01100142 CITY OF CUPERTINO
1 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
10213 MINER PL OLD COUNTRY ROOFING 01100142
OWNER'S NAME: APPLICATION SUB DATE
CHIANG ALEX H AND ANNE 387 UMBARGER RD #B 10/26/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 362-1111
ouzo ARCHITECnENGINEER: BUILDING PERMIT INFO
w F B ELECT PLUMB MECH
a D LJ I-7
v=sai= LICENSED CONTRACTOR'S DECLARATION Job Descripti ❑
I hemby affirm In..I am licenud urdm provizions of CM1npmr 9(commencing
IwFPu with Sttginn7fgg7 of Division3ofrhe Business and Professions Code,and my&emu REROOF.
is in PoII forc<and effc
:ate IicattCaaa 3S Chan I2 / T/O 1 LAYER SHK, INSTALL 7/16" OSB
L Pule/O. z c r, eummmm
�
53�a ARCHITECT'S UECLARA 30 #FELT & MONIER TILE .
•� I understand my plans shall he used as Public recoNa
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am
fiF3ao� exempt sfrom the Contractor's
is Law w for
the
following rennin. Section 7031.5.Business and Professions Code:AnyCiy or county
which refracta permI construct.ater Improve,demolish,m repair structure
t ',s Iramq the pl'am fonucnischoooRleasignartsomm t
I cents parsant Iq the plow: ns M the Contractors License Law(Chapter 9 SS t Floor Area \! ation
(comnnig•ith slid T0hrrDCon3of the Bus esu and Prideasons Cod) 0..t!tti• If',:Stq.` e.Ae 3.c� l.a '\'j,11�i.rl� . $140 }'
or that he a ca ininitheiefmm and the basis for the alit citemptmn.Any violation I
of Section 10313 by any applicant for a permit subjects the applicant o o civil pmahy
of not more than eve hundred dollars(s5hd>. 316�6�'Snb6r0 1� - . � Occupancy Type
❑1;as owner of the property,or my employees with wages as their sole compensation,
'will do the work.and the swctum is no:intended or offered for sale(Sec.70M, 305
0M,
'Busimm,and Professions Code:The Corrosion's License Law seats not apply to an Required 0 5 - FRAME Required Insp'ections'"
u1 through
r of property Who Wilds lir improves thereon,and who does such work himself 307 – INSULATION
th
of ough six own employees.prowneded Ino men improvements are not intended or __ _
.offered omple for:the If,now<vm,the l ave t or i burden
of ms n tela he did one year or 601 - ROOF TEAR OFF
imcompletion,moupose r.hnader well nn.e me bard:or vro�lns that he dm not build m '
pm.er^rnnrpmae^raam.). 602 - ROOF PLYWOOD NAIL
01;as a.clr.ifthe property,�maclusbelycommaingwall recneede^mtmsmt,:. 603 - ROOF BATTENS ;. -
-_ mnsuua he projech(See.1(p(4,Business and Prolessioru Cak:)The Contractor's 604 — ROOF IN—PROGRESS
Licenu Law Pins not apply to a owner of properly who builds or improves thereon.
and who contracts rel n
such prolan with a coronations)licensed pursuant to me. ... . . _ . . . . .. . .. ... .. _ - _
Contractor'scastoff
License Wife
� ❑lam excm sunder Sec. ' ' � � ,B&PCfor this reason 1 'a � - `•�� C/
Owner . . Date S�p/
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjary one of the following declarations:
O 1 have and will maintain a Certificate of Conscal to mlf-insure for Worker's
Compensation, as provided for by Sescalon 37W of IM1e Labor Code, for the
_ performance of the work for which this"it is issued
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700'of the Labor Code,fear me p.(^mane of the work for which this pc.I,is
issued.My Wotkcri Compcsaiion herdlike carver and Policy nymber
c. 'S>f/i ii cp)/: r'pnehyvm: /6 4597- 5
CERTIFICATION OF EXEMPTION FROM WORKERS'{ i-taNt3}. 411E" .f e(+ tr�ljt}j'1) •f.=ii'ItR: •• '•�.. 41
- ,.,.•" %'COMPENSATION INSURANCE'e_"'""
"•(This saction need not Ise complaied if the permit is for one hundred dollars
(5100)or Ihs'.)
1 cenify,thm in the performance of the work for which this permit is issued,l
,hall not employ bny ymeon in any manner s^as to become subject I.'the Workers' ' "• '
Compensation Laws of Califomin.Date
Applicant .. " .
NOTICE TO APPLICANT:If.after Compensation
this Certificate of Labor lode.you mind '• - '
becamesubject m the such provisions
Permit shall the erred Cade,you maid
z O lonhwith comply with such provisions or this permit shall be deemed revoked.
w'Z" CO!, 11 •CONSTRUCTION LENDING AGENCY
I hareby affirm Oat there is a comsturencin finding agency for ITe performance
,i�•Q of the workf hich this perms is issued(Sec 3091,Cm CJ
Lenders Name
U-� Lender's Address;. .. •
U0 I ccm;ly Nat 1 have mad this application and state that the above information is '
r�T+ •e. imiriv.9 agree to comply with all city and county ordinances aM state laws relating
"O•U to budding cunsuuriion,and fiemby authorim representatives of ihiscily oenter upon
,yLs7 the aMwe-mcmionW pmpcnY for inspect ion purposes.., Z
rF. y (We)agme to save,indemnify and keep harmless IM1e City Of CupeNno against
(n liabilities,judgments,costs and expenses which,may in any way aocrve against said
U Z City in'consequcwce of he growing of this piressW' " " "'
APPLIC NDERSTANDSANDWILLCOMPLYfWRHALLNON+POINT' ISSDedb a Date
S U ULATION .�8. y /
T9tIffLr,of Applin - /, - Date Re-roofs
` HAZAR US MATERIALS DISCLOSURE' '
,SYJI•mc applicant or.nue Wilding ecc pant share or handle havdmis partuat .Type of Roof - - - --
esdefnedbytheCupertn M, pal Cod Chpt 912 aadth Halth and Safty
Code.este nzss3xa� w i.'. { f ff "r::� •7..s'1••- ? ':: "'�';' i'0.:h•' ',:('��
❑Tea ' - -' S 1 ' _ All roofs shall be.inspected.prior to any.roofing material.being.installed._
'
Will the zpplicant in far.« ]ding oche,:t u equip,or devices which If a roof is installed without first obtaining an inspection;I agree.toVremove
emit n iounious air contaminants as ddned by the Boy Area Aar Quality Management
DisuieO.: I . . all new materials for inspection._Applicant understands and will comply with
PYA all non-point source regulations. . „
`1 ha e d ite h dous materials req t under'Chapter 6.95 of the
Calif m Halm&Safety CW,Secl s 25505 25537 d 255N 1 understand that _
Tthebuilding d doescurrently have a tenant,that it is y res,hershnfity the
occupantoth imcrmernen tbemetp to sn rf.CRfisinmof
°c-`"pa"` •'- ' " - Signature of Applicant Date
oamhodzed em All roof coverings to be Class"B" or'better
,;,I't.',�' - Date
J'
f : – OFFICE - .. .: . . . . .