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01100122 CITYBUILDING DPERTONNO PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 7576 PEACH BLOSSOM DR 01100122 OWNER'S NAME: APPLICATION SUB DATE BRUCE S . LEE 10/23/2001 PHONE: SANITARY NO. CONTROL NO. O O ARCHITEC TNGINEER: BUILDING PERMIT INFO iC BLDG ELECT PLUMB MECH W T.1 O L=J L=1 =wi i LICENSED CONTRACTOR'S DECLARATION Job Description J z v-C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROOF . P m t,w with Scxion9000)of Divisimn3 nf1ha Businessand Professions Cale,andmylin,me in full forte nal crit t ii«nreclasr 9 Lica G1 L T/0 WOOD SHAKE, INSTALL DURALITE VILLA. O er.w U Dam �_ Contractor 5 LL Ori: ARCHITECT'5 DECLARATION 1 understand my plans shall he used as public records u3T- 2 y O O Licensed Professional OWNER-BUILDER DECLARATION :2 o, 1 hereby affirm that 1 am exempt from the Contractor's License Law for the y t?< following reason.(Section 703L. .Business and Professions Cale:Any city wcounty E o which requires a permit m conswa,ulcer,improve,demolish,or repair any structure �j m _%orroiu%iamance,also requires the applicant for such permit m rile a signed statement- that h5is,licensed pusium,to fhf pilocklms of the Commetor's License Law(Chapter 9 p g�� S Ft.3,Flo Area ,• I, . Valuation (commencing with Section 9000)of Division 3 of the Bp;ipess inp Professions Code) a',{;IN TRtiL'gk A is\t l lt\.�I A 11x�. or that Kc ia'ex<mpt dicicfmm•and the basis for the allddgetl de of tjl d.Any violationIrrlll r nn of Seemn 9031.5 by any applicant for a permit wbjects the ap,li.act a civil penalty of not more than fee hundred delta.MOB). APN Number . Occupancy Type ❑1,as owner of the property,or my employees wish wages as their sole compensation, will mocha work,and ns Code: is not mtenaca or offered amp apply to a, 3 0 7 - INSULAT 304bired Inspections' " 'Business and work, and the Code:The is Contractor's License Law dor not apply tom " Owner of progeny Who builds or improves them on,and who docs such work himself 6.01 - ROOF TEAR OFF or through his own employees.provided that such improvements art not intended or arcered for sale.If,however,the building or improvement is sold within one year of " -' 602 - ROOF PLYWOOD NAI L lT. ^` ' ionipletion,the owner-Wildrr will have the burden ving of prothat be did not build nr mprove for purp6m of sale.), 603 - ROOF BATTENS "o i.a,mweerothe p:mpenY.a -exclusively cantraitwith licensed eonu:cor:m. .. 604 - - ROOF IN-PROGRESS . _ ._„ ."-er't - = consumer the project(Sec.7144.Business and Professions Ced,:)The Contractor's „ License Low docs nm apply to an owner of property who builds or improves thereon, .m T end who coormcta.(al with a ennhacmm licensed t m.the .._. .._". ... such projects ' (s) pursuan Commnor's Liccnsc Lew, m , . j ✓ .' ❑Iamexcmptundcr Scc. � 4 .8'&P C for this reason Own . Date WORKERS COMPENSATION DECLARATION 1 hereby M.under penalty,of perjury nim mf the following declarations: 11\G.A 1_E ❑ 1 have and will maintain a'Ccninci¢of Consent to self-insrs,for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the NOV 01 2001 performance of the wwk,(ar which this l¢rtnit is issued. . ,:�� II hal- ll Taint Wo ke 'C peer nr. o" ObY Sector _- ] of the LaborCode,for the pstforniance Of the k for which this permit is issued MY,W, r/k aiCo pe satlo,l sure ce ismer and Polcy,-tuber rc,. •„- BUILDII\G--r-r-- - --- --.. -- ”' e} ST'. Id; ,i. rpaircy Na '• 14d} !S-6'-Ll ` ,(�1..6{)e•. txi,''1�iiZ�q-(qtr,. U CERTIFICAT NOF EXEMPTION FROM WOFROM KE t z z s I ;NSATION INSURANCE: - _._ -. ._.. -_- K COMPE _ ('ITrs'section heed not tie enmpleied i(the permit is(or ane hundred dollars 11'.\ is BID)or less.) "• ;1 certify that in the in any of the work foe which tbiject to ii a issrkers shall not employ Laws operson Cm any madnegso'ns to become subject m the Workers' Compbnsition Inws of Celifomie.Dere Applicant 'NOTICE TOAin the NT.r'sC.OecoIf.after o. .png rCminr.msof h Lobel ian.you uhould most Serious,subjen m the Worker's visimxror tion provisions of the deemed Caere,,you must � O forthwith comply with such prmisimns or this permit shell be deemed revoked. JCONSTRUCION LENDING'AGENCY;" I hereby aRrin that Vert is conswction lending age noY for die peifotmen«' of Ne work for which thii permit is issued Ser.309],Civ.CJ Lender s Name' D}O Lender's Address r.••1•.• . - . .. ret 1crify that 1 ha ad this opplict Institute that theM infmsture.is fs.,.E. comet 1 g to comply with all city and a iy dinarre d state laws relating 0.0 to Wilding construciion,and hereby authorize mpreSentatoms ofthrsCty to enter Upon ,,, W the above-mentioned property for inspection purposes.,. A Uly el. ag ee m sa a ndemnipe and kc p harmless the Cly or Cupertino against W lion tesjdueoix,, a dexpenses ti M1 y'n any y c againstsaid U.�7y City neon equenc)Iof thANDSANDWI L t RAPPLICANTOURCE''RE N)tt$1'ANDSANDWILLC. I .. ITHALL ONP INT'• Issued by: Date /0--23-0/ Lo A 3 set signature orApphcan✓comra<mr- ,� .'. ,, —� noam Re-roofs HAZARDOUS MA IALS DISCLOSURE '-' Wtlllbdpplicant Wfture building occpant store or.bondlehawNous material Type of Roof - as defined by tho Cupe,.irm Municipal Code Chapter 9.12,and the Health and Safety ..• -• T •` b J '•'e'•."•'s' x •' ` - I - - . code section 25532rq (.n. •.,iH 3;p. t•t.`•r - IC `. b: - .. F f-.!, ' .. ❑Yeas•'•-^'r .,,;;�'l+a;il' , ar_% -". -_All roofs shall be.inspected.prior to.any-roofing materialbeing installed.-_ ... Will the applicant f t b'Id g p t sc cqu pmcmo de tees which If a roof is itistalltjd'without first obtaining an inspection,'I'agree'to remove 'mit hazardous air ccunaminams as defined by the Bay Arcs Air Qutility Management Dism<9 all new materials for inspection. Applicant understands and will comply withD. _ °Ya p all n -pojnt source regulations., dl`0/L n•.:.r.r . Ithe e rc d the h zeNous mmenals rtgmrtmems under Ch pier 695'6(the Calirmni.H lth&Safery Code SoLme,25505 25537 and 25534 1 understand the ifthe building dnotcnernlyh m tthtt yrcp b'Ity to tify,tho 1c> oceupkm of h r irements which must be r m is met priosuance of a Certificate of u _ _.l 0 13 O 1 _ Signature o Applica Date ownerwaumod3ed agenr'm wte,., All roof coverings to be Class "B"or'better i •�'" . �.dJ.�: a . OFFICE -