02010065 CITY OF CUPERTINO '
.Buu.o;ccutvistoN!,,,.. +: ' ;PERMIT .' .' ,CONTRACTOR INFORMATION:
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BUILDING ADDRESS: PERMIT NO.
6352;MYRTLEWOOD . DR" CAL-PAC ROOFINGn "i' -'r '' i =02,010065
_• OWNER'S NAME: - - - APPLICATIONS/DATE
:LEE. .STANLEY 36 RAILWAY AVE ' 01,
1 15/2002
I�PHONE: (408) 369-7444 SANITARY NO. CONTROL NO.
F O C ARCHITECT/ENGINEER:
FC ENGINEER: BUILDING PERMIT INFO
inY I, BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
Sv 1hereb' RrmNm1amlicensedunder of " - - =JobDescr. . -
i lS=C )a provisions o P B L
:�w with ball
](p0)of Division3 of the Business and PrnfeaionaCWeaM my license T/O (2) ROOFS/ INSTALL 30 YR COMP SHINGLE
.z y ix in full foac and,¢fl
O a U License Cla _L .' R—-Lic.a'
Da, Jf O Cunuamr
t u O G ARCHITECTS DECLARATION '
u0 5 1 understand my Plans shall W used as public records •_I, ,I�,I .
i a
Ain Licensed Profenioaal - . . . .. 11':' , .• it ._
c� OWNER-BUILUF-R DECLARATION _
_ 1
hereby offinu thm 1 v empl Fran the Con oco,,License Law for the
h x following riasw.(Section 7031 3.c.
acid Profes•ions Gide:Any city or county $8170
L S C which requiresTimor t construct.alter.,mpro demolish. p y structure '
w3 .pna i I q rhe pPlkantf hpc u0f1 grcd ,m t
, $;q.p t��sHH pp..rrGPvv�•1
atho rn n
I' dprx5nothcpro onofmC wt sL W (ChC !9 Valuation
or
Bud b g rrh t o efrom a)of D I:o 3 Tthe alleged
xemp&
or NW he a cxcmbt therefrom and or bans for thects,he cgemptron Any l violation --- - — ---- - - - -- - - - - -- - -- -
ofStttion103P.5 v any applicantfor a Permit subjects rhe applicammacivil penalty"
nrnntmnre,WnbwehumaredamlarsasW). . ''•_"• �.PNl - '> OccupancyType
❑I,as ath er nf,hc mpthe s ru mY emPloyeex with wages fared for s le(S a-70,l -'
as t _ r
� -wilyd0 the work:antl9he structure is'nol'ibtendetl of offered for sale ISec.']6oi;'
Buiiness and Professions Cole:The Contractor's License Law docs rim apply to vn 't 601 - ROOF TEAR]u(J)Mnspections'•'•�'1•�
owner of property Who builds or improves hereon,and who docs such work himself 602 - ROOF PLYWOOD NAIL
:: onhrbugh his own employeesprovided thnt such improvements aR no,intended or
offered fan rale.If,however,the building or,mprowcir,m is sold within one year of - -
completion.this owner-Wilder will have the burden ofpmving that he did not Wild or 603 - ROOF BATTENS
imp r..a for purposeouala). 604 - ROOF IN-PROGRESS
..:. ❑nsmowner the property,am Business
contracting ICudensncommcmrsm _.-
Pr p r r eon g wi ..
consumer the cxproject(Sec.]loin Business and Proany who
endo:)The improves
Contractor's
License Iso oar not apply man owner of atopen who) lids or seimproves thereon,
and who,contracts License
for such pmjttb.with a comrxmr(q licensed pursuant m.,he. .
Commcaso License Ww, I.
❑Ism eumpt under ser. '' � � -.B&PC far this rtason
Own Dole
WORKER'S COMPENSATION DECLARATION
1 hereby offirm under Penalty of per3 ry orze or the follow ng declarations:
❑ 1 have and will maintain a Cen firm, ,f Consent , .ulf'n...e for Worker's
Compensation. as Provided for by Section 37W of the Labor Cede.,for the
performance of the wuA for which thio permit is issued. -'
'IL
I have and will maintain Worker's Compensation Inxumnces as squired by Section - _ _ -- s• i s " �m
]W of,he Labor Code,pursue performance of the.work for which,his permi,is
issusation My
ed
Cemery�Wpf.� I. Policy number are
i, Policy
FlsEXEMPTION
tCERT
. ...- .__... .
COMP A TION INSURANCE.•
• '(This'uaidn nesid'nut be completed if the permit is for one hundred dollars ', •' -
,
piIW)orlasxJ -I . `t l
.. 1.
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mfloy an in theperformanceors rk forcome ub ct to t sxued l •, .y{t;xt . i
shall nti employ any person m any Winnerto become xub3tt,to the Workers '
Compchseiion Laws of Celifomie.Dam
N APPLICANT:If,cher making this Certificate of bf Exemption,you should
Otiicome cume su ubje6,to the Wuiker's Compeiuution provisions of the Labor Coda you must
forthwith comply with such jrovixions.,,his permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY'
I hereby dr.that Nei,is a construction lending agency for the pedo mencee
W 0 of th<wnrk for which this prbrnil isaucd(Sec.3n9],Civ.CJ ' �,,• - -._
Leo derx Name,." .a,.,. ....r .. .. ... ... - ..-.
z Lim e,v Address
V 1 certify
Rud'
have rtad,his applicmion and state that this above information is
W E.. Innen.I agrte to rum:andwith all city and county ordinances;and state laws relating /i O
Q [� to I.hl ng e ti coon and hereby s thonrt rep n,mives f thcity to n,r upon
} Fal the aW a mentioned d suit,t,nd for n pp do p rpm:lr
s.
pa, (W) g u,sa indemnify okeep ha nthe any City fC p against egmnn
Z Ciiy t ) tlg o,c t d pc s h h y in any y said
C.7 z shy c q R th gat Ag f thin pe , 6 Z
APPLICANT UYDERSTANAM1DN ILL C MPLY WITH ALL NOPoi T" Issued b Date
SOURCE REGULATION f Sd y'
Signature of ApplicanUConwnO '!" " '. .. DaTc Re-roofs • •. . . t n:- ,
' HAZARDOUS MATERIALS DISCLOSURE
W ll the appl cant or fu,re ba lding a pant start a handl card...6hom Type of Roof,-
as defiled by th C pcn nn Municipal Od Chapter 9 I] and N Health end safety
Cod S ,on 2553]la) �. , .• q .-•t •. - ,
• 'oY, All.roofs shall.be:inspected prior_to any.roofingmaterial being installed.. - -
WintheapplicantormwreWildingoccupantuseequipmentordevicaswhlch If aloof is installed without first obtaining an inspection', Pagre&6 remove
emit hazardous air contaminants as derned by the Bey Area air Quality Manage9ment . I
District? 't i all new materials for inspection.-`Applicant understands and will comply with
Owe,
- — . . _ .. ._.._..
A .P all non-point source regulanons.
`I✓ 1 First, d the hatordouts'notterials iiquirementiunder Chapter fi 9n he
61iforri.Ruth& Code.Sections 2550525533 and3553s.1 ad radhan
if[lie building
does-otcureptlyh brown.that
itis yresponsibility l ufy the
VIvinI of the beenre s which mast be mei pricarm issuance of a CenEce,of
5
r
Signature of App'llcant Date
.:
Coma,nr amhon=e
Dole All roof coverings to be Class"B" or better'
OFFICE -