02030006C
OFFICE "
CI sun of c DPERONNo
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS.
PERMIT NO.
1294 S STELLING RD
RESPONSIBLE ROOFING INC
02030006
OWNER'S NAME:
APPLICATION SUB DATE
PATRICIA HWANG
2882 SPRING ST
03/01/2002
PHONE:
SANITARY NO. CONTROL NO.
(650)969-6151
00
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
HZLICENSED
CONTRACTOR'S DECLARATION
Job Description
Fug
y �
I herby affirm that 1 am licensed under provisions of Chapter 9 (commanding
withScatinn70IXgofDivision3oftheBusinesadProfession,Code.andtrylicense
is"full fo fw
REROOF.
da
uce eany - c
T/0 & DISPOSE OF EXISTING COMPO. & TAR/GR
ca.og
' tmet77
cATI
APPLY NEEW 30 YR COMP. & FIBERGLASS CAPRO
ARCHITECT'S DEC
1 understand in,, plums shall he used as public records
po
Licensed Professional
IF
OWNER -BUILDER DECLARATION
I hereby affirm that 1 ant Occup, from the Commemr's License Law for the
a
following reason. (Section 7031.5, Business and Pmfecsi.a, Coda Any city mcounty
rD
which requires a permit to consumer, altar, improve, demolish, or repair any structure
m
pdonn its ismance, also requires the applicant for such permit m file a signed stvemard
a'(':. }S,q.:FLi Floor Area,, ,e ,
=J is
V,,aa��yyl1anon
7 4 UII
that ha is.limosed pnrtuunt to the provisions of Contractors license Law (Chapter 9
(commencing with Section 7001)of Division Sof the Business and Professions Code)
Or that he is exempt therefrom and the basis for the alleged exemption. Any violation
r: ' W It^ �' 3
of Section 7031.5 by any applicant for a permit subjects tlm applicant to a civil penalty
of Our more than Five hundred dollars ($500).
3 6 6 Sqp
1N�Vgtbrd'0
.. Occupancy Type
° 1, as owner"( the Pmpeny, Of Illy a npluyces with wages as their sale tt,mpensadnn
will do the work: and the stmcmre is not intended or offered for sale (Sec. 7044.
Business and Pmfas°inn. Code: The Con racers License Law does not apply to an
- - - - - -
3 0 5 — FRAME Required Inspections
Owner r of pmpeny Who Wilds or impral thereon, and who does such work himself
or through his awn eoewyeesh tom of
eacalemaol are Ilm mo
3 0 7 — -
ear
Wilding m sold within ooe yea of
for sale. IL however, the building or improvement
_ _INSULATION
6 01 — ROOF TEAR OFF .
n
a,npletmn, me mwndrbalmer tum have me human of proving that he die not band or
comle
mpre, far purpaseafsme.).
602 - ROOF PLYWOOD N_A_IL
'
oi.mownefufIf.Property,ameselloneiycontractingwithiicenseadommemr;t"
603 — ROOF BATTENS ... .
Lonsuuct me project (Sec. 7044. Busincss and Professions Cade:)The Comraor's
icense tutu docs mot apply to an owne, of p,opcny who builds or imprmes thereon.
604 — ROOF IN—PROGRESS
and who contracts for such projects with a conwaof(s) licensed pursuant to the
.. .. ...
Contract.,s's License law.
_
❑ota cmpt under sec.' ,B&PCfar this reason
Iines
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby sprout under Penalty of Flighty one of the following declarations:
0 1 have and will maintain a Certificate of Conant to self -insure for Worker's
�' A
Compensation, as provided for by Section 3700 of the Labor Code, for the
e`7B ,0"4 ��®
fammouaoae of the work for which this permit is issued.
and will maintain Worker's Compensation Insurance, as required by Section
°'"°�`°
the for is
AR 6 20 Oq
37M of the laser Code, fur the perforrm em of work which this permit
Policy
LL
.
uue . y Worker's Compensation lnsumncec eland number are:
1rA�ROM WO.RK.ERS', OD
OF EXEMO
.. :.
s'fKLwCON Y(L01 N 0pN
OMPENSATION
i
_. _.__...
• (This section need not be completed if the permit is for one hundred dollars
(SIM)or le,s.)
.. .._. ..
.. -
I mmpl than in the performance of the work for which this Permit a issued.
__- .. . .. . .. .. ... - .. _ .r
,t
nany
:ball not employ any person in any manner zo as to become subject arnM1e Worker" '
's
Compenmtimn Lows of California. Date
Applicant , .xe
NOTICE APPLICANT,, free making this Certificate of ocyoushould
Z;
Label
in the Label Crmkaolvmush
me Waders Compensation permit
O
mrome'suomply ,hall
forthwith comply with such provisions or this permit shall W deemed revoked.
'
CONSTRUCTION LENDING AGENCY'
1 hereby from that than, is a conswctmn lending agency for the performance
'
of the work for which this per,it is issued (Sec. 3097, Civ. C.)
Q
7 z
Under's Name'
Lender's Address
, ,
'0
1 certify that 1 have read this application and ,are Nan the above information is
�- P
nirect. 1 agree to comply with all city and county ordinances. and state laws relating
C.)
to building construction, and hereby will representatives ofth .% city in enter upon
r W
the above-mentioned propeny for mspecl o r purposes.
0.
(Way agree to save; indemnify and keep harmless me City of Cupertino against
ret
liabilities, judgments, costs and expenses which may in any way accrue against said
1
i z
Ciry in consequence of rhe granting of this p m t.
/f /
V
P"CANT UNDERSTANDS AND MI LL COMPLY WITH ALL No POINT
-
Issued by: Dat / V
URC. ULATION
8^
Signature cf ApplicanUCmmmnoi Dae
Re -roofs /
HAZARDOUS MATERIAL$ DISCLOSURE
Will Ne nppl cadt or fumm Wilding ac pant done or handle harardoas material
Type of Roof - -.
as defined by the Cupertino Municipal Code Chance, 9.12, and the Health and safety
CodeSoidim2553200❑Nn' . r t
.- i n ' +
•• _ f
All roofs shall i i"e ed prior, to anyjoofing.material being installed.
wits the applicant or future Wilding occupant use equipment or devices which
-be
If a roof is installed without first obtaining an inspection, I agree to remove
emit haaamous air contaminants as defined by the Bay Area Air Quality Management
Di,trmn
all new materials for inspection._ Applicant understands and will.comply with
Oyes . 0 N
all non -point source regulations.
I 1 have read the ha?mdmi macfials requifeintin under Chapter 6.95 of the
California Heahh & Sufmy, Code, Sections 25505, 25533 and 25534. I understand that
ifthe Wilding does not cumntly have a anent. mat it is my responsibility to ramify the4
/ ", - .3-'—�w •'
puI of the requirements which must be iet print to issuance alta Cenifica¢ of
L
Signature of Applicant ate
VeAll
roof coverings to be Class "B" or better -
Owner or emhmrirod agent - 'Date
OFFICE "