00110067CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ATll 13 PEBBLE PL
l
SIGNATURE ROOFING IN
JEHMIT N(L`�t�110�16,7
OWNER'S N
Ohl
1.31 INDUSTRIAL RD #1.
APPLICATION SUB DATE
11/13/2000
PHONE.v N /
/Vly Y2�
(800)544-74.1.0
SANITARY ND. CONTROL NO,
Z ARCHI'I'FC'1'/ENOINEER:
BUILDING PEIIMI'r INFO
111,1)O ELECT MECH
LL
]AIMLII
I_1 LUI -1 rJ
zLICENSED CON I RACrOWS UF.CLARA'I]ON
.lob Description
I hereby aBirn, that I ma Ilccnscd under provision, of Chap a, 9 (continental,
0 withSection AMMpnlUnision3offleBromiandPmfcoionsCde.andmvl;cans.
in fall farce d,,,rrr{{{1 / /
SHAKE TO COMP SHINGLES
0d
Clpj)�1�J� Lia .M 001E
u
Data
Uale Q(O] Conl11
_///(/Y nNcurrnemedon, LAR
N
� 1 nnJcn.nJ my plane shall M usd as public rcan ,
Liccn%aJ Pralcsnion'al
ce OWNER .ItU11.Denpt IiH UI?CLARA'1l(1N
111
so I hechy ufEnn that I mu esfrom the Commaror's lJoArne Law for the
a fallowing reason N action 701 Rosati and Prom,uions Code: Any city or ,)only
-
o which requires a permit it, eonsvua, other, impaoc, domolish, or repair any suucturc
prior n its issuance. also requires the applicant fiat such pcnniuo file a signed stateman
Sq. Ft. Floor Area
a �y
- Red he is heenwd morwai IIs the movi... s ,I The Courc.Cs License Law (Chapter 9
(v Ineneing with Stalun 90811of Division 3 it he Business ani Pmfessinns Code)0tb/,j14
or that he I% exempt therefrom and the tris lou the alleged exemption. Any violation
of Section 9031.5 by any applicant for a per,niI subjects the appi cant to a civil penalty
rise hundred dollar.
Apollo Number
Occupancy Type
of not more than ($5001
32F,43046.00
pn+pa y. onttr employees yeea wi g cense
❑I. as ow. net (if the rt m with wiles a, their sole compensation.
Required Inspections
will J the k d Ib t t '' notintended,i alta J I apply l(ua,
La J
nasi : r l f n Code: II L nor t 1 a nye r work himself at an
rot property N ho tdld. .. - I otenedor
chat d
305' — FRAME
va c
. 0m mpr Lnpmvem,vnld are not intended or
or through disown employee. building
mnered for ,ale. B, howevere the bathing er and nvemfem is etha within one year of
30' — I NSA II_RT I ON
�...the awnerhuilder will have the hudcn nl pawing the he did nut buildor
r
6 01 — ROOF TEAR
provtion.
,fpnwe liar paapn.e of xma.l.
OFF '
❑ I. or, awne, of pre pn,pens. ant exelaavely artrning win, licensed commoln, to
602 — ROOF PLYWOOD NAIL
. Promi., cad I rials, ions Cde:) The Contraction I
struct the paries (see. ]BWse
Linic<ontrnmo'
603 — ROOF BATTENS
eLawdna net apply in an ownerolproperty wI hailiEmpire, trent.
Can d who cc ntract% ret such projects with a contortions) licensed Pursuant to Ne
604 — ROOF TN—PROGRESS
lavalm Law.
❑ I um exempt andar Sm. .11 & P C for this Lemon
Owner [)Eric
WORK17R'S COMPENSATION DECLARATION
' I herelq affirm under penalty of petjnry Line of the fallowing declarations:
❑ 1 have and will incounlam a Certificate of L'ammnl to %elhinwre for Worker's
Congsns;aion, an provided for by Seen.. 3100 of be LAW, Code, for the
perli,onance, of file work lin which this panni, is issued,
Rave and rill maintain Worker's Coml,xinxi Insurance, as required by lection
of the l,ahor Codc, hint ,hc perlbrmuncce Lir the work fin which this pem,it is
r1,77.,.1)
MyWorker"'ss Com,virsmiion insurance carrierrandPolicy millibererrricr:_J/
% T_ 1'alicy(./tel o�o
— TSHI pILAI'ION OP PJaHMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This %cation aced nut he complutd if We permit i, hat one hnodred dollar,
IS I (WE or It,,.)
I certify that in the wrionna cc o1 the work for which this permit is issued. 1
.hall nm employ any person in any manner or as It, ba, re subject In the Wnrloan,
Co upenxmion I,awe of Calilornw. Oen
Applicmn
NO] ICE TO APPLIC,AN1.. 11, after trading in, Cnificnte of Exmmpdnn, you nhoald
iE becmne abject to) the W'orker's Corpen.mion previsions of the Labor Code, you rang
forthwith comply with woch no kim, no this pa ,It shall he devoted revnkd.
n CONSTRUCTION LENDING AGENCY
I hereby alfirm that there is a orwiniction lending agency for the pMoronance
nf,he wok for which this permit is N,nal (Su. 3097, Ci, C.)
s
Lender's Narrc
Lender's AJdres
I ecriny that I hmc,cold thio a li linoinn tad state thin the abase intonation is
eorwo I agree m comply with all city and county ordinances and state laws minting
jJ to building construction, and hereby uumorim represenulivea of (his city no clear mon
-
ill the aboVe'llunioned prollo for inspiration periposes.('y..
Y F t sae indemnify ndkcpharmless
say fC penins against
to, any
A Ciliabilities. j dg n.a,c e End 1 t hieh Y nunY Y gains(said
G City I o(Ih gn of this parl
APPLICANT UND17RlTA SA DWIILC IMPLY WI'fti ALL, NO POI
SOURCE REGUI.nT1O/yI��/�J ��� /
1Nsuedb Date
y
Re -roofs
Signature of APPli,00t trnc'`lI Dufc�
HAZARDOUS MATERIALS DISCLOSURE
Will the applicam or ti,tme bulldmiaml ,sae ar hnndlc hamnLou, m;mriel
Type of Roof .
,s icllned by life Contralto Municipal Code. chapter 9.12. and the IIi and safety
Calc Section 25532(0)^
Cyr, r<-
All roofs shall be inspected prior to any rooting material being installed.
will the appBeamorInto, baildiagocsa,Ino, c<lainn+annmtlot, ipa.wbinh
If a roof is installed without first obtaining an inspection, I agree to remove
emit hvardef arraminanfs e, defined by the nay Area Air Quality Manage and
all new materials for inspection. Applicant understands and will comply with
Didn't?
❑Ye,
all non -point sour regulations.
I have read file havnNon, ma.,l ols collate a,, order Chap., 6.95 of she
California Health & Safely Cale, Section.v 25505, 25533 and 25534. 1 understand that
if he building does non commonly furl a Ivan(. Ihm it is my rcxl,unsihilhy moonily Thu
"Evil ml he n• Ithroncnu which mast he ,,,at prior o ....ante lir a CenlEcvm of
Occapnncy.
/,�
Signature of Appli'ant Dale
fILJ
— - -
All roof coverings to be Class "B" or better
oenetmauthonud ag t nm
OFFICE