00090034 CITY OF CUPEBTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS.. PERM r NO.
OWNER'S NAME: APPLICATION SU It DAPI?
10407 SOMERSET CT MAXIMIM ROOF CARE C RFI 00090034
PIIONll: SANITARY NO. CONTROL NO.
`` RODRIGUEZ JAMES J AND LORI 423 QUEEN LN 09/08/2000
\ sz ARCIIII EC'I IIiNGIN iER: - BUILDING PERMI'I'INPO
0 40844] 09.53 BLDG ELECT P1.01,113MECH
t_I L= I'_I 1--1
yard
t4_ linal LICENSED am ONTRACTUR'S DECLARATION lob Description
- N I hemhv"Ilion)i i I mn Iif,hc B muter pea Prefv of u,Chapter Code. (corm encing
��I-{a. with Seaion]iMMD..f Uiviaiun3of NCllueinc%wnd l'mfcs%inns Code. ad my license
may— i% ��3_Z ��s7�
ce 5- in full force and eti�'I.
s s a License Cl. Lic.a _
°'O i U Dore pYa Commcmr_ _{�J(jp.+�--�-
w 3 u ARCI ITCCI"S DECLARA ION
Date
Iunderstandmyplans shallGclost a%public recordsTEAR OFF CEMWOOD, INSTALL 1/211 OSP 30 1
daoc Licensed Pmfic,N.nal CELOTEX PRES'IDF_NTIAL SHINGLES
OWNER-IIUILDHIi DECLARATION
m I hercM1Y'affm,tha 1 um exempt Wm the Contractor's License Law for the
t Z< following rese n.(Seca....7031.5.Busman,..all IYolexxion%Code:Any city or county
❑ which requires a permit u)commact,"Iyer,improve,demolish,or repair any structure
i3°-e pd°r ua ilx isxuMec."I%o reyuirexlhu aprheam lar such perminofile asignnl.vamTnem
rola he is licensed parsunmill the pro;i.xmn%of the Contmmors License Law(Chapter 9 Sy. Ft. Floor Area Valuation
(cnmmendng with Section 7000)nl Division 3 of the Business and Profession%Cudel
m,that he is swou,Nml,l}tun and In,basis for The ahead c,cmp....n.Any violmum
of Station 70315 by any applicant for a permit subjects the applicant lit cold penalty
of not more Than five hundred donar%(s5B0), A PN Number Occupancy Type
❑I,as owner of the protect,or my employees will wages as their sale cma,cr,aio i.
will do the work,unit the.stmcmra i%not intended ar offered for sale(Set.7014.., Reaired Inspections $7000
Business and Professions Cride:'I he Commaj:r',Liccn%c Law docs nal apply to m, y p
wucr of prnpccy Who hmlds or Ingaovex thcmon,:ntd who does such work himself
or through his own employee%.provided that such imprmxment%arc not intended or
oBerd r r sale.If.however.the budding fir h„provan,cm is%old windn one scar of 36929032. 00
impletion,the owner-builder will have the burden of proving than he did not build it
improve for pm,msc of talc.).
❑Las,mnerol he property.amaewxivelyaontmalr,still Ii.owdeommetor%m 305 — FRAME
Limemml e project Sm.7WL Rusin,%anti Profession%Coln l 4th Colnnrttor's
Th
cense Law does no[apply to an amner of pmpeny who build% it impooev d,twou. 307 - INSULATION
suit wbo cotuu rmtar such projects—th a%..mrvclorf%)Ii ensed pumaant ill the
suit
License Law. - 601 — ROOF TEAR OFF
ClI tun exanp,order See. .R k P C ill,This ru%on
602 — ROOF PLYWOOD NAIL
Owner Date
WORKER'S COMPENSATION DECLARATION 603 — ROOF BATTENS
Ilarchy amm,miner penalty of palm,one of the euwwing dodamtmn= 604 - ROOF IN-PROGRESS
Lel I bxv,and will nminmia a CeniGcvm or Consent m%dblamre for Worker% -
C K natve of he pmvifar for by Section, ,o nl the Labor Cde, fur ,he
perfonnanxc nl lbc tarok for which his tenni,Is ixxueA,
ue<and will maintain Worker%Compensation Insurance,to.acquired by Sectio /
37W of The Labor Calc,for the perfimnnnce of the work for which this permit is
B,i / G1/
issued.My Workers onitynson lnwrance camel and poli��cy��ni�and..s�oQaam�•::��pp
Cuvier—• x✓ Polley Nu , VUR
CERT'IPICA'r1UN ON IXEMPI'ION L'�@t(Yi-,vrWORKEI3S' V
COMPENSATION INSURANCE
(This w,hoo cad nm he completed if the tenni,is far one bandied dollars '
is l IS)or acs.)
1 certify Na in the performance of the work for which his permit is issued,1
shall am employ any v,oat to nary nTui .x..T as to heenme ,,hj,,,to The Workers'
C..mpen%mion Law,-..f Cvllfnmia.Date
Applicant
NGHCE TO APPLICANT:If.after making Ilii%Cenifcale of Exemption.You should
become udjccl 1.he Worker%Compensation pno,...nnMo
s nl'the Lan Cndc,yu moa
Q O Iirdmod,comply with ouch povi%iuns... his permit shall h,deemed ranked.
zVi
CONS'IRUCIION LENDING AGENCI'
a ; 1 hereby affirm that there is a constriction heading agency for the pa'rfom,anee
of the work fol which This Firma is issued(Sec.3097.Co.C.)
6. (� LeadeG Name
a 7 lender's Address
V Q 1 cenily that i have read this application and nate Iheuhe above ialionrmtion is
Lu p cunei.1 ngme m comply wah 1111 airy and aounly ordinances and xmm law%relaling
Q V b,b,ilding conswminn.and bomb)auNuric
snp¢ f N
sen,atives at city to enter clam
F yThe abova-mer i,mod piope ty for impectiun puHmecs_
(We)agmc to sale,indemnify and keep harmless the City of Collation against
Ur) liabilities.)udgntens,c.....and expense%which nay In any wiry accrue agnin.vl.aid
U z City is cn—juence(if the graining of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued by: Date
SOURCE REGULATIONS. C
Signamfe ofnpprcanVcomratio, Dull, Re-roofs
HA]ARDOUS NIATERIALS DISCLOSURE
Will Neappre"mortrain,huddir,occepanl.Toroorhndleha.aadolsnaludal Type of Roof .
us defined by the Cupertino Municipal Cde,Chapter 9.12,and the Health and Safety
Cale, ❑ion 25532WO O No
ye, All roofs shall be inspected prior to any rooting material being installed.
W,II The nrphcamis,I,TTtT chdNrng o,e ,sm,use cgaiparmnt o,dodxes which If a roof is installed without first obtaining an inspection, I agree to remove
anti,haxardm,;it,contaminants as delincd by the Bay Arca Air Quality Nlaamgehain
1Diatdclt! ono all new materials for inspection. Applicant understands and will comply with
0 yes all non- i t sour, a ulations.
I hall,mad The ha,indimx materials requimmems under Chapter 6.95 of the '
California Health&Safely Calc.Sections 25505.25533 and L553a.I undcrsmnd Thal A
If Nc hoildigduc.%rt,c a Tly have a tenant.that n is my aw,m %ibllityw ratify Ne �✓ /�
rccupam I 0 t h.�<eh.mix,R me,poor to I,vuance of v Certificate of —a—
oaaap:/w� �!//1
Signature of Applicant Date
Ow�orer ra alnt D:I,e All roof coverings to be Class"B" or better
OFFICE