02040091 CITY OF CUPERTINO •-BUILDINGDMSION PERMIT CONTRACTOR,IlVFORMATION-
BUILDING ADDRESS: PERMIT NO.
1 MANSCH WATTS 02040091
OWN'ER'S NAME:
APPLICATION SUB DATE
MANSCH WATTS 04/17/2002 '
PHONE: SANITARY NO. CONTROL NO.
H ARCHITECT/ GINEER:
p BUILDING PERMIT NFO
BLDG ELECT PLUMB MECH
<=
LJ C_1 L.'J 1 1
vi LICENSED CONTRdunder rDECLARATION JobDescri tion
z= Section 7M)
)of mics.hat I 3licen.Btnin rand Fiionsof ;Crude.adomy Beane REROOF P
,M with full fon?md',irecr. on3orthe eusitsss and Rofessions Code.and my licenx
y-_ Lirm 11 l...end blit.
q-6 Licenx CIOSS Lic N
O
Data Contractor
u C r'' ARCHITECT'S DECLARATION
5 I t nderstwd on,plus shall be used as p.hiie¢cords
T
Soo Licensed Profnsiowl
R OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the CommeLor's License law for the
t z< following reason,Section 70313.Business and Professions Cade:Any city or county $3000
I ❑ which requires a permit to construct,alter.improve.demolish,or repair any structure
3� priamiu issuorce,also requires ate applicant for welt permit to fikuigrcd wsmeno - - - - - - .)'• —_—____ _.__._______
that hC 'I denied purdua t W the p ilio,of the Commnors License law(Chapter 9 .. - `-"
(commencingAtb Secsmn 7DW ofD%inion 3 of the Business and Professions Code) (..'E'i`'�.t'•!.• '` !( ^. �. .e(:� i Frp^t Valuation
or that he s exempt the«from nad the bass for the alleged siempttoa.Any violation
Of Section'7031-5by any.ppllwnt for. .it subjects thcapplaust to a Null peruhy-
Occupancy Type
ofmot mae(Kam iv hundred dollars($5001. 30SM' '•ARE e.:.;IT;;D
°1.-1 owner of the progeny,or my employ«s with wage as their sole.....wrich,
Business
m�waiofand ssins st,2are Cnotcus's Liid cense Law
there sea
(Siapply to
601 - ROOF TERR OOIl P
'Business pro Professions Code:The Consactor's,ad w law s..not apply w an U ❑5 ecbon5 j1`
owner of progeny Who Wilds orimprorcstthan suchandwhontssuch int M1imxlr ----- L
«tneoy/hhisgwn employees_eWilding
iidiQcorimphwmenct mgmu gettp intended a.. _.____..._6.0.2____RO.OF._PLsY. O
W_ D NA
,,aByea for xle.H:however.she WBee th or improvdment is cola within o«rine of 6 0 3 - ROOF BATTENS '•'e'!':. . ,. sr
aampldion.the owneobuilder will love theWNcn of provin8 slut he did n«Wild«
-.
e for purpose o!axle.).
C__.......- ._. . _ _ 604 - ROOF IN-PROGRESS
owriv of the progeny un Businissimmrofeisin. li Thiconvenorsto ..-i:•il ^i
sun alta .a IS«.
W.Business pro Profcssioh Code:)Thc Intimates
a ount. '':.l'•f: :i2i ii
'deux taw dao non apply to m w«r of AopurY who Wilds«improv«thereon. '-'`
.r. L :
r. -sed. ho "Urms.f«such s.witb.a.coouan ...�__..__
RaJ«' M),Ifeemrd purwwt uses. __.._ _-.- _ _--- 01� � --
CnwnorsLttt,eLe .., "- -- --"----- "-----
�un exam 1I set1 ., x l/+ __ T.p C f arts ieason ;,;It Orar SCOMPENSATION f'�USRATfON 'li:�
Ibeachy aRrm codes penaltyof peU 7 - nithe following dechntione:.- p,n p� 0 7 2002
a 01 In itend''vlill'malnsiti i"Cc`nifiane of Consent jr, g.1neure your Worker's
Compensation..cs:pmvidcd for by Senion'-37W'of-the laWr-Codc,-fair the
perrormmce ofthe woh( huh.tha Nmul is issued. BUIL.UING
°I 'rifth'Lish Code,
Worker formpenason ln;uoirk lar hich.t i,pSection
3]00 0l the labor dude,foor ani, perfotmwce ti the work!or h dM1 mi:.,:., ja
issued.My Workels Compensluonl iurince wn< ind P6licy number ate
. -. .. -s.i t• . . _-_..._.. _.
