02040069i
CITY OF CUPERTINO
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BUILDINGDMSION PERMIT
CONTRACTOWINFOR_MA'I'ION-
.a .
' BUILDINGADDRESS:
PERMIT NO.
ASH ROOFING INC
02040069
OWNER'S NAME:
APPLICATION SUB DATE
LAPIN ELEANOR J TRUSTEE
1191 N FIFTH ST
04/16/2002
PHONE:
SANITARY N0. CONTROL N0.
(408)295-7681
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
F.
BLDG ELECT PLUMB MECH
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LJ C_I L.'1 LJ
z LICENSED CONTRACTOR'S DECLARATION
C 1 hereby aRrm Ian 1 am licensed under provisions of Chapter 9 (e mmenciny
with Section 70M)of Division 3 of the Buxineu999nnne Professions Code. and my license
Job Description
sin full forteapd bRca
4r 0
REROOF.
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nx ci'x_i�J� ��.
T/0 2 EXISTING COMP.
93x ARCHITER'SDEC noN ntratemA
INSTALL 30 YR. ELK COMP. W/30# NEW METAL.
5 I understand my plans shall be used u public records
0 Licensed Professional
K OWNER.BUILDER DECLARATION
1 bereby M. tan 1 am esempl from the Conuscmr's License law far the
a following reason. (Section 7031.3, Business and PmfeWme, Code: Any city or county
O which'rcquims a permit to mmunc...1w. imprmc, demolish, or repair any swcture
$ prior toiu issuancevliu•requlmstheapPliew fomuchpemu0o(leaslgoedsummcnt�
-� -----
- out he I ns[d pursuant m tat P i t m of the Comrsames License, Law (Chaps r 9
kommnanq,ithSm n7090)of L) uion3ofthe Businessand Pmfouom Cade);„tq
- — -
F l
S F["Floor Arear :, , '- �,
•.t e •;C i1..I $fj e"ation
or Jia he a evempl therefrom end the basis for the alie(ed exemption. Any violation
,
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`rof Scutnn 70313 by any applicant fora pennirs.bjec. the nDplicam m a civil pcnalry-
'of Hot noreOmitfive hundred d.Z[&,(300).
Ap
36�41P tLrOtlbbt'0 -., :• Occupancy Type
O 1, as owner of the unpany. ur my employcat wish wages u their sole compensation,
,
;wit Eo tfie egrk". and the structure is nat intended -or offered fdTule'(Sac:70047-
Basin.” and Piofeaslons Code: The Contractor's Liccmc Law does nm apply u, In
:` S ,r
305 - FRAME Required Inspections -'
owner of propcny Who Wilds or imprvves thereon, and who does surf: work himself
or throe n his own employees._ provmep.mat such improvements are not intended or
offered or ale. If, however. the building di in stovem sold ooe year or
-._.__..___..3.0.7._..m _._.INSULATION=, __...._...._:.....---..._--......,_
'dompinion, the owr¢r Wilder win have Jm WNen of proving tNt he did nor Wild «
n
moving he did
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6 01 - ROOF TEAR OFF '^ 1` f r'o .<'3: s'
icup roae roar pwrpnx or tole.).
__.-..___..anaexclusi._.-,.ontr..... ... ..__..,__._sed
602 - ROOF PLYWOOD NAIL
❑I:es OwnerMiect(Sec. Of rh� contractingwithadc:)
__
603 - ROOF BATTENS "' °'r`-�-- ----- ---
•- fd.D•�li. _ -„i ICF;
7,un Business he Concmnm
comwnthe and GWeu)The Contractors
(Sec. 70,14. Business andProfessionswho
License oesw
mar mmox= of,with Dropenywho WLicesed
604 ROOF IN -PROGRESS'”' -
whocwdw pmvustnerenn,
-sec IiunsW.puuuanoto.the.
ii ..and.whous
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Ucqu.forsuch..projecu.with.e-cmwncmr(q
Canwaoh Littnx Law.;:J;'O': _dn `.: ^r'3 Lp_'. .,r., '.-'
` ❑lamucmpt.utider Sec,.. Bg:PG fmthL,reason
..... ...... .._.-.
ame, Date
•.' ' WORKER'S COMPENSATION DECLARATION
..._.. _..-'---...._...
- na<ra sere .Bim ot�e.,. � :.
by pntalry of penury one of the rollowing dedanaov:---
FBI'YAs �a.
