00120029 CITY OF CUI)ERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUH,DINGAD RI-5956 NOONAN CT FALCONE AND SNYDER (l"VIM:00120029
DNI 11
OWNr;R'sNAUEF-IRER NORMAN H AND LENO 1E R 650 LINCOLN AVE AI'1'1.ICATIfyNJti4!1�4�I�/�21ZIIzI(71
PHONL. (408) 292-9705 SANITARY NO. CONTROL No.
O z ARCIVTECI'/IiNGINIiIiR:
BUILDING PERMIT INFO
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ZOmE 1.ICI?NSEDCOM(RACTOR'SDECLARAHON Job Description
I bereay:tlrn,h tl ,nlr cd mar,pnv at f Clwp,cr 9 m,ara ng
°'�9 wensarn„7gRom'u„ nsnnnean. ,e..anJrme.:,m.Code l yhaeue SHAKE TO TILE
ay ,
is in lull forced nm
1 sen Dlaax � .7D3 -
O a O Da,a Commmnr
ei O G ARCHITECT'S DE CLARAl'ION
1 undmiand my plans shall he used as public mends
S5 Liaarscd Pmm"ianal
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OWNER-BUILDER DECLAItAT10N -
u ^_ I Mtnby (See that at Easiness
n ITInn the Cantrac Co Llccme l,uw fur tea
Z S whirl,re
rcawn.kation 9000rtil,r nc,, and Prnl cxxions Cod,:Any city lir county
Which its issu.'1e,altil toplicas the m,er,il„prn such
Jtlm,r.t,ire a signayxlme,Yrc '
se that he
Parallax ill
lhovisioso for Conamemiuonlese LawJ.htensm
moms la ingwitpumuannomeprDivisinrtillCmnmsinessloenscWwtcnalner9 S FL Floor Area V•II ani
(it that
is exempt
t therm 7000)orthe
basis o t the le,ed ex and!mp ion(Any vi Cote) y' $�d�J8O
of Sec M i7 exempt tnereftnm and the aper.for ah%aHcgN exemption.t.Any violation
of Section7031.5v hundred doll for apermit mhjcc0 the applicant mucivil pcnahy -
nrran mme,hunlivahunJmJJollors(SSg). AP�! (Itkle�'FrE,. 00 Occupancy Type
ClI.a,o.n,lof,hc pmpuny.mmy mnploym:.s with wuga as lhcirwAc annpc.nmiolr. t�] `7�
will do the work,rad the shucmm is no,mended or ott,md lar rale(Sri'.7044,
]Inxincxs and Profession Cod, I'hc Contractor's Licmne Law does non apply to an equired Inspections
rof propeny Wilt,buildsoc re
hopumen thereon,and who does such woe himself 305 — FRAAE'
u through his own employee%.provided that such homwenma,art no,inmmled or
unlod for Bale.D.however,the Wilding or mnptwmorm is cold within one year or 307 — INSULATION
ompletion.,henwnerhuild,will hmnme burden ofproving that he did not buildar
rival601 — ROOF TEAR OFF
for purptua of Baled
0 Las owner of the pm,isert,.am exclusively contracting is th licensed Counactor,to 602 — ROOF PLYWOOD NAII_
Cnxnnct the punct(see.70,L1.Hmhmxx:and Prmessions Cuda:)The Commm"` 603 — ROOF BATTENS
lem"Law dna nil apply m run owner of property who mads or improves Ihemoo.
mid who contracts ton such pioeris with a amltraelnnx,rcaused parsmtnl to the 604 — ROOF IN—PROGRESS
CCl
I am exempt
Law.
I ala eaetnpt duller see. .n x P C for this reason
Owner Date
WORKER'S COMPENSXrION DECLARATION
1 herety a0irm under pra n ly of perjury nuc of me following:Ieclmationa:
❑ 1 have and will nhllnmin a Cenifcme of Conw•nt It,pelf-insure fill Wader'
Canlpensa,ion, it, provid,ki lar by Suction 37(h0 of the Libor Coda Int the
I,crfnrm.mu.ol'the work or welch this prrntit is Issued.
❑I have and will maintain Worker's Compensation Insurance ax nariald by Section
3700 of,he Labor Cale.for the perfo Trance of,he work lith which,his permit is
issued My W akm,Compensation Inmmna carrier and Policy numM7r r: O
Ca � IIIC I(NCIF F.Policy '10�1�6N FROM 5'
COMPENSATION INSURANCE
(Tin,a,fov recd net be completed if the tcnnit is lot one hundred dullurs
(511),11 or los.1
1 cenify that in the Ierlbrm:ume of the work liar which,his Permit is issued,I
shall not employ any person in any manner stn as nr sternum subject to the Woderi
Compensation lane of California.Data
Applicant
NOIICETO APPLIC\N 1':11:after making this Cenilicalc of Escm,hum.you should
Mcome subject In the W..Isms Cnni,mminn providing of thWmo
Ill,Who Code.You t
Q Q
forthwith comply with wch provision,or this Perini,shall he deemed revolted.
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t"a
CONS them a can'LENDI ra AGENCY
a 7 I herehy ulllrm thin there is a mmlmclioll IvnJing ugeney for tea perl'nnnunoc
al the wad I,,,which unit rys ni,is Ie,a.d(Sec 9047.Cls.CJ
0. p Lander',Name
= Z Lcndcr'e Address
V 0 l amity that I have re:d,hi%application and%mm that the above infatuation is
Gs. E.. eorraa.I agree to courtly with all city and county ormamees and state laws relating
V nr Funding construction.and hereby authoriLe reprexem:nivo of this city to enter open
y R the ah,vcmeatior al pngN,ly or ampcmion Pu toga.
.r os (We).,,,a to save imluntity and keep r, less one City of Cup"Ina)against
rn halulhic,jadbmcnl s,cnelx:IIId uxpunscs wln'Ic1,ol:Iy ill Itlry will tic cmU u aro”sai:t
V Z City m rcnsumencc 0 It.glanGng of,Ms Pauli.
APPLICANT UNDERSTANDS AND WIL 6mPLY wI'm ALL NON-POINT Issued by: Date L V�
SOURCp Atl�o Ot �/2_Due
Signor p r mtatn D-te Re-roofs
IIA%%RDOUS MATERIALS DISCLOSURE
NVl iamaP,IwiwI lir f mrt Wild a,occupant vom'or handle Wolin nm mown,il Type of Roof
as defined by the Cultcnino A ipul Qde,Chnp,er 4.12,unJ the rleul,h unJ Sxfny
Code,Sonia 12553fluyt
OYc, 'Nn All rool's shall be inspected prior to any roofing material being installed.
W'dl the appllciIII,or Poiare baikiagoeeupam nw eam'ipment or drviccs which If a roof is installed without first obtaining an inspection, 1 agree to remove..
con,hounlnus air cnmamivasdcf..cd by the Buy Area An,Quality M:umgemm�l
. Dison", sa all new materials for inspection. Applicant understands and will comply with
0Y" all non-point source regulations.
1 have mad the hararduux Inatedals requirements under Chapter 6.95 of the
California Heath Rr Safmy Code.Sections 25505.255.13 and 25534.1 understand that 7v-1^
iIthe building duam
es no,currently have a re ,that i,is my reaptmi dity m notify the /2,S—�-d0
(0.jYa'j'pam�m �/nyuirtntenu W Hien ,ml he Incl prior m i"mmce of a Crnllicatc of —� c
Z Signature of Applicant Date
Osucrut authorial a'ca ]).,aAll roofcoverings to be Class "B"or better
OFFICE