2LHer_I 1.L.i rt2rsrRteoliyh c '` r -(C fV..i, 3 C.-
(t, LCERTIFICATION OF E%EMPTION,FROM WOR •. _' L- \ ix,
,LL;:' t rY'f COMPENSrkTION NSURANCE _ A,) a 0
TrM1 a nitron n«d not b<tam Ikea it me ..
"'I` '' r p Permit a r«ane nanarea aouata
st
:41 d,r inn in tM K nn of arc wM f fi ch thssueJ 1 _ — .-_ ..
hall nm a pI Y nY pcwn y er m w become bJ no the Worke - t lsti k f_ - s' ' -
Compcnwt on[a s o(Cal fo D '
„App t - ..
N „ICEL PCICANT If Nt LI SNS Cenlf dle ofd a pS on Yo should
Z become )ecuo the Wo icer Campe"son prov s of the labor Code yo ,t
0 fonhw th comply th such pmv lions o th pc t shall bed coed rtvakN
r'CONSeriiss0N LENDNG AGENCY '' l
(r ti °`"'N Thereby Sffim that the .cdn3auao dtgy agency!«Nap craments P:.Yr ..'1 L..
of the onkf--which the permit issued 3097 Ca CI .la •i.u_:.m. - c:_ '
...LindCrs Nome _ .... .__. .. ...... . _._ ._. ._ _ _ ___... . . __. -----
L7Z Lend sAddrtss-r , j •^.�', _. : : ! i' ^
i certify that 1 have read this application and state that the abow information is
let F•e coirccii
l.agr«to msnPly.with all city end county oNipengn andante hws slating
[) wWilding mnstrvction,and M1erthy amhbriie repssenuthes ofthiicity to comrupon
W the eWve me t aped property f Aspen on purposes -
I„t cW IW )q ro sive,I demmfy.mtlkc phumless the ryofC pent oegunat
ZI liabilities.J lgrgens.Cosa W cxpenxs..h ch may in my;s'ay mcher,said
V Z Cisy m canxqucnce of tha grant g o!thii perm t qJv
°'t APPL7GA\"f 4NDERSYA\D5 a.\(J N'1I,[,CO\IDLY WI ALLe\b\tFOL�'"[-c
socEP�Er� Qm t N 1 Issued by: Date
StemostbApplteanveo mor,..' e; — T �r:`K..,.1:: Re-roofs 'tit
) -HAZARDOUS MATERIALS DISCLOSURE 3
,t. conn the xppl t«Pomrt Wle gottvlmnt taro«bmale n.:,ido,material - Type of Roof-
isdefied by the Cuperrusibilurnicipal Code.aspic,9.12.and flue H Ith and Safety
Coca Said.25432(.)?,tl r� ? L i.r"sui c'
.. All.roofs shall.be inspected nor.to,an roofing.material.bein
❑Yc �No 1 t d _^-•^�
..., ...,, .,, x , ' , P. P Y g g,stalled._
B thepplcmtorfpturg Wilding«d pat useequipmenta e t e,which If a roof is installed without first obtaining an-m3pecuon I agree to%remove
M
hawda s. eonteMnws u dict rd by Ute Bay Are ty Air Quit Management
Dien I' f�'fpsafr� I,L all new matenals fo;,ins ctton Applicant understands and will comply with
-all non-point source regulations.,.
ary P
the hrsc matmsli q m
CJifamaHHealth ryCoadu25505:25533 nurl V1 33Caha1 pstdr osm nodf Ntheet
tithe building does 601 atcn=Lttitismy spo,blnify the
o«vpwof me riiemnambich cast met
m .. _ - 4- d.rnitu
Oc<u cY responsibility
dry «
t ignature. f A pplif ant... Date -
wt aayent D t. All roof coverings to be Class `B orbetter
„' .... ..OFFICE
Ct,• i i., p .i _. ._