00070016 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERb11i O�
OWNlilt'S NAME: APPLICATION SUIT DATE
7918 OCTOBER WY LOS GATOS ROOFING 00070016
'UNE: I SANITARY NO. CONROL NO
TSUNEKAWA TATSLIHIKO AND OSE A 1771 SMITH AVE 07/06/000
O z i ARCI{ITECULINGINEER: - ❑OILDIN ;PEItMI"I'INPU
m O C - BLDG Iil.14M, PLUMB MliCll
a �. /S`2-.� Q�.¢�
(408)358-1233
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LICENSED COMRACIOH's DECLARATION
z 8 w, - I nerenr amrin stat l a1,t peenxea onrmr pmvlxlol,x orehllprer n felan,raenuing Job Description
Cy;� with suer ion7gN1)ol'Divi.ian 3uflhe B.......and l'mtellinnx Cala and toy liccroe
y^ is in fall force and elrca. 'y 3�' '
z z S rule c Cl L3� Lic.«_T 1-{]a(I_ /� /
6 0 1,y Dme //(� 60 Cammm�la. /=off A""j1IS .
a / / ARCI{ITLCI"l U1SCLARATION /Qed�(>
J I understand my Plans xnau be n>ed a.public rcemax RE—ROOF
ac w¢�' Licenced professional - /
w6_O O�
I-o m ONNIontBUILDER DUthe Cum ION
m I rea....(lien on 'inn cBu,in from the Cask.,C'S License Lnw for the /
( Z O fallowing rcasa,n mull t 7D15.nosiness Intl improve.
demolish,
h,tar Any Illy nr manly T/`� �/-/ / l� 6
E n o wh¢h req - penult t .I 11 fi d I sh rep r'I nun; �«i 3 -)/y— �/
It.,h r n Is. I thepl l' t t h pe in file 'g J Clu nem
.,all Mthsw n70 P ind3 c 1' t dl L (u lards Sq. Ft Floor Area ValDatiol3G�
(comm enc ing want therefrom
anofhe Sion3of tealegedxs.md P(slfAnys i LMeI
or hat he in exempt tm,a,pii and the basis for the alleged".¢endo or Any viocaion G
of but mo 7UL9 by any hundred
Lunt but Pump xuhjccls Jin nPPllc:mt nt r'i'd Penalty
nfnntmorcmanrvenawmJJouaR(ss(n). / APN Number - Occupancy Type
❑I,ac, num dtoe pru,W..onny am,loyecx wish wages mdmi rode eomnensafnn. �U
will Jo the work,and the.nucwrc is nal intended ar offered for sale sec.7194.
Business and Pmfe%%ions Crdm The Comba s License Law does not apply to an Required Inspections
uwnc
r of progeny Who hinds or improves Ihercnn,and who does such work himself
of through 141 own hu Plnyut,pmddm'mm noel,improvement
memo ate nor one yea or 3621.3035. 00
completion,
for sale. w er milder
the building or urden of
n sell within one year of
oalnpininn,the ownarbuilAcr rill have tM1e M1nrJcn of proving that he did not huildo ,
utprnva far par,aw,of sale.). 305 — FRAME
❑I,its owner of the pmperry.am exau.ively amtmvang with licensed cdntractnrx'" 307 — INSULATION
myruct the prnjc t Isco.7194.Bulbous.unA PnJ'esxmis Ceders Th.Comraetors .
Licen.c I,ov does rad apply m o n owner ul propcny xmo Huila,lar unproven levrcer. 601 — ROOF TEAR OFF
and who common flat such prnjens with a contmetnr(s)fven,eJ punumnt to the
Cammnars Liecasa Law, ' 602 — ROOF PLYWOOD NAIL
❑1stn exempt under see .It PC l its 11111 really'
603 — ROOF BATTENS
Owner Date
WORKIBCS COMPENSATION D11cl.ARAIION 604 — ROOF IN—PROGRESS
1 hereby affirm under pewhy of perpar,one of the following dedamtione:
] I have and will main®in a Ccnilicmo,of Comm or self-in.wrc far Worker'.
'ompem:ninn, as provided for by section 3700 of the labor Code, for the
pcd'oo,.o scr ol'thc wod too,which lis pcmoil is oeamd. ,
❑1 have and will maintain Worker's Compcnation pomace.as reyuiml thySection
3700 of the Lubar Cade,far the perlbrtnanec of the work for which this permit is
M ur
iWade tial Int and Policy no four are:
issued, i f pyo c�78U;rSBaeoo238�00
Carrier._
CLRI'IfICAI'ION O17 bXEMP PION FROM WORKERS
COMPLNSATION INSURANCE
('rhlc aceban Hua nm be cn.nplomd It the Beni,is frr.me hulWmd dull...
(5103)lar loss.)
I certify that in the performance of rhe work for which this permit is issued.1
Shull not enoploy any person in any manner so as to become subject to the Workers'
Compensation lows of Califumin Data
Applicant
NO IC17 I O APPLICANT, If aftcn udau'this Ccniticmc al"Usenoprio.,you should
Mome.object m rhe Worked Compensation provisions of fhc Labor Code,you mm3
O O fonhwith cmnply with such provisions or this parrot shall he deemed revoked.
Z N CONS'IRUCtfON LENDINGAGENCY '
a ; 1 hereby affirm for tlmm is a comaunion lending agency for the purfomiance
o(1hc work for which thin permit is iswcd(See 3097.Civ.C)
LLender',Name
7 Lenders Address
U O 1a,ffy that I havcrmd rhlx uppbcalian and nam atm nicanove intonuolon is '
canes"1 agree in comply with all city and county ordimarecs and None law,relining
budding conamction,moa hmebyatithorire reprettntipo
laes ofthis city to enter un
[y] Ilia abnva"lncntioncn prapcd,I.,lnNwednm purp111cl
tom„ p„
(We)agree to savc,indemnify and keep harrole,the City of Cupcnina against
(n liabilities,judgments,casts and expenses which may in any way dame against said
VL CilY In en yunme .. lmgranting ul t11ix 7-\/roy
PPL N UNDERSTANDS LC :flON. 1 Issued by: Date
SOU E
Signvmr of AppllcanuGmlmclor I Rc-roofs : -
nAZAR0005 h1ATURIALs DISCLUSUHE
W Il me aPpfeam m future
brddirp o ci pant Imre m hmmme nara,drwx m,aleda Type of Roof .
defied by the
Capcnino todem,'ip:d sub Chapter q.12 unit dm Ilcallh;inn 5afcry
Code.section
_'S5321e)7
❑Yen o +ate All roofs shall be inspected prior to any roofing material being installed.
Will the appfc.ntarfutam nuildingoccu,snt neequmtnem or Jevieex»'hich If a roof is installed without first obtaining an inspection, I agree to remove
until haordous air contaminants as defused by rhe flay Area Air Quality Management
Moll"? all new on, erials for inspection. Applicant understands and will comply with
O Yes all non- d t source re ula
I Nine,cud the h1¢nnI I 1n turimlx rcyniren,no,under Chapter figs of the -
Califinial al do&Softy Cado.Sni ^_$SUS 5513 unit 25534.1 nnJurcand lour
if the buil docs not cusum 'hu yy ppm 'n is yrcspon>ihility n,nmifY the
cups o the requirenmm ;hi .1 fc fe psis t cc of.Cervi a¢ f
nem Date
� --,-nature of Applicant
Ow 1 nl lnnhuriml ugaa D.1
All roof coverings to be Class "B"or better