00120121 CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGAfit)0j;39 RIDGEWAY DR FOUR SEASOPIS ROOFTNEPERMIT No.001,20121
OWNCR'SNASCHOBER RICHARD L ,TR F,49 HORNTNG ST nOucnvo12/ 19/2000
SANITARY NO. CON'I'HOL NO.
1.11(1NH:
(408)278-0330
ARCIII TECT4ENGINEER: - - BUILDING PERMIT INFO
RLDG GLECT PLUMB MI!CH
w 1=1 1=1 I_•I 1=1
Sri LICENSED COM[RACrOR'S DECLARATION Job Description
%= 1 hereby afro!0ed 1 am licensed muter provision%of Chapter (commenemg
py�u� w;m saran 70!1!11 nrDmisnnn3onnm Bnanm.,dna r.ne.>n,n,ender anti line ncea` CEMWOOD TO 40 YEAR COMP
Y a n Bal tome and len.O
O 6 U Li�an,c Cbi" _ Lim.
j LL y DatC // Conuaclor� /C
ARCHITECT'S DECLARArr10N /
I understand my plans shall be used as public m"nrJv
F�
�p O LicensedProfessional WNFRAWILIDIFIR DECLARNI ION
1 hereby nffum o nl I L exempt trmn me Conlfncmr'x Liana Law Poli Inc O
C%a !allowing dawn.(crouton 703LS,B.alncs and improve.
vie inns h.or Any city s mature /
7.x e which requires a permit m am,lma,aper,impnnx,tamulisM1,or repair any structure
a3ca
Puertor Ko y ;the ppl'ctr . hpc i0 fl g J %amen
that he is licensed srsu. to top r,oftn contractors LLow Chillier Sq. Ft. Floor Area Valuation
(eon ad5ai 7Lom nr ',ls n
T l . a
Bs, n r:, ,ave) $9000
n nal he is caempl thamlm....nI the Iasis En the alleged evmmp0on.Any on
at Section 7111.5 by any applicant for a pcmd subjau me applicant to a civil penalty
of not more than five hundred annar.(ss00), AIY4l�ptr>.bCr�F Occupancy Type
a
❑1, ,owner of the property,or my employees wen wgm
a ,as their suit compmnsalion. r.41�Cf
. 00
will do the work and Ilio nmottim is nm iomndcd or odvamd lin sale(Sets 70a4,
ravines ami Pnnmvnms Code:'Ihermttralta',Iiten,e!stow doe, all apply In ma ^0S —FRA Mk,quircd Inspections
owner of pro,am y Who builds or improve,mean,and who does such work Idm,elf .':,
or through his own an,lo,ve,powided that verb imprmcatem,am nm intended or 07 — I NSUI AT I ON
offered for,all.If,hnwesc,the building or imp nsm .,at f
aem is sold within year o ,
completion,the uwnenbuilder will have the burden of proving that he did not build nr F,0], — ROOF TEAR OFF
improve far purroc of,ale.).
LI 1,aawmrofthe properly,amexclusively comradngwith licensed a,mractos.to 602 — ROOF PLYWOOD IVAIL
Lnotmo the projecr Sec.Dad,Ramex,toad Proke—on,C,AC:)nor Contractor. 60: — ROOF BATTENS
icense Ire all not apply a an Owner of property wIm builds or innpnnv,deacon.
and who contracts for such projra.s with a contractor,)licensed pursuant to the F,04 — ROOF IPI—PROGP,ESS
Contractor's Limen,%Law.
❑lam CxCoun mnlcr sero .B&P C for di,roa,on
Owner D:nc
WORKER'S COMPENSATION DECLARATION
I hereby alTnn under panty of perjury one of tire following dellmolems:
❑ Nova and will onainlano a C1011ke,c Of Con,cnt to nallin,arc lar Wooer's
Compenstnion, es provided tau by Section 3710 0l' the Labor Coda, for the
pctfmna..e Of the work Ibr which thix permit i,i„ued.
❑1 have and will nmimnin Worker's Cnmpen,ation Inmmnce,a,ow.ired by Section
3710 of the l.uhor Cad,for the verlon none of the work for which this permit is
is,um 1.M�,y)�Wurkdr's Cnnywnnulinn Ian
nsurance Currier d Policy mi nher alit: ,
Caaricr—}[r�r,�jQr1Ge Nr Z Policy No.:fjk&k �7�
CHRTIFICA'nON OF I!YEMITION FROM wORKHHS'
COMPGNSKNON INSURANCE:
[rbis section neCal not he e,mnPlcled if de noil is for one hundrtd dnllan
fB IINp u,Icss.)
1 mem y that in the perfomnunce of rhe wort:for which this pc.Oil i,issued,I
shall not employ any person in any manner so a,to become subject to the W ifl en'
Contpen,aion Law,of California.Date
Ali
N(YI'IC17 10 APPLICANT':11:afrmr making this cerilicac of Haemption,you should
heeonte xubjcd m be Work,,,Cnmpenwtion provisinnx nl the l.abnr Core,you amxl
Q Q Rrnhxvid comply w ith...It pmemor,or this limit shall be cleared m—keJ.
Z
CONSTRUCTION LENDING AGENCY
' 1 wit by affirm That dere i,n ctna....am leami ng agency lin d,performance
fdow
VI the w,,,k lin whirl,div,annual iv ted(See 3197,Clv.C.) ,
A. Q lender',Name
7 Lcndcrx Address
U Q 1 canify that 1 have read this application and state that the above information is
la. E.. correct.I agree to comply with all City anti County ordinances and slate Is—relating
Q V to banning nnsmtnlon,tel naroby Inch..lac mpm entmive-A hi,city m enkrupn I -
the above"oten toned p o"o'for nnxpCCllno p......s.
(We).,meis save.indermilyand keep harmless line Ovid Cupenim,ugmmt
V1 liabilities,judgment.,costs and aspen,,which inay in any way accrue agmmr said
(� "L City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULANONS. y'
5i nomtcnfnppncanvc:.nnanm Dale Re-roofs
I IA!s,RDOUS MAI ERIAL.S DISCLOSURE
Will the applicant orfuture wilding occupant store nrbundle ha.amin,material Type of Roof
as Jcrned by the Cupenim,Municipal Cndc.Chapter 9.12.and the Health and Safely.
Calc,Sccnan 15532(x)?
13 YC' XNn All rool's shall be inspected prior to any roofing material being installed.
Will the applicant or future holding Occupant use ryuipment or der ices which If a roof is installed without first obtaining an'inspection, I agree to remove
emit hazardous air comamimana a defnrd by the ILny Area Air Quality Management
Dmmerr all new ma[eri Is for insins Applicant understands and will comply with
LYa, /�"° all non-point wrce r t herons.
1 oo,c read the ha mon,namaials reyoimnnnts unds7 Chi,w is of de
California Health&Salely Ct.le.Sections 25505.25533 unit 25531.1 undersand that
it the building dor not currently have a tenant.that it is my res arrod lily m notify the
CvCu,,od of the r air hicIs must he rale!prior m isunnmc of t CcniG<um of
O1Cape y' yrs. Signature o Applicant
/ " /7 _ 6, Date
oo—sunt%�a iamd.,COI (i ODom All roof coverings to be Class "B" or better
OFFICE