00070031 CITY OF CUI'ESION CONTRACTOR INFORMATION:
BUILDING DIVISIONPERMIT
BUILDING ADDRESS: - PERMIT NO,
10431 PRUNE TREE LA 00070031
OWNER'S NAMG' APPLICA'T'ION SUB DATE
-SHEN 07/07/2000
PHONI3: SANITAIIY NO. CON'I'kOI,NO.
C CHI'I'IiCT/ENGINEIiR: BUILDING PERMIT INFO
131.DC IiLli(T PIAh1R MECH
h
Ni LICENCED CONTRACT'OR'SoChARATION Job Description
1 hercn>sflinn that 1 am licensed under pilot
"I'd,mf Chapter 9(commencing
with Sen ion 700p)of Dwision 3 of the Ranine,.and Prou%sions Code.and my license
kill hdl lone sad a tc,, RE—ROOF
enae chis
Lie,,x
3Du
Es. ne C....reor
G ARCHITIiCI"S DHCLARA'1'ION
FiOj IndvJSII .fill W cwd as public records
fuse
w�p0 LicerwidP 1.:' 'I
c OWNPR BUII OI k Dtth C aan,a - - -
I h) II dt III the 6 t n I'' Law lathe
C=a Iiyl b IS i ou ny
—xC wbchrtymresn De an re construct.their. mfor such
wood t ore a siirany nalarucmrc '
Cw 'hatpoorhe sIissuance,
owdpursalso myo themov%mcam for mchpenailmfilea sigaNaaemem
that nel,reen Witpmxaamtrtome poskli,!none Cnmrannrx uaan,e Law(cnapt,'ry Sq. Ft. Floor Area Valuation
(mnmme isewitht hemn,inanoI Oivhlon90ltWIWdncxxand PrnrAn,—CNc)
or that hu is 31.5 b tall)a oro and or nods for the subjects
the evoke't o Any vinlmion
of Sermone than
s v any applicant for a permit mhkns the applicam to a civil penalty
9r not meet man file hattercd annarx Issas. APN Number Occupancy Type
01,as owner of the r,,,.y.or my employees.unit wage,as,hcir-le nm,pcnseion.
will dm the work,and the nmuatmc is not intended of obese for'Ede(See.]Ma,
Ilnninenn and Pn,rex.on,Cldc:'Ilie o.tttrnetnr,Lla:mc I.aw do,,,ern apply m tum Required Inspections .
owner of prolI Who huilds orIini mn'es thcmmt,and xho does such work hinwch
or though his own employees.provided that such impowCon tit,arc not intended of 305 — FRAME
olfcr d for.sale.If.however,the building or improvement is sold within one year of
completion,me owner-huilder will have the burden of proving that he did not build or 307 — INSULATION
imprve forpnmo,ennee.). _ 601 - ROOF TEAR OFF '
D 1.an owner or the property.ant,exclusively coasting with hcenxen contractors to
602 — ROOF PLYWOOD NAIL
omauc,the project(See.]1111.Business and ProleW I,Code:)The Comranor'n
License Laxdoes not apply to an owner of property who builds or Intpmvcs thereon.
and who contract,For such project,with a contmctoa,l licensed pursuant to me 603 — ROOF BATTENS
C(ntract"rs LipppBe Law. 604 — ROOF IN—PROGRESS
ClIan,cacnrpt under See .B&I'C for this mann
Owner (late
WORKER's COh1PIiNSATION DECLARATION
I hereby Ginn under penalty of perjury one mf the following declarations:
❑ I hove and will n doln't n C1l11lio;ec of Comcnt to aclf-imam for Worker's
rnnpenwlion, as provided for by Scc'tinn 37110 of the [.shot Coke, lot the
rformmnem of the work for which this pecon i,issued.
01 have and will nesimain Worker's Compensation Insurance,ax mquirN by Section
3901 of the Lubar Cale,Ibr the perGamunce of the work for which min permit i,
Issued.My Workers CmnpeEel tlun Insurance carrier and Fol,y manbur nm:
Camiee Policy No.:
CEffUrICAI'ION OF EXCE"11 ION FROM WORKERS' '
COMPENSATION INSURANCE
(I his suction need nut be rnntpbmd Bible tout is Ibr ane hundred dollar,
($100)nr less.)
I lenity that in the performs ce of the work for which this pem,it is issued,I
shall ma employ an person in anygflnner7 0�u1c`r--vy ecu m the Wmob's'
Cotnpennaion Lux�Ii urnr !— V O
npplhatn L
N(YI'ICE'rllA I.IIAN'I' f.elm kingmi,Curtificamof L'xcngnlon,yon,hn:tId
hmc Nimpi un it,.W..k,,,Cmnpen,minn Pnrvkion,of the 1-am,Calc,you
must
O Oer„forthwith....illy xith such prbv oma or this permit shall be deemed«inked.
f ^ CONSTRUCDON LENDING AGENCY
ai ,> I hereby affirm that there is a cmrvtmction lending agency for the peni,rmence
of the Is k Ibr which thi,pem;e i,is,ed(Sec.3aJ7,Co.C.)
L Q Lender',Name -
D z Leticia',Adde,
V I cell that l have mad mi,application and,a me dial the aWinformation ve infoation I, '
ks [.n cnrI It I agree u,cot ly ,in all city and county onlinancm and sate law,miming
O V ,,building emutmnin I.E Ihercnylotlrue m,m emtutivesof his city to carer ups,
the above.tnca Eat propcny for in"w'Imn nmu—,.
F 0.
(We)agree to sane.indemnify and keep harmles,the City of Cupertino against
liabilities.judgment,,coq,anal eapemes which may in any way warm Iib,,said
C.7 Z City in consequence of ern gm I of III permit.
APPLICA DERSTAND WILL COMPLY WITH ALL NON POINT -
SOURCE R . r )NS. -7=7-00 Issued by: Dale
signnmits of Apphca Contrm, Date Re-roofs /e—
AZIRDOUS MATHRIAIS DISCLOSURE L
Will me applicant or future Wilding u,,am,nm.cmc m hardle hvallous material Type of Roof &M �JpSf '/ lle /1/ IN y
as definN by the Cupertino Municipal Calc,Chapter 9.I?,and me Health and Safety
Code.Semon 2573200t
0Ye, 3-41 - All root's shall be inspected prior to any roofing material being installed.
Will theapplican,nrmare builfin,occupant mecyuipir,m ,,deviceswInch If a roof is installed without first obtaining an inspection. I agree to remove
mit haznNous air(nntaolmams is definN by the Bay Arta Air Quality Mawgemem
emit
all new materials for inspection. Applicant understands and will comply with
''Y" all non-point source regulations. ,
I have ll) the naaurdde.Sections
2 rcquir 5533 a under Chapel erst of the
Cess buil ingfiedo&Salary Cote.ave ti mman, hat it 3 and,poen, I undcnmit the 7„7--o 6
if the building draws not curnn0y hove a moans,Iba n i,my rcsp^nsibility Iso notify me
1,=��nl��{{ rcyuirtmene w 'c maim W met prior wix9a7�7-9U ignaiur of Applicant Date
G—rnraaami abvtu Date All roof coverings to be Class"[3" or better