00070133 CI'py OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AOI fQI8J' 85 N STELLING RD JNSJ, ROOFING INC PERMIT NO 000701.33
OWNER'S NANVALLEY CHURCH OF SANTA C ARA C 1268 LINCOLN AVE, S fl!" 111f�°I�1MY/24/2000
'f1Ol'i - (408)279-6171 SANITARY NII. CONTROL No
0O76 ARCHITECDCNGINEER: BUILDING IrERMIT INTO
If LW, I.I.ECI PLUMB NII:cH
�y LICENSED CONTRACIOR'S DECLARATION fob DCSCI'IpllOn
_p 1 hereby affirm Ina(l In
licenced under pmvisiom of Chupwr 9lcommnnemg
P0:4 with 5cetion71a,!Division 3of(hcBurinecsand Pmfession,CMe.and mylicense RE—ROOF
a -
is in full 6rcc and o Tm(. C Q's
s w'a License clan -69 Lic.x _ 1��+3`v
Q Ic 7 QO Contractor
1100,
ARCHI'FECI'S I ALCLARATION J
CLL�� I mude,and,ay lLan, hills d i hl Ns
S /
d 6 p 0 1.¢cn J Pr f:. al
OWNER-BUILDER TION
w 1 h by ffmr In.,,t exemptm the contractor's
f th C t car :I' L far the
h roll,ol(Sa 7031511 or—nal 1c,i isC AY city tnty /
gg p sun it titanic.,a P III( imcl illi, nallov,drinialish.or re,aury siroarim,
6 S� rrtil r Ism rem pili. n chw tiff 11 :g I.fwnrm
main licensedpursuant( top r. Ins Contractors L en.ehw(cnamer9 Sy. Ft. Floor Area VaiCn' dbo
(commencing with Seen(,,,101lo of Division 3 now Business and Professions Glide)
or that he is exempt tnerefmm and the basis for the alleged exemption.Any violation
of Sectio 703 1.5 by any applicant fora pecan(subjects the applicant u)a civil penulfy
of not more than Eve hnndrcd dollars 6500n. AP'.A'0627. 00 Occupancy Type
❑1,d the
work,anti they,m my is
note tended at offered
wife pen.cnio,. 3 tr 7
will do the work, sv the an, a in not intended% J e se i ata for sole(Sec.'list,
Business and progeny
War b ilds o Thr Contractor thereon.and w hw J«s not apply or elf RRee rinsed IntipCCll005
of his a%Who huiws or ovided atsuchand who Jmcn re n work norsmended
,, 305 — F RAI,
ownerlaccli r his own employers a building
Ilan such se car is
are not I,mnded ar
ramrodflit raw.It,er will
ttn rip se ar .,for tanninti c,year nr 307 — INSULATION
imtnpwe lio the owner builder wul have me n�ntdrnn of nm ing drat nr did n„I Huila nr 601 — ROOF TEAR OFF
prove Ibr purprai ornnlc.).
0 L as owner ohne penalty.am exclusiaely contracting with rccread contractors at 602 — ROOF PLYWOOD NAIL
construct me project(Sec.7094.Business and Profession.Citric:)Tne Contractor. 603 — ROOF BATTENS
License Law does not apply man owner of pm]wny who huil,N or improves thereon,
cand who contacts be sticb projects with c eannaeo(s) Herrod purstuua to(rte 604 — ROOF IN—PROGRESS
nno-nvou"Liernuc Law.
01 ma esetnpf under Sec. .R k P C for(his lemon
Owner Dara
WORKER'S COMPENSATION DECLARNHON
I ncmby affirm undirr penal,of perjury tine or Ii flowing dcrlamtioir'
1 1 have and will maintain it Cenificate oI'Consent Io wlf-insurc for Worker's
ampcnwtinn, as provided for by Section 37M of the I.aM,r Crile. for the
pedommucc of the work far which this pe.all is isw:M.
❑1 have and will mturn n Wodet,Cnmpemaion insurance,as required by Section
37k)of Ice Lubar Cade, in the Illormence it(rte work Ibr which If,Ixrmit is
timed.My Wnrkrr's Gmgwn\Lflma lmu runic currier and Policy number ore:
QQ��teVH itssonalwl
r:_Iaxe10ERTI2Y lblrif r�r.Policy No.: A(1 LI_L_LDQiL-Q6
CERTII'IeeAllO.l'O EMPI'ION FROM WORKERS
CONIPENSAI'ION INSURANCE
fI Ids ruction Iced an be ac nileed'I me permit is fin tine hoofed dullnrs
(Slim)or cas.)
1 ccnify that in(he performance of the work for which this permit it issued.I
shall not employ any serum in any manner va us to become subject to the Workers
Conrpeamfiun Laws of Cull foto ia,Dae
Applicant
NO'1'ICE'f0 APPLICANT:If.ufail,taking Ihls cenili,we nl Excnnpfion,you should
variant,sobjet(o(n,Warker'r,Cnmlxmalk pro visions of the Era,,Code you moa
Q Q forthwith.Imply with such prncloom.nr his permit shot]be domed rcvnkd.
F 14 CONSTRUCTION LANDING AGENCY'
1 hereby affirm Inns firm is a constitution lending allay,for the perfnmemre
of the walk to,which Ilu,permit Is-sawed(Sec.30W.Clv.Cd
6. Q Leader Name
7 Z Lender's AJdrea
U0
I certify that l have read this application and state that above information is -
emcee.I agree to comply with all city and county mainamrs and state laws relating
O U at banding construction,and hereby amniotic repmacmalws of this city to ether unman
W tire abow-mco, act prose",toratspcerinn pnrpn,. .
d (We)r,ow it,nav,indunuttty and ocp ltenalcs l he City and Copes(inoag:dnst
4 liabilities,judgments,cas s and expenses which may in any wary accrue against said ^ y
V Z City in tsmaequence a(rte gmatiaf in permit (r\.
APPLICANT Usigg STANDS A99pMp WILTITH ALLNON-P INT Issued by: DatE 1
SOURCE RECD, Tl. ()P5._, 7�is.��OO
Sigmntt •ulAl,pla:mllcm
otnacr Daw Re-roofs
IIA%AltOOUS MAMMALS DISCLOSURE
will fine applicav(rte future Funding occupant atom nr handle haimcom nracnal Type of Roof
as dtlinM by the Cupertino Municipal CMB Chapter 9.12,and it,,Health and Safety
CMq Section 253321arr
0Ym 11 No All roofs shall be inspected prior to any roofing material being installed.
Will it npplieanl or lattice hulling vans:tttl ma Cutopmcm or devices w Aieh [fa roof'is installed without first obtaining an inspection, I agree to remove
UIWool sir comamin"o,as dcf ed by the Bay Arco Air Quality Managemem
UisI iOi all new materials for inspection. Applicant understands and will comply with
oyes Cl No all non-point source regulations. � ��
N I have mad me h:taardnar materials requirements ion itis a ander Chapter b?5 of fo r p ��r%'^e'^"/"" It-A00 Cillavalu llcalm. Surly Calk.Sections25515.25533 and 25531.1 o,dcra;mA Phut `{�X/ �I/i
II'Ins nmdln'nng dos all cmmmly Barr a wttatt,Inn n is my rc.pandnil'dy w Bradly mr
oc'euprnl n1 the wquiw cola which must be A y to iswttnee of u Ccnilicvw al
Occa'vow, _ ' J ���p Signature of Applicant Date
ownemam tnriaed agent /I -1otter All roof coverings to be Class "B"or better