lender's Address - --
V 0I certify That l have read(his application and,nue that The above morroulam is
W f+ corrccl.I ugrec m comply'with ill Oly and caunty'oNinancu+and stem laws relating -
V mhilding tonmmninn,and hereby authority reprezentmivm uf,his cirymemcr upon '
W be nPove-ramitilared lin pony for m peau n p r,ex: ..
L Wl)agree in save,iialforrilyanhA I harallosstheCty ofC1 nlun agairst
rn liabilities judgment. .:and expense,velach T'y in aa,way tileme aBain.,said r f
V C'ry in comme,em,cof life rami,of this'non,
APPLICANT UNDERIANDS AND WTI.].COMPLY WITH ALL.NONPOIST -lssuedb Date
EREDULA IN.
��• '
a'p •SOUR h ° y' -
autrtafApplitanHVG a", Date _ Re-roofs ,
AZA MATERIALS DISCLOSURE
Willme.ppbatime,future Nlndmgac.tpant.tare or handle bu.ademx maimil "type or Roof
as defined by the Cupenim Municipal Cade.Chapter 9:13,and the Health and Safety
Code,Section'553,c), - - _ ,.
❑Yes �. . n{ "qll roofs shall b' prior to any roofing material being,installed.
- Wi)ltheapplicantorfuturcMaddingoccapaniuseegaipmamordex;ce,which If a roof is installed without firsi obtainingan inspection, 1 agree to remove
snit hneurdmu,uuconmmin.nun,defined hy,,he Bay Arca Air Quality M...gamma , p- g ,
Defeat. _ 9�� flCW ittaterials=for-inspection. Applicant understands and will comply with
- 0 o all icon-point source regulations.
I have itaid[he 1 a':1 leas d 1b reg dent:under Chiller 6.95 nT,he
California Health S,cry le Section,25505 d 5571 I understand that
s
I(th buildingJ a t dyl tenant,that
ityresponsibilityt City the /
t I t of the rqu eau which fastb amt pri is nIt,,x •binCan lie 7 4
Ora Oancy.
' 3 2Slgnature of Applicant Date
/ b
own. annahse
goalDate All roof coverings to be Class:`B" or better
OFFICE,..