00080092 CITY OF CUPERTINO
BUILDNG DIVISION PERMIT CONTRACTOR INFORMATION:
IW iLDING ADDRESS: PERMIT NO,
OWNTER'S NAhE:1686 NOONRN CT LOS GATOS ROOFING AIILICATION6Ijti Jj.�10092
I WE: SANITARY No 101G CON'IROL NO
PANELL PAUL C (IND JAN C 1771 SMITH AVE . 08/1.4/2000
O C Z. AItCIII I ISC'I IENGINEER: - BUILDING PERM1'f Ed 0
° (408) 358-1233 Bi.DO ELECT PLUN B nn_CH
Q� i I_I .lul 1=1 r=I
Z N= LICENSED CON'TRACTOR'S DECLARATION .lob Description
°e'z rn 1 h,mby aff, Thar I am licensed under provisions of Chapter (corona ring
0 ,vilh Se,tinn 7000)oflZislon3ofthe Businessland Professions Code,enJmylianee
m= is in full force and effect.
z Dare e / p
° I Ila,_ CDECI or
ARCI{rrF:Cl"S IIIiCh ON 3 El
F LL LL"g 1 nmler<tand my plans shall be awed as It c memtd.< INSTALL 0LB FELT AND ^c7 SOS OF HUY B
.—n, Licemad Prolu........
OWNER BUILDER Id:CI.ARA'rION
ce I hemby off nn thn I sun c,Oa,a limn,the Cunlmemrs Lieeme Law for the -
C Z< Iiflluwing ramOn.(Salton 7031.5.Bmincvx Ind I...fic,,w.,Calc:Any On,or cowry
5 x o which o,,mres a pem,il n,eta lrucL slmr,improve.demolish,lar repair any stmamre
i? pHu,to it,i....ncc.ol...v,.or,the applicant for such promo file a signed statement
that he is licensed pursuant In the erosions Of me Contractors Lieen.e Use(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 710 0)of Division 3 of the Euxine,s and Profession Cole)
or that he is exempt therefrom and the basis for the alleged eaempliun.Any violation
of Nation 7031.5 by any applicant for a permit wbject%the applicant to a civil penalty
of no,come than Ove hundred dollars($501), APN Number Occupan T fie
6�
❑I.as owner of the nd the s or my cuiploycev intended
doges fe edfsole nmSec.70mn.
Bal nc the work,and the antaure i%not ctor%<J of a Law for Bale(se,. it)
B viler ox trod ery Wio b Code:The Contractor s License o II docs not apply u, if a aired Inspections
w ofb h,,u y who hylas lar improv'at o,h,,aaJ who ens'such wnrk himselr 35719073. 01(1
ur ibnmgh b l own em{a,cr,11 pmw,ded than nnrh Ira a,OI is eels arc Dol....c ,outrider!ur O /
oflcrcJ lar star.If, r,,vner.twit lin ,cfl m o,di,nvcmcm i.sold within one old laf /C
,mn,Plel'Inn,ma lawnembnEder wilnlavn sur ntlmm�nl proving that M1elm suit Huila lar 305' — FRAME
itnpmvc O,r pugmsc of wale.). �
❑].;is(,suet of pmpny.am exclusively o n ricang stir,licensed coaracmr.to 307 — I NSULAT I ON
Liaomwmat he projat(Site.70,14,Bndnrna and Pmmw.inn.w C„dr:)The Cnntmeln,. 601 — ROOF TEAR OFF /O�
en
Law Js no,appy'h,an owner of property be Wilds or impmm vthereon.
and who Comment for such popwo,with a contrectorRl licensed pursuant a,the
OmtmctorsLicense Law. 602 —
ROOF PLYWOOD NAIL
❑I am es eh in undue Sec. .B d P C mrthis remou 603 — ROOF BATTENS
Owner Dam604 — ROOF IN—PROGRESS
WORKER'S CONIPENSAI'[ON DECLARATION
1 hereby anhm under p hall,of p,,i,,y nor of the following Jeclantions:
O 1 hove rud will n rondo :,Ceflilientc of Cnnscnt m self-insure fnr Wnrkcra
Canlpcn.ml—, :,s .....Will t'or by Seriian 3701 it the Labor Code, fnr the
,,it..rmance of the wnrk for which his permit is I,,.cd.
