01070081 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10492/10495 MERRIMAN RD JIM KRAUSE ROOFING 01070081
OWNER'S NAME: APPLICATION SUB DATE
DESMARAIS RICHARD Z AND LOIS J 2310 DIANA AVE 07/18/2001
PHONE: SANITARY N0. CONTROL NO.
i (408) 779-0704
q O ARCHITECTIENGINEF,R: BUILDING PERMIT INFO
sC
to BLDG ELECT PLUMB MECH
Niro L_1 CJ I__7 CI
as
,S H_ LICENSED CONTRACTOR DECLARATION Job Description
D Z y G 1 hereby affirm tha 1 am licenxd under provi,ions of CM1aper 9(commencing
pmt' our Section 7")of Division 3ofthe BuxineasandProfeeeionsCode.and mylicense REROOF.
a m y is in fall home and t
Emma LiaenaeC coa�armr S T/O SHAKES, RESHEET 1/2" CDX;
nO Dd10 ADD 30# FELT & 40 YR. CELOTEX COMP. SHING
ARCHITECT'S DECLARATION
t g 1 understand my plans shall be used as public records -
Z�
u i o licensed Pmfersirnal
OWNER-BUILDER DECLARATION
1 hereby adfnn that 1 1. exempt from the Cession, o License Law for the
firilm1-Z M which requires
a Permit
]I13Lmer.alter.and Profusions Code:Any city or merry
F t which rt s a non ro conamn,ahem improve.demolish,or rt any strvnurc
ata so issssuarca.also rc encs rhe sham fmsucb uofleasigaef stamm� -_ - --_ .. .._-.-._.__
quirt p: Prov Pau
Ihas hl i5liccnsed pumuvilgto rhe ProvaePons of Ota Conva�cwi's Liccnse Law(Chaprer9 S F.[ Floor-Area nation
(commencing y;m sect;yn]cool or Droismn J or d,e BaUneasaw Promasmm coon f'!)!i f t-S.:q'i t i `.+: $12 9N
,,,,bar he is exempt thcmf,u.and he basis for the alEglJ eserripMin.Any virlatlun
of Section 9011.5 by any applicant for a pcmtif subjects the applicant to a civil penalty A'
se nor more firm five hi:ndred did[o,S5uu. 341L ")1bftir•• Occupancy Type
❑I,as owner of the ppenY,or my employees with wages as their sole compensation, 11
—will do the'work.'and the straaure is not intended or offered for sale(Sec.70a4,
Business asd•Profcxsions Code:The Contranor's License Law does not apply to an 305 - FRAME Required Inspections", •'
owner of papery Who Wilds an improves thereon,and who does such work himself I
m through his own employcex.provided Dat such improvements arc Bat intended or 307 - INSULATION _ i --
.offered for sale:IL however the building m improvement is sold within one year of ---- - - TEAR� - --
completion,the owner-Wilderas ill have rocWrdenofproving that hedid not Wild or 601 — ROOF TEAR OFF ' �NALE'D
improve forpnrpaaofsale.l. 602 — ROOF PLYWOOD NAIL_ __
_ . . . . _, - . it -- -- - SEP -
❑Las oaf rhepropeny.mnexdusivdycunvuoingwhhlicenscJ<umonarsro 603 - ROOF BATTENS 1�'O ZOO1"
.. ., nwne
°nnrvd rhe 10,W.Drolect see.VO ,Business and Professions Cade:)The Contractor's L; r • sy,„
arse Law area not apply to an owner of prolseny who WBds or improves therein, 604 — ROOF IN—PROGRESS
;. ,and who contracts foo su<h.prujccts with a. nvunorl.q.liccnud.Pursuant.m.rhe. _.__. . ._-.. .. ._. I .-r BUILDING - - ---
C nwnar's
License
Law.
Oleo exempt under Sec. .B&PC for Nis recon •:y';•{h'.
Otani . . . Date t •' ..