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❑ 1 have'ua will, maintain a'Cedifideie of Couxetu' io' aelf-insum for Worker's
Compensation,-m-ptovided-for by Section 37M of the9abar Code. -for the
_ performance of the work for which the p unnit a ixmM
, APR 2 6 2002
O I have d JI mpintnn WOTker Compc sauon Insurance. as iyu red by Se,'nion
' 3700 f the Labor Code. for the performance of the work, for h ch, Nt pemut u
towed My Worker's Co pen don Insurance cam and Polity ombe art
pu'LDt�I�
BUILDING.
.
_ ',W� PoLey N'oA(.Li(�) �J °
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_'s le- -i IIT t.•tT ..4"rl t`,.t,
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J' r IZ RTIACAT NOF.EAEMPTIDN OMWORKER50
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-.,.,,,m .c COMPENSATION INSURANCE '_,';,"'_,_'
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(This uatonneW not be eomple¢E d the perms is forone hundred dollars
Ci':.. P t,;la_ ; •i li .,•., •-�M ...
".. I ttnfy thatin Jse,perf e:ee oflM ork T'hieh th pc'I 'tuwW,l
'hall
not employ any pe sa In any manner so us to become b) t to the W rkem'
Compcnsawon Laws of Cel fors: a. Dam
'Applicant!'--''.?_...:..:::.__.__..___,v:::-z_--::._....:_._......-.
_....
;1NOTicE TO APPLICANT:;IL ober maklnP this Ccni@me of Exemption. you should
:. •..
becomeh thelamer
ii
complothe suchpsCoions ortiisPer revoijou'must
forthwith comply with such provisions or this Permit b< ticemetl rcvokctl.
shall
"'CONSTRUCTION LENDING AGENCY •••
U .� -ri" t .,-t- ._._
onl IIt— !,Ya� rltl that thea haconsWctml lending agent :prft perform, ce
t'... J. t(', t
e ofd:e work far which thispermt si d(See 3p37, Ci, C.)
�..-Lcndtrs Neine •.••,: .•••.• I__
.._._._. _, _..._-. _. ......-_ .. ...... ... ....
' Leadcrs'Addresi "
• 1 emify taro I have and this application and state that the above information is
doireciamgrte m comply wid: vll wry grid county oNinancn and sum lows mating
m Wilding mmwnion, and nerttiy auNorixe rtprtsenuavei of this city m wt, upon
J theabovememioned Property for ipspttsion Purponcs.r_--...:..,.. +...-._...
(We)Sgree losevc. Indemnify an8 keep harmless the Ciry of Cupenino
7 h t es, jud meow: cosu and exile su <htmey n a i ey ccmei age asst said
ut said
ry n [ons vetRe of the yfa UnP of lei( crmd
PPkIC0. yT-DLRSTAT A.N OVLPLY s3Tltf ALL �bfi POLVr"'s
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Issued by: Date O'1�
MNr at p ussmr, '•• - - ,:(: ate •.'t.
i--,;' HAURDOUS ' ' �
Re -roofs
MATERIALS DISCLOSURE l .
•:, wul ppOcant m foo WJamg accupmt n ern al n,mmlom a er,.l
. Type. of Roofa.
coed by N<C peruno Mu-epallCode Ch p¢r917 tlJm NNtn dSarry
7. ❑vex Na s f
`, t1 v, I�1.1-'- ---'
7^ S r I Y r
All roofs.sMI.be mspected prior to.any.roofing material. being. installed.._...._.._
c . Wdlds Pplcen'a' 0 It WJdngoccupem q ipmento d «which
..
If a roof is insialled'without first obtainin an echo, I-- rec''.....to-remove
't hued s e cont m nts as def ed b) Ne Bry Art A r O al ry M' geme t
inspection"
g P g
o amcN _
PY x',` e S,^"
_ all new materials for inspection. Applicant understands and will comply_with
, ; ; 5 .. n n
all on -poi •source regulatt
r I�ha x rcd'the hazsNwu materiels regmrtmenu, an&, Chapter 6.95 of the
California IN& Safety Cod'Sections 73303 HSS!ensu3el understandmn
-ifflu: Wil does n
occu en rc stet cunenJY.have tenant that it any responsibilityto noti( the
imme u wase si be met p o'tb issuance of I Cemrcam of
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y
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-.S] a re -of Applicant_ _ Date�T
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All roof coverings to be Class . B or better '
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a• ams 2Wagent D.m
OFFiCc
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OFFiCc