have and will maintain Worker's Con,cmatiou Insurance,as required by Section
1] 1 of,he IaWr CWc,for the pfloomwe of the work for which this permit ie
isxuW.My WnrkersC Insuranceo7YCT/dnce rani9 JPoliuer are:
Pol,{M eQlCfi�nt• � "/a—Qcy nmb
Croner.—/jVS� CO. Na:
CIRTI19CAnONOp XENIFROM
RS
COMPENSATION INSURANCE '
z3 �
(This section need mol W completed If the p,mir i,for lane hundred dollars
(MINE ur Icss.)
I anlfy that in the focrtimnance,of the work for which this permit is issued,I
'ball no,entple,any peon in:Dry Ioanner so as to become.able,,tat da,Worker:
Cntnpcnxntion Laws or Cltlif rnit.Dor
APP,...a
NO]'PCH'1 D APPLICANT 11;alter makinghi
, w Curoficme or Ex,mptlmnnulJa,Yo.x
bcmtn,wutIje,Ie.the Workers Cnmpmmion pow i,mit the Lal CIA,,youmol
Q Q forthwith cnn,py withsuch is...ion,or this permit shall W deemedrevoked,
V] CONSTRUCTION LENDING AGENCY
71 hereby uRim did,them i'o cnnstmction lending agency for the perfoman. '
of the work for which this permit is issued(Sec.3097,Civ.C.)
yC Lander,Name
5 7 lender's Address
V Q 1 cOnify that l have rood i...:,ppllcxllnn and rur that the above ofonnndon is
kT+
correct I agrcc u,coloply with all city:mJ county onlln:mccs and state law.rclaling '
Q C.7 lu buildin,on,coction,and hereby muhurlmrcprcmntativcs mf this city to enter afoul
the ahnve-ntanicool plopeny lot Inspcednn Purialu,
(We)agree to save,indemnlly and keep hurudess the City of Ciper iou against
LI ✓J liabilities.jn g�,enbnpc
.. .1,and cxnwl 11 id,I(ty'n an say ,rue ag;,insl still
f) City in car n e of the granaryy'of � �
Ii r /}
APPLIC i�UNDE S: PcE H :Y\ I IA NON-POI T Issued by: Date
S /
_)Si a, emApprcanJcmntt-aim— - 8F! Re-roofs
HAZARDOUS MATERIA LN DISCLOSURE
Wlift appream or Imire W'tldiag,.'apatstlareernamdle hroardo,mamial Type of Roof
,s defined by the Cupertino Ntunicipal Code.Chapter 9.12,and the Health and Safely
Cmlc.Section 25532(x)'
oyesNn All roofs shall be inspected prior to any roofing material being installed.
Will'he orph ant ort mtdding oc,npnt use ewipmenl sur arenas whin, If a roof is installed without first obtaining an inspection, I agree to remove
I,
i
cm :¢l Dons sir.....wminanls ns J,lincA by tM1C pay Area Air Quality Mga
nnancnl
c ,v all new materials for inspection..Applicant understands and will comply with
ED We, No all not ie r g latio int sourcS:
I have mind he holurr:(n.mmcrialx requirrnrents under Chapter 495 of the
California llealth&Safety Coda Sections 25505,23533 and 25534.1 under,ona the.,
if the holt not torrent,hagC��n,that it istay tospsm,dolity n,cutily,he
1%CYPa ,f I rCw...c anccl,fUCtn,fi<u1C ;f
$0
/,u� gnature of Applicant Date
law „aalnnei,ed agent D, All roof coverings to be Class "B" or better