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03060159
CITY OF CUPERTINO BUILDING DIVISION PERMIT ICONTRAC4TOR,INFORMATION ;; BU ILDING ADDRESS: ROOFCO OF SILICON VALLEY PERMITNO03060159 9A91 Mp�R(-7T)ES OWNER'S NAME: 844B EARLE AVE PERMIT Issue DATE ONE: (408) 795-3335 SANITARY NO. CONTROL NO. ARCHITECT ENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH IOOOO ' LICENSED CONTRACTOR'S DECLARATION ]sub Description i u� I hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing with Section? M))of Division S ofdd Profession e."Orylieuscia me a infuflfoaodefen. -34""N —7.7s[JREROOF License CI fe. e=p Dalc unemlar ny �/ A HITECI' DE M�I'C�TION y�Gn VO C(,f ��` _ p )E u aJFundcr II c cJ V / ALEQ5 1yU (� i sOh LucnuJ Pn euional 3 Oat I am exempt room DECLARATION f�'S j�2 1 Wmhy affirm that 1 em exempt Trent Je Comnaph License Law for the JUL 1 9 ZO03 -00 following reaon.(Section TID1.5,Business and Professore Code:Any city or county 5 m which ru tures A permit un Conswm,she,,improve.demobh,or repair any mumum _Z< prior to its issuance.also MiRims the applicant for Amh permit to fitcasigneJstouuot E O that he is licensed pursuant to the invisinmorthe ComrscrohLt.. aw(Chapter 9 Sq. Ft. Floor Area BVIf.EYiilliwon Yrs-$ (commencing with Section 7")of Division]of the Business and Professions Cmle)or tl� that he is exempt therefrom and the buffs for the alleged exemption.Any vloladon of 34222090 . 00 Section 7D31.5 by Any applicant for a permit subjects the Applicants o A civil penally of APN Number Occupancy Type - not mart Nan five hundred dollars($500). ❑1.As owner of the prepcny,or my employees with wages u thein sole compensation, will do the work,and the swnum is not intended or offend for sale(Sec.Nikki.Business — Re aired Inspections And Profession Code:The Cman cmr's License Law does not Apply man owner of 307 - INSULATION g properly who builds or improv memon,And who does such work himself or through his Own employee.provided that such improvements an not intended or offered forale.If, 601 — ROOF TEAR OFF however,the building or improvement is sold within one year of completion.Ne owner. builder will have the burden of proving ren he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL ale.1' 603 - ROOF BATTENS ' ❑1,as owner of me property,am esclusively contracting with licensed conuaeton to 604 - ROOF IN-PROGRESS construct In pmject(See.]0414,Business and Professions Code)The Contractor's Li. cane law does not apply to an owner of property who Wilds or Improm Ihemon,and who contracts for such pmjecu with a consncmra)licensed pursuant in the Contractor's Licence Law. ❑l Am mention under See. B&P C for this moan Owner Data 13011 WORKER'S COMPENSATION DECLARATION I hereby Arfum under penalty of perjury,one of she following d CRWiou: have and will maintain a Certificate of Consent to self-Insum for WorkehCompm- n,u provided for by Section 37M of the labor Code,for the perlormanec of ted for which this permit is issued. have and will maintain Workers Compensation Insurance,a squired by Section of the labor Cade,for the performance of me work far which Chia permit is Issued. Workel Cnmpematiun Insunna rtier and Policy number em: s�yer. //// � Policy No..05 6r" LUx'f V CERTIFICATED EXEMPTION FROM.)YORKERS' COMPENSATIONINSUR E t (Phis WCHOO and not W completed If the permit is for one hundred dollars(g1IX)1 or Ices.) 1 unify that in the parfl mmnce of the work for which this permit is Issued,l shall not employ any person in any manner an AS to become subject to lM Workefi Compusallon Laws of California.Data Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become object m the Worker's Compensation proviaiona of the Labor Com,you must QD roMwith comply with such provisions or this permit shall W deemed mvnkc4. r CONSTRUCTION LENDING AGENCY 'rt I hereby affirm that mere is a comtoACI1m lending agency for she performance of Ki> the work for which this permit is issued(Sec.ID91,Co.C.) W� c Lender's Name 7 z lander'.Add.. //(Vys//.//_/•}/(�// U Q I Certify mal 1 have read this application and sum that the above information is 0 l7' cuildin l Agree onstoio co,plyand with y auth and represountyentatives ordinances of and Cede port r upon the D U RhOsengcosoned on.and hereby Aumon p repmsenmliv of this to enter upon sed W ahovomeminned property for inspection purposes. 0. (We)agree to save,indemnify and keep harmless me City of Cupertino against to) liabilities.judgments,costs and expenses which may in any way acme gainat said City U z A conscquencc of rh 'VSTA g of lhll pe u. All ICA N RSTANDS A ILL PLY WITH ALL NONPOINT Issued by: Date /Al� SOUR[ I NS. Re-roofs re oJ'Applicanot/Comelictor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum Wilding occupant stow or handle hanrdeus material a defined by me CuPMOD Municipal Code,Chapter 9.11,and the Health and Safety ewe,oro 25532(.)' All roofs shall be inspected prior to any roofing material being installed. W ill ted applicant or f�turrle.Wilading occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove us Air cnnumin.ntsa ensu by the Bay Area Air Quality Managem Al all new materials for inspection. se rev the haaaNrms materialsrequiromeu underChopterd.95 oftbe Califon Safety Code.Satiom ZW5.1551J an SN.I muscmand that ifthe Wildinge y hem A tenant,that it' my hi 1y m notify the occupant of the too atbcmclpd eau nifiumof up cy. ,g' nature of Applicant Date .thomcJ Agent os All roof coverings to be Class"B" or better CITY OF CUPERTINO REROOF �' 3 ° �' o � 1 7 CUPEkTINO PERMIT APPLICATION FORM APN# / �� Date: b Building Address:' Owner's Name: n� © r Phone#� `�- Q1 -7 79�Lj Contr or: JJ Phone#: icense#:J / D�Cu ,s: , a u Z99 55 �17U743 Contacne#: Cupertino Business License#: 73 76,�;Ph� 223 Type of Roof Covering: Existing: Proposed: �Buill-Up Roof ❑ Built-Up roof . ❑ Asphalt Shingles )(LAsphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles 'fie,Other(Specify)�r,LX ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: p1Z Get— t`jCtNC� 7�j ,7�I371—ALL WE-(A) Ct]p Residential q Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any re tcti LJ Cost of Project: (�P Type. C ruc ' n: Occupancy o tt.�ll/VV r Qty. if ApplicaKe, Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING ULBSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING