00100117 C OF COF CUPERTINO
HEMMING DIVISION PERMIT CONTRACTOR INFORMATION: i
BUILDING ADURIAS0738 10738-1.0740 MAX AV I_ ANGELES ROOFING PERMIT NO, 00100117��TT'].
OWNFWSNAME:14 W014 15310 CALI_E ENRIOL 1'1'I.ICATIONSd114O4T617/2000
HONE: 4087794688 SANITARY NO LL kkJJ// CONTROL NO,
tt]. ARCIII I'I:Ci'IIiNGINFER: BUILDING PERMUr INFO
00
w— BLDG Ii1.liC'1' PLUMEMIiCH
Hj LICENSED COM'RACfOR'S DECLARATION - lob Description
Z� �, I laeeby anion thus 1 an,li'a .I nndar,o,cmunc of Chapter 9(eon iul ndl ng -
?a`,C° wintSe'r,n7111)nfDoi ,5;f In'ine...... f nc„Je. d REROOF WOOD SHAKES TO COMP
m— is in full Imre and cH'ca6-�
z z w License Clan
O a Date (l'�.D6' Commcmr AI
5 w ARCHITI('I'S D[CLrytyA_I'ION
ylentmad loon rIt un J us a¢anus
'p Licensed Prnfce.tonul
r i o OWNER-BUILDER DECLARATION
seas_ I haraso.Scat that 1 am exempt from the C onion Co eLicense Ac law for the
—Z-¢ wo,thxing reason.(.....lion 4HI6,Business andimprove,
ve,demob Code:Any shy or snooty
`$° wh ch 1 - I III t I 'll ,i p mo, I YsIrucmrc
d o 'barb d ..I th J,ficralion,ril ahlxnuuoll Law
-
��`-° mama l rip mold m r cool c Ira 1 ....Co'9 Sy. FL Floor Area Vanua
(commahe is a with Section 71XXn.rhe Division o none Hortne x and ion.An vi Code) °9500
or that he i.campy thercrrnm and the basis fns the Misted exemption.Any violation
of Section lmnacoo us by any applicant for a permit subjects the applicam m a civil penaltyttfn:tlmnnreenn:taradeddollnlassnln. APN NUI�bC
❑1.a.. rpones rr.lcny.. .nr enttrmy«s with wases as theira..le compensation.
4. 00 Occupancy Type
will do the work.and the,wnurc is aid intended or oReml lin sale(Sec 71H4,
Business and Profession.a.le:'nte Cotoraca,r.Liana Lax does not apply to an 305 — F MAI 'ed Inspections
imcs
owner of property Who builds or proves thereon,and who dosuch work himeelf
orz tbm..gh his awn em no,rs,.Pnrvldcd that noel.imp„tvamcuts ort non intended.r 307 — INSULATION
lf,red far ale.If now .the nuilddng o mer.. rnl is sold within one year of
aoplation.me ewner.no mar will hiwa ata hadan„i�.,wib,the,he did a„t nnilan 601 — ROOF TEAR OFF
improve for pur,ow of vale.).
❑Lav owner of IM1e property.inn csclu,isely contracting with licensed conmtnor.to 602 — ROOF PI_YWOOD NAIL.
Lidnnet the pm ,jacl(Sec.7144,[1 atm Prole......is Cnde:l'rba Cuntlr:minr: 603 — ROOF BATTENS
cense law docs and semi,n,an owner of p,,,,r,y who mold,or Improves(hereon,
and who contracts lar such projects with a commemrr9 ucen.w•d pumuant it)me 604 — ROOF IN—PROGRESS
Contractor's License law.
❑1 stn comon under Site .H k P C for this reason
Owner D:aa
10 WORKER'I COMPENSAnON DECLARATION
I hereby m fins under petahy of pr,m,one of the following declaration,.
,7 Lava and will mainland u Cedilicnre o1Corwin m w 14,rra for Worker's
Camp, adi9m, us pntvidcd for by Sndion 3719) of the honor Code, lin the
,if nnnaoca of the work I'm which This parm,In hued.
Cl 1 have and will mains' oder'.Compen.alion Ineurenee,as required by Section
)71X)of the Lu or .!or'he per timnnwa of IM1e work for which mi,permit '
mu'd. r' Co p or Insurance c:micr:.d�Pr 1J1Xj�1 yl,.d rpm L)
Currier._ i'nliry No.: V S U 7
'[R I I IIC•CDON OP EXHIAPT ION PROM W ORKERS'
COMPENSATION INSURANCE
('Phis seer...need nod be....optima if the permit is foram hundred dollars ,
SdX))or Soni
I certify that in the performance of the work for which this perms is issued.I
,hull nod employ any pesam in any titan...or a, ,,become object in the Workers
Comremmion Law,of Callfomiu.DAne
NUII E
N(YllCli., to
e Woe:It.:dmn'nnk'mg tisinswo calif of Exemption.You should
es, ,
twnnnith is
nt m,the\soda's wi,i is.,,his pn..it hall the ee Mor Code you mud
Q 0 Lmhxhh comply win such prmisinn..or his permit shall he,Jennal mvokaJ.
[z" 0 CONSTRUCS[ON LENDING AGENCY
I herchyadilin Irt there nese mnaructiun lending agency or the pe,turnnc
I�
of the work Ibr which this permit iv Issued sec.3197.Cil.C.)
L ❑ Lender',Name
;D 7 LendRa,AJdrt,,
U o I certify that I lance real do ulo-dion and slum that Inc Wawe information Is
neer.I:gra to amnply with e.1 Lilly nnul assn..y'ifornec,and state law,inlaying
O V m
building andrunno.and nanny atohodvc reprceenaive,nftloscym enter upon
the uM1om,n amionnl property for inpc
, aion Impulses.
F y (%'a)ayrteu,save,indemnify and kap harmless the City of Cupertino against
Vi liabilities,judgment, swig and calknec,,Inch may in any way nerve against aid / (�
U 'L City in emwcynence of the gra^tiny of this permit.
APPLY TUNDERSTANDS UILI, mW )MPLYWI'I'HALLNON-POINT Issued by: Date(
50 .9REGULATNt(y S, /—L/'` j•O s._.e—O
Signature of Arprcanl//CCo^dmctn Date Re-roofs
I IAZARDOUS MAfLR1AL1 DISCLOSURE
W11 theapplic:nn nr future balding oc,r, i...c n handle na,.utdou,material Type of Roof
Vat,dr by the Cnpmlino ManiciNJ Code.Cl,,.,,,,o.12.and Ilan Health and Safety
Code.Section 29512(u)I
O Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
avium<arrleamorfrom baillingnecuponl.«eyaip.itemmde,lce^which If a roof is installed without first obtaining an inspection, I agree to remove
nil hummnn.air cnntan onanl,'a dalind by de Illy Arca Air Quality Management
ain7 all new materials for inspection. Applicant understands and will comply with
Dyes °N" all non-point source regulations.
I have read the incautious materials requirements under Chapter 6.95 or the
iCaliforniain,do, Safety Code.Sena Ic 25509.2551)and"al",1 understand that O .
alifornia Hs39x5 Safety
Codeh uvcumn25505, it33 and 25534 it Jymnod i fy the C p ../ 7 ^ Oa
re pan eta rest a ens which.nu.I be stat prior.;,.ounce of a Cmlraam oI nz
use
ignature Gf Applicant' .Dart
amnaAodmO'd --o a All roof coverings to be Class`Bt' or better
agent Data
i OFFICE