00070135 CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: ` PERMITNO.
OWN'ER'SNAME: 7 AI_I_LANES ROOFING APPIACWI "�J INS' 135
1.911. 1 PRUNERIDGE
HONE: SANI'GsuY (l�S".l]I(>),yVr•
HP 1250 CAMPBELL '67/24f2
w O�p ARCHITr:CTI iNGIN EW BUILDING PERhII'r INFO
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(408) 261-2 G ELEC1PLUMB MECH
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Int� LICHNSED CONTRACT OR'S I)ECLARAl9ON Job Description
z0 z=C I hereby aM....that I a.a licenced and,.......runt.of chapter 9len.um."ho,
arm with Serio 700((of Dlounn.3 of he Bavinessavd Pod ssinns Cod,undatslaraoc -
ay^� is in full force and He
x z License Class. ��ry+��1_ Lic.a_ -
u 3_ Uate]�V K� CHITECT'S DEC,LAR A11;
1 unto
dersod my pkmw,hall be used ae public accord. RE—ROOF
^�r
oo Liwn.vJ prop.,d..m.l -
qq ur,I an,Irwoup,iR ur the 1tATlON _
1 hemny.Oran the I an,emntpt imm the C,,i t, is e:Any,Law to,the -
h2r 703 1 Bu,lnmsmarmtldeeiann Cody:Anycity in county
m x O which requires u Peart reamer the alter.imfntve,h penin it t file
repave any t runum
��'9 pro flanhej,uvea.<e.also requires thm,i,i..of forthe C.hpcm.iuo file asigned w(Cha mem
s- (commeshameJpSectio m0))of Dsinnamnnd the
rosinesandme Law(ChapterCte.4 Sq. FL Floor Area a®n
(commencing be is a with Section 71ga of Division J of the[rosiness t,and Profcny vi latJN
or the he is e.aempt ihemfrn.n and the basis for the alleged enemPtion.Any violation '
of Section 703 1 s by any applicant for a.coin nubjeets the applicant to a civil pewlty
or not onom than five hundred dollars(S500).
APN Number Oc q,pBRCY 3c
❑I,..owner air ate.ntpeny,m my emrmycd,w'Idt wagc,.1'her,ogle emnp6neation. I G4 rO
will do the work,and thu 9lmemre it not inn nd.1 or uttered for,de(Sr,.7fW, _ gel
If.'ine,and Pmdeuinnn Cade:The Contracmr'e Lirvto,Law does not apply In an ?1607046. IZI&"ired Inspections
owner of property Who builds or improves thereon,and who does such work himself J
or through his awn employee,provided that such improvements am not intended or
officinal for v1e.If,however.the Molding or improvement is said within one yea of
completion.the aviar-holdmwill have the burdenofproving that hedid not build or 305 — FRAME
itnp...ve far perlxtvc of eak,) '
01,as owner or uta pn,pcmy,aloe.ewaivdly donor,an,wuh hcen.e eo.armaors to 307 — INSULATION .
I1o a n i t is 71,44 B .a r m.c d )'f c tmm..fe 601 — ROOF TEAR OFF
un. L ctrl varipropertyant . thine P Bmmnn
and vett. ontraes for such r je - in t Ik)licensed r t to Ire 602 — ROOF PLYWOOD NAIL
Contra,...s License Law.
0lam exempt under Sec. .B&PC far this.",a 603 — ROOF BATTENS
owner Date 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
1 hcmhy.Jllrnt under penalty of Perjury arm..(due following Jeclarwlo.vr1
O I have and ,11 matio,on a Certificate of Consent to self-insure lin Worker'.
Ic open...on, a, provided Iia by Sccdon 3700 of the Labor Code, for the
perhrzmmnce of The work In owhich this pennil is issue,
❑1 have and will maintain Worker'.Con,roation Inmmnee,as"aimed by Section
3709 of the Loris,G.fe,far trc performance of the work for which this Pontin i.
.awe.My Worker'.Campeau., sft19�ranee cams rid Po(live rnmbcr am:
Carricr:sTATF. c �olicy No.: $ (Ia1 Z• 8 V
C 17R 1IPICAIR N UP BXITNI1'T[ON PROM WORKERS'
CGMpliNSAHON INSUKANCE
(This action need n I be cnnn,lcmd if the perm,is for one hundred dollars
(SI W)or less.)
I cenifv that in the performance of the work far which this permit is issued.I
shall not employ any Perron in any manner.a as In become suhjem u)the Worker.
Compensation Laws of California.Dale _
A,,licam
bKO IC13 TO APPLICANT!If eller making Ihiv Cdnibam of L'xempdon,yon should
hec...nv...hied ut foe Wmkc,'s Con..cn, oa....vision,or the Lab or Cole You must
Q 0 runhwlth eamply with melt Pnrviainna a thin pemull,hull ba Jccme.'evoked.
z
rr tZ, CONSTRUcriON LENDING AGENCY
1 beteby uMo.that there is v comauction lending agency for the performance
fire work for which this trc.air is i....J(See 3097,Civ.C.)
G. Q lender s N...
.7. z [.code's Address _
V Ie ityd tlh dlh: ppl' t d latethuh b f .ntrt s
fi F" u'rc t I agree t ply ilh all ei,,' ly ordiodarcesand st,ac look rda(ng —^
f..)
dib r an"nola,anclIterchy e P Pi Ilh:111Y lo tan Put
E} R7 the M t 1 P P tY I' peen p .
,. 0. ( al,rcvto amc, J.unify and keetr M1vnlcn:Ih CtY fC pan Igor tel
W liuniliWn,
rts onJ a which mry m any way.peace.Paco..said
C.7 mIssued by: Da C5.gn. 'mentr - Dace Re-roofs
IIA%Ak UOUS MA'fliltlAh9 DISCIASUNE
willde or lWmc bulding ace.pam store or handle hio.ro a..mataridl Type of Roof
o dchae by the Cupmin..Munlcl,d Gyle,Chupmr 9.12,sad the lealth Dorf savary,
Code,Salina 2553200?
G Yca 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant at future building reentrant use equipment of devices which If a roof is installed without first obtaining an inspection. 1 agree to remove
mit haea dam,air contaminants as defined by the Bay Area Air Quality'Nutmgcttetn
istdce all new mat rials for inspection. Applicant understands and will comply with
O Yes 0 N n-poi I sour e regulations.
I time react the It t onv ntam'lao,rarylrcnmme under Chapter b 95 nl'fhe Q
Colilomin Hcalht&Safe Code,Sccfiaa,25505.25533 and 25534.I r.minr,mml that n O f W
i1'the Mi an re umomn,that n I.ley c"oraibility t....tiny the • -
ant of ac,v u r cots n h n a M Incl Prier In hsuvnee of n Ccnifcum of
'° are Signature of Applicant Date
7'Z All roof coverings to be Class•'B•' or better
ox-ncr or amhmieal o cut Use //