WORKER'S COMPENSATION DECLARATION
1 hereby afro under Penaltyof perjuryi one of the following declarations:
❑ 1 have and will maintain a Cenilicam of Consent to self-imurc for Worker's
Crmlansminn, as provided for by section 37M of the Labor Cole, for the
p rfommnce of the work for which MIs permit is issued.
Ihate and will maintain Worker's Cmnpmisatimn insurance,as required by Section
300 of she Labor Code,for the performance of Me work,for which this pcmut is
issued MY Work ',CompensationI somice carter am Policy number am
Cart .. �i`PolicY No /-0J'� D ��- `-il P.— iris rtes` 1%%, If"ta_';`••� Il'1 t
.:c IFICAIJUN OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE".".
'(This vliioe need not be completed if the permit Is far one hundred dollars
' 1 rem that in the rfmmance of rife work for which his Permit is issued,1 _ -- - - - �M __ - - •y /< „ , .
•r�' Y• Pc pe• - ra li
.M1a11 riot employ any Perot,
in any manner so s m become subjen m Mc Workers'
Compensation Laws of Cal'd..rim:Data
-Applicant.
T NOTICE TO APPLICANT If,after making this Cedificam of Iominnion.you should 1 -
QO bdco ubjc1mrhx W'mr C prnsat
plshultettCvukYuumost
Sothis'Mc ply with ach provisionsothpe lbdedcd taI
z It
GCY
F-' ` I hereby fErmCOUthat STRLCT10em is a rN NEhDINGction lending a8ertcY for the rc dormaricc
Of the work for which this friat'. s.mN 15c UN] Civ.C.)
0 -- ._ ,... ... .. _ .. .. _ .. . ..
"Lender's Name _ -
� Z �LcnJcr's Address
U. 1 certify that 1 have read this application and ata c that he above information is
�e: est.I ogres o eonuvwith all city. I mmvp•o"Iirm""and state law,mlating
u•nbuildingaonsuuation,iu,d l,ocbyomhor iu m m,,auu,00r dessert,toemvrupun
the atmvementioned property for inspection purposes.
F y IW'e)agrecrosave,indemayand keep harmless the City of Liefinoagain,
rp liabilities,judgments,costs and expenses which may in army way accrue again said
U Z Cloy In emo,muce of the'Braoing of this panni L.
.APPLICANTUNDERSTAND. s'ILhCOMPLYWiI`H'ALLNO�-POI.'�'T Issued by: Date
: SOURCERECULATIONS �1��c� y'
Signature,ofApplmamlCo r t Date,,. Re-roofs
HAZARDOU5.1ATFRIALS DISCLOSURE
7 ^ / — a
Will the appgcwtm forum Wilding ttccupanurme rr hendlc bavmous mammal Type of Roof
asdefired by the Cupertino Municipal Code.Chapter 9.12 end the Heahb and Safety •., -.. ' r'•'r `a'.� , -
Code Section L15321a1':; , eta-•.:r '';. r .. ' •• `.
tore. �: . '. "'. . 'i• . ' • , All roofs.shall be inspected.prior to any roofing material.being.installed.. _
.will the vpprcaat or future building ac=apam use equipment or devices which; If a roof is installed without first obtaining an inspection, I agree to.remove
ami,haxardoW air comami"amv a,defined by the Bay Arta Air Quality Mmugemem
District - _ all new-materials for inspection._•Applicant understands and will comply with
ores f�'�' all non-point source regulations..
1 h tear the haraolotc,irc,cflil, q" t'multai Charter 695 of the
Calf H Ish&Safety Cord Sections 25505 255JJ d 255Jq I orders tend that
If thebuilding Jas ro tl h
must be met prior to issuance of a Certificate
t rh t t my m.po.ilii tyr tify the •�Q
acupa t fifth uircmems wh'ch ficate of
°"°p°"y _ Signature of Ap -scant Date
-'- owner or aamaria e r -r Dae All roof coverings to be Class"B"or better
.. .. _ OFFICE _ _.