08050108 CITY OF CUPERTINO
BUILDING DIVISION PERMIT oA\flflltlTQ,R�T1��URN, IA'TI.(7! I+
4fm" PERMR NO.
Bu1LDtr �lPssN' PORTAL AVE EM ROOFING 08050108
JVER'S NAME: PEWIT ISSUE DATE
843 7TH AVE 05/13/2008
PHONE: (650) 363-8388 SANITARY NO. CONTROL NO.
ARCH=/ENGINEER. BUILDING PERM7INFO
BLDG ELECT PLUMB MECH
O z EC LICENSED CONIRACIOR'S DECLARATION - O
m° Job Description
I hereby alliin W,1 am l bmtA under S Dns or Chapter Y(mmmcncing
i� with Section 7IX1U)afDividonlafdm Budmasard Pmfrssioru Cole.andmylieen¢is RE-RF RMV2 LYRS OF COMP SHNGLS& INSTL 1/2"PLYWD&
<° in fun force and effm
g°qz ueenr-�`qty .C3 Lm.. _ a NEW 30YR COMP SHGLS CLS A 22SQ. EM ROOFING RNWD
7Fp Dam �f.3p ARCHR SDECIARATION BUS LIC 5/13/8
W7W7W1 undersand my plans YWI be unit u public remNs
U
SG Licensed Proftari
3 OWNER-BUILDER DECLARATION
a� I batch,air,.that 1 am exempt from the Conu ktofs license Law far dm
°° following mamn.(Section 101 L1,auxins and plofasions Code:Any city or county
$tai which mqulret a pumil in conswcL¢her.impure.demWiN,or mpnir any struck.
i y prior m ila,mance,also requires thc applicant foranch permit m file a signed samment .
< totek is licensed purmant to no provisions of the Conractar's Ucam,Law(Chapmr 9 Sq.FL Floor Area Valuation
?F(�g mommendng with Sated.7")of Division 5 of the Budreaarld Proked..Codc)or $8140
S
that he u exempt therefrom and the bas,for Ne alleged eampdrn.Any violation of
Section]0713 by tery appBant fu a perm,aubjecu the-Rimae an a civil penalty ofNumber Occupancy
trot more than few hundred dollvs(5500). 31628053 TiffType
❑1,a awhar of die property,a my wpm cn with wags a dte'umle cornpeaadon,
win Pr thewoe,andthemvmme,noesF man oroffered fur We(Sec.]0a/,owner
and Profession Code:The Convacmis Lkwo Law dao eat apply lf rt awry of Required Inspeetlons
e rnenYwho builds orimpromchermn,and who dm samhaoh himalfar Waugh h,
awnemplayuanproHdedthan suchim is mid nmarenos inmMWmplatmd for Weer,
huwever,indied id or is mid withinarcyak of hope.m.deomof
Wilder win haw tM Widen of pmvine that he did rote WiW or improv far puryax of
ale.}
❑1,as owner of the property ten exclaiwly conuaming with Baeaed conuaaou in
mnsutmt the project(Sec 7014.Imdtma aM Pro(eadms Code:)The ConuacwYa Li- .
cense Law duo not apply in an owner of property who Wilda or improwa themmr,and,
who contacts for such projeus with a conumtor(s)Demand punan,in the Conuxmh
Licarme law.
❑Lamesemptundu See .BBPCfar Nismason
er Dam
WORKER'S COMPENSATION OECI.aMTION
I hereby affirm under fatuity of perjury ane of the following declandaa:
I Iuw and will maintain a Cer ifci m ofCoaenl to self-lawn forWoods Compa-
ration,as provided for by Section 3700 of mc Labor Cade.far W perfomm¢of the
wortfor which Nis permit,island.
&haw atW will maintain Worcs Compensation fauna¢,an kindred by Section
7]110 ofthe Labar Can .for the pcHoramce of the werk for which this Permit is lahad.
My worker's Compe//nutma hu.euro and Policy nm.'amar are:
Cartier:v�Q+C C d PolicyNo.:�yS >�_
CERTIFICA OE�FFX P`T10N FROM WORKERS'
COMPENSATION INSURANCE
(Th,muan hand net be completed lithe permit,forme hundred dollen($100)
m laa)
I wary that k the perfomme.of the work for which Nia permit,issue,l snail not
employ my perm.in any manharm an in become abject in W Warden Conformance
Laws of Cslifomia Dam
Appliwu
NONCE TO APPLICANT:If.after mating N,Certificate of Exemption,you should
became subject to the Worker's Compensation pren,ho ms of W labor Cud,you mute
Z forthwith comply with such provisions or this permit shall be acemed novated.
z OCONSTRUCTION LENDING AGENCY
[—i� There by sRm Na Vert h. loading agency far the perfoance of
G's7 de work fm which this Peanut,dated(Sec.J09],Or.
mC)
CL A Lembes Name
= z Lrnnh Addrw
U C) 1 certify Na I have read this applicteim and sum that the abow infomaum, -
D,F, came l-pec he camplY with all city and county ordinances and ata laws misting to
C) building construction,and hereby amhonne repmenuuws of Nis city to color upon am
W alpvcmunudgm property for ie pavan purpewhich ms
CL (We)agree m ow,indemnify ad k kp harmless the City of Cupertino against
to liebilimquedgmenhe grarms iand eapcaa which may in any way active again,aid City G
nce,of
s Perrault,
L.1 z A PLIICCAmN'r UNDERSTANDS Aof tND WILL COMPLY WITH ALL NON-POINT Issued
� 11109 Re-roofs
Stgnuuk of Oak
i DOUS MATERIALS DISCLOSURE Type of Roof
Win not applicant or future Wilding axvpant marc ahaMlc haxtena mammal
nnoc l by de Caperton Municipal Con,Chapter 9.17.and the Health and Safety
.Sectio 25532(¢)?
Ely. )kNo All roofs shall be inspected prior to any roofing material being installed.
Will the a Bar,car feum buildin amu ret ren If a roof is installed without first obtainingan inspection,I agree to remove
PP 6 pa ca Air u,ornviccswhich Pe
eDisirki rens air conuminsna u defined by Ne Bay Ana Air Quality Manaecment all new materials for inspection.
❑yea
1 raw read the heard a eactials mgviromma under Chaper 6.95 of Ne Califor-
niaHalNhSafct,Cod,Sec6ora25505,25573arx1255M.1undersand Nmifde building /��
does ml cumlo
ndy w a mann Nat h is my rcapamanitY m m,ry dm a,,a,mt of W
recti emwhichmusbemapriorto, ofaCarifialoa(Qccu .SI UCe plieant Date
Owner w authanrcd agent pramAll roof coverings to be Class'/V'or better