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I BUILDI NG.
CONTRACTOR INFORMATION:
DIVISIONCUPERTI
PERMIT
BUILDING ADDRESS:
PERMIT NO
10406 PALO VISTA RD
COOPER ROBERT J AND HARR
ET 1070057
OWNER'S NAME:
APPLICA ION SUB DATE
COOPER ROBERT J AND HARRIET E
07/13/2001
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEF,R:
BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
C_J LJ I__J CI
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Shard am licensed under provisions of Chapter 9 mommeming
with Section 70001 of Division 3 of the Business and Professions Cade, and my license
REROOF.
License 1lt .1, q`°' Lit.a z
T/0 SHAKES & INSTALL 1/2 SHEATHINE
Date Can. to, —
30 YRS. COMP.
ARCHITECT'S DECLARATION
I undersand my plans shall be, used a public record.
FINALE
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm amt I am exempt from rote contractor, License Law for me
which ngremon. ermittt ,on r, Baslnew and vefdeioli Ca le: Any city ateaunry
which requires a permit m conamct, ager, improve, demolish, or repair any swctum
JUL 2 0 2001
i LU Srl:.f4. I'IUOI'Aree .. •s
SlUiltlOn
Business
iveing wit p,mn:ion7"pfDivision the Ce tractorBasin's License LawChapletCode)
Profess,vi
morhC
Sec,ion9a1and the Division t the and Cada
or that he is oro and ,or basis far the j{eJ dx Any vipenalty
or that he is eaimpl ,any
l - r.. .. s _.
7
of Section by any o to
fora permit subjects She opplicam m a civil penalty
applicant subjects applicant
I ... ccupancy Type
a than hundred ll
,of not mare than ase Honored donor, asap.
3 5 7 elp� �I�lm"
.,
❑ 1, as owner of the property, or my employees with wages as Sherr sole compsmanwo,
Required Inspections
3 05 — FRAME 9 p
,will do the work; and the structure is not Intended' or offered for sale (Sec. ]au,'
au[mess and Professions Code: The Contractor's License Law does not apply to an
owner of propany who builds or improves thereon, and who does .such work himself
3 0 7 — INSULATION
intended
den that autb improvements are not one year or
provt provcmcn
..D 8 P
Iivase-sir�m sir
cothrough
nine
.. --. - .. . . .... .. .. .. ...—. - . _ ... _. .. .. ._ _,
6Ol ROOF TEAR OFF
.Uprnl,swa,hadinba�
exandeim. he:ILhowever.the
proving
owner. Wilder will have the When of ,M1al M1edid nut build or
'
improve larpurpoxhfsate.l.
602 - ROOF PLYWOOD NAIL
.. -
❑ i, as owner of the .. ..- clu _. licensed
pmpcny, oro exclusively rommaing with li<ensN contractors to
..
6 0 3 - ROOF BATTENS
aeamet the project (Sec. NAT, Business and Profession, Cade :) The Cental
604 ROOF IN
License Law does not apply roan owner of prhpeny who builds sir improves thereon,
- -PROGRESS'''
.and who.contracts for such. projects with n.commictntlsl licensed pursuant m the
CanSmnors License law.
-
J'
❑lamexemptunderSas .B&PC far this reawn
•'l
Ownet Time
WORKER'S COMPENSATION DECLARATION
I hereby ofnmS under pemlry of pe,jdry ore of the following declarations:
❑ I have and will memudis Certificate of Consent w wlf-inwte for Wotker's
Compensation, as provided far by Section 37W of She Labor Cale, far the
,
per nertmnce of the work for which this permit is issued ,
❑ ]Wm and will maintain Workers Compensation Insurance, a, required by Section
3100 of the LWr Calc, for ,he performance of the work for which this permit is
issued My W.'Imex Co so'cuu on Insurance carrier and Policy number am:
Carter. C/,•T%5 /%i Policy Na: %Ii'r%OZ/O
_
s :j -. .
il!
CERTIFICATION OF F,XEMMON FROM.WORKERS''
1• I.•'��, 11 .1'e .•i'1
'. COMPENSATION INSURANCE•; `', '..
_._-. ...__._ . ....._..__..._ .... ....... ...__._...-.
P. "(Thii s�niobnaJ ohtWcinnpined if the permit ix far Otte hundrN dnllas
�!-. ;1^IICv S`.'i .
(5100) or los)
I .miry nut in rhe pedam of Ne work for whim this permit is issued1
. '. t f
'shall na employ any periun in any manner so as m become wbjccttn She Workers'
Dat
- -•„
..
Campeaca..aLawsofCulifomia.Dart -
.Applicant ..•
NOTICE TO APPLICANT: IL of n making hi, Ceriacat of Eaemp,ian,,an should
hecom;e subject m She Workda Compensation Prov cions of the W Wr Cade, you most
forthwith comply with such pmvisiam or teat, permit shall W dttmN mvoAW.
I
^" CONSTRUCTION LENDING' AGENCY
I hereby effiint in,,, then is..hesitation lending agency far the perfunnence
of the work for which this permit is ismed ISa. 309]. Civ. C.1,
'
.. ___ _. - ..• ._
_... .... ...
Lender's Name
-
Landcr's Address '
,,., S �. i,
I certify ,hal hove read this application and stat Thal the above information is
.Immel. I agree m comply with all city, and county ordinances and crate Inw.a refuting
i to Wilding construction. and hereby awhorim representatives of this city to enter upon
,he ebovrmentionN property for inspection Purposes.
(We) agree m save, indemnify and keep hatmlos the City of Cupeniw agains,
liabilities, judgments, cost, and exptnw, which may, in any way acme i game said'
City in nmsequenbe of the granting W this permit.
'APPLICANT UNDERSTANDS' AND WILL COMPLY WITH ALL NON-POINT
Issuedb : Dale
Y
SOURCE RYri1LATION5. jl: i'i) � f_ -��
Re -COOTS -
iSSgnaur fApphcanUConrun , • .. I Doc.
HA],ARDOUS MATERIALS DISCLOSURE . ., I -
W'illtbcaPDlima.,fiwtebulldingoccu,ma usmorhandle haarduusmaten:d
Type of Roof - -- "•-•-as
defined by the, Cupertino Municipal Code.. Chapter 212, and the Health and Safety
:.
Code. Secrihn25532md .1.
CYen oNa,..; ";,;' _'' `
- s t
All roofs.shall.be inspected.prior to any roofing material being. installed.
WII theapphc t f J rc Wild ng ac pa t me eq p t a devic. %hick
If a roof is ins alled'without first obtaining an inspection; 1''agree in remove
em, h - d ch w t: defined by theB Area A Quality Management.
'D.t tall
new materials for inspection. Applicant understands and will comply with
CY" I C"" -
all non -point source regulations,
1 M1 ad the h urd -mater als q mate S. J Chap¢ 695 of the
Calif nam Health A Safety Code Section,25505 5533 and 25534 1 understand that
iftheWli gdoesnt Jyh t Sthat 1, v pon.b'I'ly to notify the
/�� //�•/a // l.Cti�—i���'/
hccupabt of the requ t men, which mus, be met p,as,,o,xsaancc of a Ceri Gcme of
-
'O
Signature of Applicant Date
All roof coverings to be Class "B•' or better
k
owme orambmiaedopera - Dam
.. _-,... -OFFICE- - - - -