01030050CITY OF CUPERTINO
„BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION: T
nD11.DLNG AUDH16S:
PERMITNO.
Z9 y
JNSJ ROOFING INC
01.030050
OWNIik'S NAME,:'
APPLICA'T'ION SUB DATE,
14
299 D BASSETT ST
03/09/2001
PHONE.
3'24-- 66
SANITARY NO. CON I ROI. NO,
4082796171
AltCIII ITCGENGINEER,
BUILDING PERMIT INFO
BLDG FLEC'IPLUMB MECII
IACENSED CONTRACTORS DCCLARAI'[ON
Job Description
p
I heresy al'I ion that I on, develed Order pnrvisione of Chapter 9 bliono a ai.,
inn Scniom 7nn01 of Do men 3 of the Business and Pmfessioms Core, and my license
Lin lull epee n°'I de'39 7�� 0_
icense cl (� I.ie, a_
REMOVE EXISTING ROOFING,
✓ _ _
°'t` ��-I on
,
ARCHYFLUr:S
INSTALL NEW 4PLY GRA EL—SURFACED BUR.
I understand my plana .hon he used m public records
3�
ran dP r
OWN H c,e, Illik n DECLARATION
I mat fl n tl pt I'n J t rota i' r ire the
/�/
70 l city
billowing g IRntit 7011 S Business J 1 f. s Code: Any ly county
r
y 'I nils t tiItern J heli, p ratemeon
-
prior to
priorunuiswam'eialsore...Ihethe such permitmlove.signed nt
Sy. FL Floor Area
Valuation
morrotfor ChRmenl
,hot he farm, iNpmction adPi Law lcbapm9
with Section 70g ofDinnsn Sot he Bu,ine,, Code)
is ku end Promsny
Division 3 othe
or that he e an and a Any violation
for the alleged exemption. vi
ed ex
amt for
neat he is 31nap Oany
i a ,l pe ono ,,
ll for a Permit snnjctl.v the epplicam lu n etvll loyalty
of Sin tau 90.a S by any hundred
nr nm more mon Teta numdnsd finnan, asw).
APN Number
Occupanc*4pIW
❑ I, to aw'ner ofthe , ..Nr y, or my employees with w'uges as herr, sale entu,enwtion,
will do the work, and he strvcmre is not intended or offered for sale (See 7044,
online., rel Prnres.imn, Cmiu:'Ihe Cm,lmctorr Li.xn.. Law does ,at apply ,, an
3751. 1 0604,-gt*ed Inspections
was of property Who hilts or improves theron. and who Jens such work himsevl
or tlnmugh his own employee,. pmvidea that such improvements are not intended or
,
offird for vale. IL howeve, the building or intprm Onven is sold within one year of
conplafnon, the nwnrobdlder will have the have=n nrpmving that he did not build or
305 — FRAME
impmvr for parpamol'ta.).
307 — INSIJLATI0IV
❑ L to of the property - on withadeaa un
TEAR OFF
sla d Perfeing
the Businesshe Contractor
the Cade,) Toe Centmreon.
sec. 7t14d. Beams%and Try,
601 — ROOF
whion,
iverwconsumer
does woo) thereon.
nd M Law tees not apply form osvnw
,
— ROOF F LYb100D NA I I_
lice seimproves
with a iannv
arta wba cmmaek tam such project, wan ti conBaetorrn) licensed paraaam m he
602
Luw.
Donal,
ROOF BATTENS
eral.iccnse
❑lean xettmt ander ser. .n2x rclot his mn,aa
603 —
604 — ROOF IN—PROGRESS
0, net Dale
WORKER'S COMPENSATION DECI.ARAPIIIN
I Hereby idftmt um ler lennl'yofpajmr me of t ac lbllowing declaration,:
-
❑ I have ;lad will o sin am a Cenitiea, of Consent nn self -mare for Wnrkcr's
Cooperation, us provided lar by Section 3780 of he Labor Conn. lin the
,
performed. of he work for which his perm, is issued.
-
❑ 1 have and will maintain Worker's Compenation Insurance, as require) by Section
3700 of Labor Code, For the pedonu;mce ofthe work for which leis permit is
inaed. My workers Compensation Insulin rc carrier and policy tire:
anohr
No:
cvarier:�fdM'IFI �()IV
I7EkrNi'yIPTFROM WORKERS
COMI 1NSATION INSURANCE
(Thiscfa m need not be r: inplemd prmiT if the is for one hundred dollars
($ Into of an")
I certify that in The p,rfnnuunce of the work for watch this permit k toned, I
%hull no employ any parson in any manner se, as m become wihivi to he Workers'
Canm rnanion Laws of California. Woe
Applicant
NOTICE TO APPLICANT: If, after making this Cer iticam of Exemption. you should
hecrtue vuhjccl m the Worker', Contpensani on Provisions of the Labor Code, yds mnal
forthwith comply with such provisions or this p:nnit shall be denttd revoked.
CONSTRUCTION LENDING AGENCY
1 hrrehy nlTren taut them in a ai mdmetion lending agency for the performance
or the work for which his permit Is issued (Sec. UNP, Co. C.)
Lader', Name
Leta lcr', Add...
I certify that 1 have read this application and state that the above infnmrtion is
eofrecL 1 agree,, amnidy wish all city and cnuny oNintnmc, ;nit craw law, rclafmg
to Wilding construction, and hereby authorise reprexntati.es of his city m enter upas
The uMrve-tncmi( ed property far invpcokm pupv,.e,,
-
(We) agree us save, indemnity and lave, hamdess In. City of C.'rima... last
viabilities. ju ignnentc covrc and expenses which may in any wary :mane against said
` g, /
Cry in conn tic ncc of n
CAN N Rs'hc poutOmg of Odin Icrmit.
ILL COMPLY WITH ALL NON
U ( /
SOUR hNIlTANDSAND -POINT
Issued by: Date
/ )
Re -roofs
SI'TedO t \pplcvnVGmu nota, )Gane
I OUM - DISCLOSURE
W ill the applicant or loom tiding len., wore of Wndlr hazardous nutrrial
Type Of Roof
s retired by lac Cupadino Mw cipal Code. Chuprf 9,12, and de, Health and Safety
Code. Section 25532nd.1
Cl Yc` 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or more building nuupant use equipment or device, which
If a roof is installed without first obtaining an inspection, I agree to remove
ctnh haznrdau, airc raannini 1,asdclinnl by rnr Indy Arca Air Quality Meatgcmenl
Districe
all new materials for inspection. Applicant understands and will comply with
ElYen ElNo
all non - Him source regulations.
I have read it,, hazaabmu materials requirements under Chapter 695 of the
Colilinnlu Health & Safely Code. Section, 25505, 25533 unit 25534. 1 understand that
italic bei orp_in, not currently have a tenant. that it is my resprradoity to unify the
— 0
j —�q f
'cup.n luvnnr tst be tuel prior u, I ,m n c of a Certilicuo it
Occult
39 a
Sig fA Icant Date
A root coverings to be Class "B" or better
-..ea agcn 1 W—
OFFICE