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00120064 CITY OF-CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: - PERMIT NO. 10775 Iv1INETTE DRIVE TAYLOR ROOFING INC 001.20064 OWNER'S NAME: APPLICATION SUIT DNUi PENNY CLIFFORD 1.853 S 7TH ST 12/11/2000 14 LUNG: SANITARY NO. CONTROL NO. 1 c4081971.-7500 ❑W Z ARCf11TECr/IiNGINEER: BUILDING PERMI I'INFO H,OO B D ELECTI'hUMIi MliCli Hx. L 1 C.1 IJ I—I ¢n F y YLICENSED CONI'RACIOR'S DECLARATION ]Ob Description z= 1 much,fur on that 1 am Iicenxed under provi,inm,of chapter 9(commencing "C.a withSe,lion 7l)O)d Divi,ton3 f he pushes,unit Prokxsio de,and my liccmc ao mlroreeseals TEAR OFF EXISTING TAR 8 GRAVEL APPLY Bf ieen,eQ '?�� q oder Dare1 p;, conimeror GRAVEL. ARCUITECrS UECLARATI F m 1 unJer,,und inY Plans>hall Ire axed ns public Bennis i aO O Licensed Profoxional o u OWNER-BUILDER DECLARATION 1 hcrchy n1'lime Incl I um exempt from the Contractor's License Law for the L z a following reawn.(Section 4031.5.Husine,s and Prauv.owns Codc:Any city orcoun,y which requires o ismoilh m mnamot,able improve,demolish,or moub any amaure w G ce poorI I c I...re,ims1m.,,filarm forlam,Ivenuilt file g ml witavemat '[,at he licerroldp ,I h p if he Comet IL (Cil4 Sy. Ft. Floor Area Valuation comemancinses r that he s emm here l mnwith Section na111 a and basis lir NTo,don 3 of Ilie Busitics-and I e alleged eecnmp t Anyviolation 3 of Section 7W I5 by any applicant lir a Irrout subjects the applicant lie a civil,vmilly of not mom than eve hundred dollars(550(b. APN Number Occupancy`' ype ❑1,as owner of the progeny.or my employees with wages as Their wle comPen,alim, will Jo the work. rid the suunure Is not mended or ulfcreJ for,all(Sac.7094, r I' B.,inc,,,and Pmrcxxion.Code:The Commnor's Licmoc law, ot does napply m an 375320'71 • uired Inspections ox r it p 1 ty WI h ll, it improve, hemor.tied who does such workti self or Il through M1' p ddmbarrel a such en t art tintendedor red l 1 I .11tl building P m h t :: IJ ' ' year ot 305 — FRAME c uPp I, Ih holder lit Ilhctl bas Ip 6that he did nor n 'IJ lir inr,esoc for P m f ' ) 307 — INSULATION olat n property. exclusively nI I Int edt er m 601 — ROOF TEAR OFF cofisrmct11 p I I(Sa ]Iam BusinessandProlessioniGd I lie Courricuarn vl Lcerse Law does not apply to anoxmnof property x ho build,or improve,thereon, 602 — ROOF PLYWOOD NAIL r and .1...contracts Inr suds projects with a unar,enq licensed puNtunt to the 0 Comtmcce,License Lax, 633 — ROOF BATTENS V 01 aa.c.vn,w order See. .11 k P C lar this reuwn Q owner 604 — ROOF TPI—PROGRESS Dal, ✓ WORKER'S COMPENSATION DECIARA'r[ON I hereby affirm under penally of perjury one of the following Jcelaru,ions: 1 1 have and will nminhin a Cenilicam of Cement Io.ell-e\um lir Workcr'x ompmealion, as provided ter by Section 37W of the Lahr Code. for he Perfonmanelet the work for which this ,rail 1,ix,acd, ❑1 have and will maintain W..kur',Cnmlansution lic'manco,m myuald by Sent 371)of he Lubec Code,for he performance of he work for which his p[nn;t i, issued,May worker',Compo Doan....Inmrmce carrmr a.cul1poolliiccyy aammber ore y Carrier-L// CERI'IFICA N OP CYEMPI ION FROM WORKERS MPENS "ION INSURANCE. ('This nation ne d or he rot lined if he perms is fob one hundred dollar, o R)I lir leis.) I coed,that a he ,for a of the work Ian which hi.,permit is i....d.I shall nal oingloy t per n ny ci. ,m Io bee rum whjret m the Worker: Oriental Le I al In Ic _. Applicant_ a. r hunld NO'I'Icl 1 'LI' '1'.II:ober making Thi, cru mora of lixnnpliba,You s M1ecome,ubject oI Workers Cnlmpersolion gmrisions of he Lala Gds You ter„ C Ibrnwilh.Imply thwchprovhiui'or this pmorl,null bedeenmd rmokud, Z ( F• ^ CONS'I'RUCHON[.HNDING AGENCY CL — 1 hereby aBinn l them is a conarvclion hal agency for the p,donal I.one work lir which un Penmi I,is,ucd(Sec.31)7,C,iv.C.1 0. Q Lender's � Z hander's Poll _ U 0 1evrifyl .r I ve read this, plication and state that the above information is CL neer I agree r co. ply wan all yand small ordinance,and scom laws miming Q U robs l i b tme- n,.rdhc.b Ih ri pre m i ca inn: 'rye mrupen he aM I rope Prry 1 1 'lin , 9 W N I S de fY d keep b rml the Cly f C pen ago st V) lud'II J t. p wl h ) any way 6'hn.a. id U Z Cly cre fah s to ft es pc t SOUP( , CN 'RST )s D\ IIICOsIPLYWITH AL NON-POINT Issued by. �7,ar ate 191 v J. mg- plicanuc nlmmor [)ale Re-jirir*on- int HAZARDOUS MAI ERIALS DISCLOSURE the applicant lir I um budding orcupem store or Dandle humidor,claterlal Ty as ddi by the Cmweino Municip/al Code,Chapter 9.12,and the Health and Safety Cort fol^ 5321o)? 43'N ave, _ Alle inspect d prior to any roofing material being installed. Will the zip tea Iorfuture building occupant use ewipmentordevices which If alled wit ut first obtaining an inspection, 1 agree to remove emir Ita'aune. nm sa,del' d by the Hay Area Air Quality Management all ls for i potion. Applicant understands and will comply with 6 yL" all rce r gulations. I has t etc liarud formit:ds mgriarl rimer Chapter 6,95 of the icnokitCalifornia[.] &S. y0 ,t cla me 25 that a is my c,,e,i.1undersmnd that 2 C hernia r n . r yl :ncnu5O5. S 33.,125534,hitityto....and ht � /+euanl d Ices cr xylv4.ynmt be nml Prior m usuun,erfacendieum of D<erpar r m /K—V/) � � // igI atur f Appl cant Date '-'� f4—/!� All roof coverings to be Class `B" or better eaglet maim OFFICE