02010102CITY OF CUPERTINO
;
'',Is1ILDINC DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
11882 PLACER SPRING CT
OLD COUNTRY ROOFING
02010102
OWNER'S NAME:
APPLICATION SUB DATE
SAKAMOTO RONALD K AND SAKAMOTA
387 UMBARGER RD #B
01/28/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)362-1111
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r= O 1_1 C=]
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hercby ae, Rthat I am licensed under provisions of Chapter 9 (commencing
with Section 7") of Division 3o eBusi d Professions Cale, and my license
is10^ull'OnceeflSp repn,� "
REROOF.
License
ice ' tie. ��
T/0 SHAKES, INSTALL 30 # FELT & MONIER TI
Corer c
�( R ITECI"c DEC TIO
I undersmnJ my plans shall he us d as public rcceads
License) Professional
OWNER -BUILDER DECLARATION
1 M1ercby affirm Our 11. exempt from 0e Contractor's License Law for the
following mown. )031.5, Business and Professions Cade: Any city in county
Cal
which, a (runt t conswct, alcor, improve. demolish, or repair any struaurt
am issuance,
e, obvim
poor m in issuance, elan mquirts the applicant fasuch permit hostiles signed sumrneno.
that _heis licensed pugaq,tgo the provisions of the Comracmrs License Law (Chapter 9
(commencto, .ith Secdpn 701 of Division 3 of the Business and Pmfysions Code)
Sq. -Ft: Flo Area. , . •
g_';�,_1,.X"i't;�:_y.';.; lk pa, y�;,, ['1
I a uation
or that he u exempt thfmfrori m lthe basis for the allciid eoemptipn: Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant o a civil p:nelty-
of not mate than five handled d,Bans (S500).rrtber
,P-1:: r , , Occupancy Type
❑ Las earn, rf the property. Lir my employes won wages as they sole compensation,
FRAME
v,41 do he work; and the structure is not intended or offered for sale (Sec. 7 ,
Business and Professions Cade: The Contractor's License Law does not apply to an
'- - _ -- - ---- --- --, ----- - - -- -- --
307 - INSULAT IRl3Aulred Inspections 1a
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements an, not intended or.
ROOF TEAR OFF
]" Q
n sold within one year of
oRercd fen.{ale. omerwevrq t& building Br imen of proving
c
completion, the owner -Wilder will have the burden of proving that he did not build or
,_ -6-Q _-. -_ _ _, ___ ___ _..._____.__.. _.-.-._..._.. _
._-._. _ _._-._....._....
: '
602 - ROOF PLYWOOD NA IL: •-'-
int
impovemrpuH,o"°rail`).
603 — ROOF BATTENS
❑.I;asowner pfthe p(Seertyam orsm
ntrofe.....Cdc:)Th,
PROGRESS ---
604 — ROOF IN—PROGRESS tt�" • `t"t
project (Sec. it) a owner or and Pr y whob Cade:) The v trwmr'x
Businessand Conn
Linear the does of apply w an owner of property who builds or improves thereon.
License Lawwdcense
,
such projects with. a.commcmr(s) licensed PursuanLm the_
commcWcr
ontracmrs License La
C e law.. P ,
❑lath exam rand $sec: •'' ',BB PClonhis near
Owneho
Data
" ORKER'S COMPENSATION DECLARATION
" I hereby affirm under penalty of periti, anc.f the 011owing declamtim s:-
❑ 1 have and will'mainmin a certificate or Conserv to self -insure for Workcr's
Compensation, as, provided for by Section 37011 of the Leber Code: r fothe
performance of the work for which this permit is issued
O 1 have and will maintain Worker's Comp maission Insurance; as required by Section
3700 or Oc Labor Cade for the performance of the work for which this permit is
ucd My W k r'a C mpcnul lin Insure °mer and P licy nu
sand,�
,CERTIFlCATION OP E%EMI'TION FNOM WORKERS'1'
._9.. s],-,.4, �'_a O 5. s•^ ld,n 2:-1A ,t.r t1.
COMPENSPTION INS
v
__-.�..,._._."•....,__-.__..._,..—'..___.�..._.-..f_.-_I-_...... ............._._...._..__—___ _.... .. ..
�.,
I "' 'senior neJ ata be core Icmd if the un ars
Permit hundred doll„
I'f'• "' I''(:" _ .
ISI WI or
1 cm th udthf ce f thk f r which t o 1
_
-- .1, I
l
shml'nm employ any person m any ma ns m become subfen to the Workers
in neer so o ct ergo
Comicant! con Law. of California. Dae
Appl
NOTICE TOAPPLICANT. makingthis Ci,i..amof Exemption. ym6sh,uld
heowith cony the ,',C.far,
of the WWr Cale, you must
tihis
Providers
forthwith comply with such provisions or this permit shall as deme) mocked.
such pr visions of
I
CONSTRUCTION LENDING AGENCY
t
h I hcrchy uthrn the than is d couelending agency for the performhnc2
• ...,. !i -< I "
of the work for which W this see
is issued ]Sec.. 1097: Civ. C.)„
,limit
._...:�.. ._.::.
_. _.. ._. _..____..__. ..__-.___...
"n,der'i Address •r .
1 cenify that I have madthis application and s, te that the abuve information is
coc8et. I agree to comply with all city and county ommanees and state laws elatingto
Wilding construction, and hereby Offimiic rcprt.¢matives df this citym enter upon
le
the above mentioned property for inspection purposesI
Wii) agmi m indxaGc. emnify and keep harralas the City of Cupamino aiuialabilities,
judgmaus. costs unJ expenses which may in any way soon against said
ity in
consequence of the granting ofthis permit.
APPLIGNT UNDER STA, SA' WILLCOtv1PLY WITH ALL NON-POINf
Issued by: O t/
innattle ofh rHA7 RDOU -,R •: � path';
d'
Re -roofs
.., HA7ARDOUS MATERIALS DISCLOSURE -
lthepp.pert con building acpatsmrcor handle
add enm
Type.of.Roof___-_. .. _— _ _____�.
Health
asdf d.bythCppenmMu cp lCmdc Chapter 9.12. and the HealthaWSlry
Code.S�cyon 255110
❑Nei.
'
"'Will
V All roofs shall be"inspected prior to, any. roofing, material being installed.
th ppl t f m W la gocc pant Lm eq pm t d itts which
If a roof is irisialledWithout first obtaining an inspection, I'agree to remove
d conformation.. Jefin JbYthBay Area Ail Quality ht reg t
D t t
District?
I
all new materials for inspection Applicant understands and will comply with
'
°vc,;' Phial
---- - - - -
all non -point source regulations .
],have read me haeadau.i mmerims requirements under Chirpier .695 of the
...t.:.
California He61th & Safety Coda Section, 25505.25533 and 75536. 1 m,dctasnd that
"tribe building dues not currently have a tenant. Oat it is my responsibility to miry the
_ y �' �• _ r; Z '
—x
\" l �"TJPn'Y
occupant of the requirements which must be met prior m e oa issuance Certificate of
tY/O-/ 1�..._
Occupancy,,
/-'�
� - O-
Signature of Applicant Date
PP_-
— - . .. —- -, - '
All roof coverings to be Class ••B" or better
Owaer or.aahenrrd rg2mt " Doe
'-OFFICE