01060094 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18900 NEWSOME AVE. ROOF GUARD ROOFING CO 01060094
OWNER'S NAME: APPLICATION SUB DATE
JOE KUS 740 W SAN CARLOS 06/15/2001
PHONE: SANITARY NO. CONTROL NO.
�fl� ��3�gsiq (408) 293-9519
I+�i O O ARCHITELT/ENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
azof GJ
8P,=�.n LICENSED CON'TRAC.OR'SDECLARATION Job DCSCIIpIIOn
O ot f-o I heeby allirm Division
1 am tic<ne p under provisions of nsChapter Code.
(commencing
F,Hf. withSeainnetailofDiv" ^}ofthe amessand ProfessionsCad ndmylicense REROOF.
a is sefullforare an, _A
a w J laden>e sass r / a X05 O(o S 2 BUILT UP ROOF TO BUILT UP.
a. Date ummmor
g a. - — CLARATION
understand as plans shall W used a public records
Y
uani?p Licensed Professional
a. o LL OWNER-BUILDER DECLARATION
m 1 hereby affirm That I am exempt from the Contractor's License Law for the
following reason.(Section 7031.5.Business and I'mfe.aions Code:Any city or county
E F o which requites a permit to construct,alttt,improve.demolish,or repair any structure
ce frrT t t .. ce.al. q thcapple tf such pem t fl 'ff dswramenT, - - - - - --
e. thntle I' 1Pnn I th pnv v.. rH co t unr L' I (Chi p c,9 .. S FI FloorArea .•t f ' a Nall 011
(co g HSet ]UWI dUv } fh U :ne: JP t...inns Code) f,.r tl`.•"
or That he is exempt therefrom and the basis for the alleged excmpbnn.Any violation
of Section 7031.5 by any applicant for a Permit subjects The applicant to a civil Penally3:90umber Occupancy Type
of not more than five hundred dollars(SSW). ^t"
❑has rof the pmpcny.or my employ«x with wagesasthei's^le<ompenvti"q _ P Amp
will do the work:and the structure is not intended or offered for sale(Sed-70dU,
Basinesd and Profesdotts Code:The Contractors License Law does out apply to an 307 - INSULAT ItOtWired Inspections
orthrough
owner of property Who Wilds or Improves therea",and who does such work himself _6 01 - ROOF TEAR OFF
or Through his own employees.provided that such improvements are in intended of
offered for sale.IL iowcbcr,the Wilding t n sold within one it of - -- -- - -- - ----- -------
'completion,the owner-Wilder will havel�e Written of proving that he did not buil)or 602 - ROOF PLYWOOD NAIL
improve ro'parpo.e or sam.l. 603 - ROOF_ BATTENS __ _
°I - ithe p(Sec.7 amexdi. ly -r 1.with x 604 - ROOF IN-PROGRESS
°°'r°°' ' FIIVA`LED
instruct the does
h (Sec Ito a Business and Pry i ons Code)The Contractor s
License Law d«s nos apply to a^owner of Pmp<ny who Wilds or seimproves Hereon,
and who contracts for roto Prolcaa with a c^nvactnrtal licensed pursuant w the _ _
01meoprpieendeLSw. JUN 25 2001
❑lam eacmpt under Sec. .B&PCfonhis reamn �� t" '
Owner Date
WORKER'S COMPENSATION DECLARATION BUILDING
I hereby affirm under penahy of perjury one of He following doxlamtio"s:
❑ 1 have etd will maintain a Certificate of Consent to self-insure for Worker's
_ CompSectionW
enxation, as provided for by 9] of the Labor Coda, for the
performance of the work for which this print is issued.
°1 have and will maintain Workcr's Compensation Usmmncc,as required by Section
3700 of the Ir Code,for the- urnunc<of the work for which this permit is
issued.My 'kers Compemmi nwmnce carrier and Policy number are: - _ _ _-, „. ... ....... ...__......... .. .. .,. -.,. _.
Carrier `� Pul icy No.: 'm G S/3 S
CERTIFICATION F EXEMPTION FROM w'ORKERS', - `' t`-s�•.•
COMPENSATION INSURANCE
This section need not W corm.ed if the permit is for oad hundred dollars
(S 1001 or less.)
1 comfy that I.the Isid.nnare,
manner
work for which this perms a issuedWorkers 1 •
shill not employ any person i"any m r so as to become subject to the Wohcri
Compensationianlaws of Colifomia.Darennc
Appl
NOIICETOAPPLICAN"f:It,after making this Certificate of Exemption,you should
Z necmne suhjea puM1<Workch Campensmion proviaimns of the LaMa Code,you moa
Q Q forthwith comply with such provisions or this permit shall l e deemed revoked
FCONSTRUCTION LENDING AGENCY s
C ' I hereby affirm that dam is a c inn^union leading agency for the performance
of the work for which this permit is ised(Sec,}(197.Civ,C.)
0. Q Lender's Name t.su .. . - _ ..__ . ._ ._ ... .
Q.Z Lender's Address (;, s i
C.1 Q 1 cenify that 1 have read this application and state that the above information is
ka.[�.. correct.1 agree to comply with all city and county ordinances and state laws relining /
to building construction.and hereby authorize representatives ofthis city to enter upon /-
'�m fs1 H<uhnve-memionM pmpcny formsprot o purposes.
.Fi G (Wc)ugu msuvu.indemZlyand keep ho tell The Calof Cty,erdr.against
-kiO liablliux,,ddipri<nu,costs and expenses which may,in any way accrue xgain.a said
V,Z City in consequence of the goofing of this parmil.,
APPLICANT UNDERSTANDS AND WILL COMPL W))TH ALL NON-POINT Is b Date
SOURCE REGULATIONS. lft Y'
GSC �(/c .� 6 1'/
Slgnawra of Appllc
HAZARDOUS
Dam ' Re-COOP$
r1AZAfunum MATERIALS DISCLOSURE
Will y theapplicant or
ps"im,umre Wilding occupant Chapter
a 9.12 handle Health
Safety Type of Roof
as defined by the Cupenina Municipal Qdc.Chapter 9.12,and she Health and Safety s m s f
Code.Section sss}+Isla ': . . m• .-;', T ,
❑Yes °Nn- All roofs shall be inspected prior to_any roofing material being installed. -_.. ,_..
Wmu HeappriicantortUtUrChLlildingnacapant a.e egniymenT or eeviae.wnian' If a roof is installed without first obtaining an inspectiofi,I agree to'remove
emit hazardous air conuminams as defined by the Bay Area Air Quality Management
District, all new materials for inspection._ Applicant understands and will comply with
°t°' °`" all non-point source regulations.
1 have mind the'lb.zardmis materials q ement under Chapter 695 of the
California Health nl &Sartay Code,Scct 25505 25511 and 255IJ 1 understand that
'f1hbinding does 1 T flyh it tthtf m p._do1if,t odfy the
occupant f the requirements which musi he' t p ioi my uance of.a Certificate of Occupancy. Slgq Lure of, pplica Date .
.. Owner or auttinnoedagend Date All roof coverings to be Class"B" or better .
'- OFFICE --