01050009 CITY OF CUPERTINO - -
BUILDING DIVISION ' PERMIT CONTRACTOR INFORMATION:
BUILDINC,ADD gkibb -'L_UCILLE AVE/CRR ROYAL ''ROOFING , PERMIFNO. " QIilT50009
OWNER'S NAME - + � - APPLICAI ION SUB DNI H '
TRAMMELL` CROW RES. SERV CE' ;1345 VANDER- WAl' — 0511b1./ @01
, .
PHONE: { ' -:1 SANIFARYNO. -p COMI'R(ILNO,
' { (408LO79-2330x- .,
n ix ZO ARCHITEC'DENCINEER:" x { ' - • BUILDING PI?RMII INTO '
w— BLDO ELECT PLUMB MLCII
2 ac, zc. LICENSEDCONTRALTOR-SIIECI.ARATION' lob Description
_ 11 h b it m th I I t licensed nJ , s-o Chapter 9(c annealing '
OZ will,Sr7000) rDi nl fth B e.ad fns C 1 dmylicense
sw Lt serB.f ty� « �LE® REMOVE SHAKES INSTALL; .1/^c"CDX AND 30 Y
m.Cre6 Li CWs�,�`/.�e�' 9 L p 7ig9p p�Q
u'S 3 y Dmc ,'C/ c ntma r Y C'vV e
ARLHI'ILCT_S DLCLARA IL ,
l undershoot]my plan shallh used is pubic re in a r
w o o
Licensed P lasximnal AN 2 4 2002'
OWNER-BUILDER R BUILDf R Df CI ARATION '
u� °• I h reb)aff that 1 e tpt form,the C t r License La f the
!-Z 2 following ea .(Section 90115 H in 1 P fc. Cal A y city",aunty BUILDING
f F O wh ch require. a permit n:true,aIle mpo ve,dv li.M1 r repo r any ntrvciure
imprior,.t ' - , k.bo,inestheppl a O n h permit fit a signed statement t
'hot IN licensed urstallithe paro,mom.ofm Contractors License L (Chapter9 Sy. Ft. Floor Area Val t,
(romnenc'ng with Section 7000)of Diss m 3 of the Basin sed Profeethn:Cele)
or(hut he is exempt therefrom and We W,is for the alleged exemption.Any violation ^
.of Section ID31.5 by any applicant for a permit subjects the applteam to a civil penally .
of but ince man Mhe handled dollar, _ APNNumber Ocbupancy Type
°I,as owner of the properly,or my employees with wages as thei r.sole compensation, 31602094. 00 '
( will do the work,and the.wcmre is not intended to offered for cele(Sec.7011. -
' Business and Profession,Code:The Contractor's License Law does not apply a,as - - •� ( - Required Inspections
weerofPrnpenywinbuild.,serimprove.hereon,and whedoes such .,it himself 305 — FRAM _ .
of through his own emplki provided that such improvements arc not intended or
offered for sale If,however,the building or imprmcmetn is oAd.wihin one year of 307 — INSULATION'
omplet ion,the owner-builder will have the burden of proving that he-did not build or
completion,
for pamnxe ser sale.). I 601 — ROOF TEAR OFF ._
ol,as ownernnhe property.am exewsvety cra"mctin, allamomerd rimmuchas in `502- — ROOF• PLYWOOD NAIL
cnstme,the pmject(Sec.7011,.Business and Professions CWe:)The Coal......s
ame Law does not apply loan owner of popery who build,or improves Remain. 603 : .ROOF' BATTENS:
Gad toted ni ntrricl,for such proems who a matmctar(,)ficensed,parsaaal to the C-04 — ROOF I N-PROGRESS „
Comranoex license Law.
'❑I am exempt under Sec. - .B&P C for this rcamn
Owner - Date
WORKER'S COMPENSATION DECLARATION
• 1 hereby am.under penel(yydrypctjaone of me following redactions:
° m
'
1 have.and will maintain d Certificate of Consent self-insure far Walker's
Compensation, ., provided for by Sermon 37W eaf the Lahr Cale, for the
performance of the toms,for which this permit is issued. _
me and will mainmin Worker's Compenentinn Frearantt,ev required by Section' _
)I 1 of the Labor Code,for the perf°mmnce of the work for which this permit is _
issued,My Warket's Compensation Insurance carter and Policy rummer are: t ,
Carier:/lwarcrAn Policy Nm:5 $]OI
CERTIFICATION OF EXEMPTION FRO. WORKERS'
COMPENSATION INSURANCE - -
(This section need•not ba co e,lmad if the permit is for one hundred dollars
(3100)or less.)
1 certify new in the performance of the work for which this pirmil is issued,1 - -
shall not employ any person in any manner no as to become subject to the Workers.' -
C�mpensati�n laws of Calif aria.Date -
Applicant
NOTICE TO APPLICANT:IL after making this Cerifcate of Exemption,you should i - - ,
Z become subject to mWa
e rkers Comp arroadn m
pvisi°m ou of the labor Cale,ytaus, -
Q Q fonhwim comply with>ucn provisions ser this permit shall be dttmed revoked
-Flt •.�. I ,CONSTRUCTION LENDING AGENCY r
a , 1 hereby alum,that mete is is construction lending agency for(he perfomtamce
Wof the walk far which this permit is issued(Sec.3Wr.Civ.C) ,
L Q Lender's Name
.1. Z Lenders Address
V' Ilenity mat l have read this application and hoe,din the shove information is -
�T. F. correct.1.,me no romply with.11 lily ad ,,only sadinence,and stem laws minting
• Q :..1 to building construction,and hereby authorize representatives of this city to enter upon
W the eMwe-men(ioncd property fear inspection purposes.
F„ L . (We)agreem save,indemnify and keep harmless the City of Cupenin°against
J) liabilities,judgments,costs and expenses which may in any way accrue ugalmt said
C.7 Z City in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS ANDWILL COMPLY WITH ALL NON-POINT Issued by:
SOUR. REGULATIONS. y: Dille
�2f_
Si Ire of ApplicanUContcctdr to Re-roofs
HAZARDOUS Al !ALS DISCLOSURE
Willtheapplicant or Poore Municipal
Wildingrotationalsore°.handle Health an Safely .,Type of Roof
m defined by the Cupertino Municipal Cnde,Chapter 9.12,and the Health and Safety _
Chole,S«tion 25532(x)? - -
°res GA. s All roofs shall be inspected prior to any roofing material being installed.
wRmeapplieantorfuture Wilding occupant use equipmentorde%ices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit haseamous air contaminants as defined by she Bay Area Air Quality Management ,
Distr;c,^ all hew materials for inspection.' Applicant understands and will comply with
°Ye •ri'A0o all non-point source regulations.
1 have read the hmu ode.omens 2 requirements d der255 4.1 ilmun 6.95 of the • .
ifteCalifornia health&Safety Coda Sections 2550125533 y n 25531. understand than /
iflhetion ongd«snanicans ;hick must
met prior myssuanceof a loifica of
• «cupam of the requirements whish roue M me(prior to issuance of a Cenilicme of '
pceapanc)'
o �
gnature of Applicant� Date
Owner! amhodzed agent ate rOo covermgS t0 be Class nB,s Or better
OFFICE -