02020028 C[BUIIU NG DIaVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10310 MORETTI FALCON ROOFING 02020028
CROEKETT PAMEZA 13088 POTTS DR A02C/�0772002
PHONE: (408) 225-1705 SANITARY NO. CONTROL NO.
MOO ARCHITECTfENGI,4EER: BUILDING PERMIT INFO
m❑ BLDG ELECT PLUMB MECH
osy i LICENSED CONTRACTOR'S DECLARATION Job Description
=� ction7")oftnalomlicenxdunderyyyyyyrovisionsofChapmr9(commncing WINDOW REPLACEMENT/ELECT BOX FOR LIGHTS .
to
with Section]01101 of Division 3 of tnc Busi nd Pmfcssians Code.and my licenx
m is in fulljjyyFF a and effect. •� / c
z K 6 License.CNs. .• LIC.k 7� •SP ZC, l! G
3 a DJte Contract.
E' A RCHITECT'S DE A O
<! understand my plans shall b used is p tic records ✓
Licensed Professional<� MAR 2 9 2002
i E.o o
e 0. OWNER-BUILDER DECLARATION
1 hereby affirms that 1 am exact from the Contractor a License Law for the
C a following reason.(Section 7031.5.Business and Professions Cade:Any city or county $2000
$ o which requires a permit to construct,after,improve,demolish,or repair any stmnure BUILDING
e3z ,pdortotilauencpunurequires the applicmtfor Cc tmmrsLiceo file w Loccgned armen, �• g �3. V1Ya)h. V •.< --- .--
- Matheriii,ingwithSurnitoISHoflyision3lrcCeBusinesLiansetawonsCdi tl �a,,�� !• t Valuation
(c thai be ing with Secbou]oW)ofhe basis o the a Business and (Any vi Code) '1 ti• l'7 V 2Q9•r . N .."� s 1 V i
or that tie is 31.5 bt many ap li and the basis for the subjects
the eaemant to Any violation
of Section 7031.5&I,hundred
for ape;aaubjere me appremtmarmo prnmtr- 101 V010h9DATION Occupancy YP
'.IT.t.m„m man rive bartered dopar.,SIM). APN Occu ane Type
❑Las owner oftheproperly,or my employees with wages as their sole compensation, 102 - PIERS
will do the work:and the structure is not intended or offered for sale(Sec.7015;
Bu'-ess ane Pmfesswns Cade The Contractor's Liccme Law docs not apply to an 103 - -UFER Required Inspections
or through
r of property Who builds or imprneo
vcs thereon, ad who doe,such work himself 104 - REBAR
m through his own employees.provided that such improvements are not amended or
SaICIL the have terimpwemrofi,:hd within-onediotWil:er- .._ ....__—_10.5-..-__ANCHOR._..BOLTS__... ...---., :...._ ..__ �_. _...._.._ .
'improve for p r ownerb le.).will have the burden of proving that he did not build or
improve for pugrox.r.xle.). 106 - SEWER & WATER
r5iasosvner onn�'m n am eWusivei'mmrcfn ithlronxa confrocimr bo - -- -" 202 "UNDERFLOOR -PLUMBING '
- par r<onm gw,
_ construct the project(Sec.]nw.Business and Professions code:)The Comrarmra 2 03 - UNDERFLOOR MECHANICAL! ,
C contrast,
owes not apply to as owner of pm,ny who builds m improves thereon,
and who ontrast,for..such.projects wish a commetor(s).licensed putsmid.o,ibe. -
License W
_ . _.-.-.204- - UNDERFLOOR --- -.__. . ..__ . .. .-.--.-- .
OOlcon escmpiLundcasv�. ,B&rPC for this season 205 - UNDERFLOOR'"INSULATION
net ., '';•Date ..
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION _ 302 - TUB & OR SHOWER
• lheresy alRrmorder perally.rperjurynm.rrnrfollowing d.rlamtmna: 303 _ ROUGH MECHANICAL
0 1 bive'Sm will mammm a CenlBcatr of Co.,,.,1.elf-im.re for Workers 304 ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Cade, for the
p boodance4 the wt„k,rnr Which this permit is issued. . 3 05 - FRAME
01 have and'will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
J]W of he Whor'Carl for the performance of the work for which this p<rtnit is 3 07 - INSULATION
issued.My W rk'/s Compensation 1 suxnce ca anJ Policy number a¢
er [ >�8 308-F ,SHEETROCK ---..•.. .........
. ... '. — _... . _...._.__.
Sr�O/r t / �r o
I -RTIFICATIONOFE%EM ON FROM WORKERS”' .? 11309 % ..iEXTERIOR�.LATHi, p
CObIPENSATION INSURANCE •- _ . - H�---••—............. ....._ __ ...—__.._._.. --
•• h
.. _. ., .. . .._. -0'-s---I;NTERIOR LAT r..
(ThisI,,cI oodred nor be-completed if the psomr is for one hundred dollars 311 - SCRATCH COAT
333= -= ROOF.:NAI'L _, _
,
er fy that in the performanceof thework f which thisPermit IS Issued,l
Shull not employ any person In any manner so as to become Subject in the Workers 501 - FINAL ELECTRI CAL`
s "ENERGY
Appmpc�t„n Laws of California.Date5.02.....-.. FINAL .-PLUMB ING.._ENERGY_
NOTICE TO APPLICANT.If.after making this ceoirmt< fE pt on.yodinouia 503 - FINAL MECHANICAL' ENERGY - '
Q Ohcome subjeo to the Wo ker Compensat on pro nas of th Wbor Code,you mus,
forthwith comply vvitE such provisions or this Permit shall x reamed revoked. 504 FINAL BUILDING ENERGY
Z''4 x,CONSTRUCTION CEN DIN'< AGENCY � 505 - FINAL ELECTRICAL '
C > I n6renr
Mom that them n a constriction lending agency for the perfom aoc` 506 - GAS TEST t n
a,do,work for which ihispermit is issued(Sm.309].Civ.C.). " __
y.Q "Lender's Nome•,.✓..'_._.. ... __r:, .. ._..:...•. �.
5{z Wnq.r.nddre.r, 507_- FINAL' PLUMBING;
' U:0 . I<emryma.'Ina, semis'apphr,donmd,xt�. I .eann„.inr.rrmti.,;ia 508 - FINAL MECHANI�CALII .�
W-E+ cones.I agree to comply with all city and count oNimnces and nate laws mlaling 509 - FINAL GRADE
-' oar, �obuildingconsnaction,andherebyauthoriurcpreientativesbfthiscitytoenterupon 510 - FINAL PLANNING
h h. < b ned. t r ,
(WS) kr n,p cmc fyandk php I. thdol, reap nh.aga1°s` 514
U: - FINAL PUBWC WORKS
W HIb'ficsIdg c. c d expenses both may ,I any y Farnn said O
Z City in conxquence of granting.(this permit.
>kPPL10AST UNDERSTANDS AVD WILL[I1llPLY WITH ALL N'ON •PINT Issued by: r Date
Bt;E'R
St IULOULA.Ty(ONS:- � •r' � 2
lmirKcc&Apvliza Uctim-ntrvrmr C . L WGG111 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will iW pplica t or future Wilding mcupant scomor handle Woncepus material Type of Roof_
as carried by the Cupertino Municipal Cal chapter 9.11 and he Health and Safety
( ( Y -
Cod Se, m15�32O A tlkfi - AI� )ii Ii' l�Y IT. TI -p i",
❑r. ,; �' _ All roofs,shall,be,mspected prior to any roofing,material being installed_. .
. •I
Will the aMile ntorr build g rpt eeq postal o d cea n<n' If a roof is installed'Without first obtaining an inspection; Pagree`to-remove
m,htourdOUB air comarrificants as J fined by theBay Area Air Quality Manag nt,
D,,,r,c,l all new materials for inspection_ Applicant understands and will comply with
❑Ycx - No r .. -
• „• ,,,,,_ l. ,; ' all non-pore[sourcece regulations'. . ,
•
.. 1 have otwi the hazardous materials xquimmenujunoer Chaprcr 6.95.ot the
California Health&Surety Cade.Sections 25505.25533 and 25534.1 understand that
Irn ebuildin dues not curmol have a tenant that it is 'bilis ,o notify the -
.p a r r responsibility v i -
bccupant of the iequircmemi which mutt be tact prior m issuance of a Cmifcme of
.. Occupiencnmh .
, _ Signature Applicant of Aant_ _ Date
y .r,a- 04 Da ... All roof coverings to be Class„B„or better
Owncr . ... .OFFICE. -
x. „_ .. .. _ . ... .-. ..