01070039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22669 STEVENS CREEK BLVD JIM KRAUSE ROOFING 01c0P70039
CAMMLTER JAMES A AND MARALE 2310 DIANA AVE 07/ 11/2001
i PHONE:
(408) 779-0704 SANITARY NO. CONTROL NO.
�
nal ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
O�i LI LJ
y6i
Z 6 H i LICENSED CON19tACTOR'S DECLARATION Job Description
O m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROO F.
pm�m with SeencinJ0001 of Division3orthe Business anJ Rofcssions Code,and my licence
m ismmurareeande T 0 3 COMP. SHINGLE
f-z a uamn,e aces tr�— uc.e SS 5 / r
Z
o a Date � 21 cant ter ADD 25 YR. CELOTEX COM. SHINGLE.
m 3 a.N ARCHITECTS DECLARA'TI N
F'aa.O g 1 undersmnd my plans shall be used as public mcordx {wy�
mne ne<Z Licensed Pmfessian d B• �'p■��y�^ E
co O O OWNER-BUILDER DECLARATION
n m I hereby affirm that I am exempt from the Connector',License Law far the I JUL 3 1 2001
C Z a following reason.(Section'RD1.5,Busiu¢s and Prnfes,ioms Cafe:Any city or county
Y 2 which requires in permit to comltucl,alter,improve,demolish,or repair any saucture
n 3
prior to n. s I q m ppl tf hpen t R4 'g ad statement - - - --- - -
Ihat h<ill licensed p rl tto the farvissm,ofin Contractors License L (Chapter 9 S
( ' , and _ Y ✓s9 Ft .Fslo!o_r,Area,•
uation
e) BUIL {
'commencing lM1S I JIQII IDJ (h N ' e Pufe..' .0 D MMr the, hes ahr th Irom call the basis for the alleged exemption.Any molofo
of Section 7011.5 by any applicant for a permit subjects the applicant m a civil penalty
of act mare than five nnndr.ddollars(gsa). 3424FA�!341190 I, Occupancy Type
❑I•ll d owner o1'the ndproperty,
structural
et is otintwithwages etheirsolec (Site aioo.
"Busitio me work:and the swmme is not intended Li or offered rot ante(see.10 4.
an 305 — FRAME Required Ins ections '+
'Business and Professions Code:or i e Contractor's License Law docs not apply to an LI p
r orpmpeny who nwla,or improve,thereon,and who does such work himself 3 07 — INSULATION I
owner
his own employees,provided but such improvements are mit intended or
'offered for sale.If.however,the huilding or'improvement is sold within one year of 601 = ROOF -TEAR- OFF- _
.j ..
oprowcorpmean=rtalderwillua.emennmenorprovmethanedidnolhnildor, 602 — ROOF PLYWOOD NAIL
improv= purpnuo
_ .. . .. .. _. 603 _ .ROOF BATTENS .. . --
_ °I•as owner ofmA property nm eadusively mmncting with licensed contractors to
_- -
consumer he proj«t(Sec.7044,Business end Professions Code:)The Co......', 604 — ROOF IN—PROGRESS -
License Law diva not apply to an owner of property who builds or improves thetnon. 1
:. and who.convacu for.such projects with a contrachoi licensed pursuant as the ......_...._
Connotations License Law.
- - ❑I am exempauMe,Sec. ' :B&PC for this reason L••, 1•e,�],nn . ..
Owner - Data-
WORKER'S COMPENSATION DECLARATION -
+ I hereby affirm under net,,of perjury.ms,of the following declamrions:
I have and will maintain ucCenifieate of Consent a self-iron,for Workeis
Compenaaion, as ptnvided for by Section 3710 of the Labor Codi. for the
.. perfommnee of the work for which this permit is usued;,, r
./ 1 have and will maintain'Wai Compen.salod Insurance,as required by Se/.1900 of the Labor Cade,for the performance of the work for which this permit is
issued My Works,Compensation'7Insurance canter aid Policy number am.
I a i� e/g^' acy No.:.28.5—d/ -fl/3 fss
,c C'CERTIFICATION OF EXEMPTION FROM WORKERS.( t.,C. � t-••k'- - , + S a., s l a
r...COMPENSATION INSURANCE." .� __.-____.......__._..__..._.. __ ......-..._._... ��
f h s sccuori Aced not be'ci n plet d if the per cit is for one hundred dollars
(S100)or less,)
I certify that in IM1e pertorniance s f the wink on who h this pe .. •. ,• .. ( L. .: ..J.• ..
,boll not ay any person In any manna,,aft Ifs Id became anbjed to the Woikeis'
App pctii; i: Law.<nfC if Will
NOTICE TO APPLICANT 11 aft kt g(miCcrtiricatentE pt you-should s
Q Obecmcsuhjco to theta k Ciinni ionprovsons of the Labor Cotie.you must
mmosith enmply wi@ such provisions m Inis permit shall be deemed awaked.
CONSTRUCTION LENDING AGENCY"
hereby affirm that there is n construction lending agency for the perfor fiance "
line winks for which this Is=n't i,issued(Sec.3099.Civ.C.1
QLender's Nome .. ,... ...._ .. _... - .-.._ _ .._. .. . . . .. ... .
z) cZ Leader's Address'
U-0 I unify that 1 have mad this application and sum that the above information at
�T..[.. correct.1 agree to comply with all city and county ordinances and seta laws relming
+ Q_U �to Wilding construction.and hereby authorize representatives of this city to enter also
tike above-mentioned pmpeny for inspection purposes. .
(tad agree to save.indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,casts anti expenses'xhich may in any way accmc against said �-
J Z. City in consequence of the granting of this permit. - - Issued by:
at-
APPLICANT U, v NDS AND .L COMPLY WITH ALL NON 0/1,x' / V
SOURCE RE f ATION .. fir If/ e
Sigrmmre crApplican ommcmr - Dm=' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant rfuture Wldirag occupant store or handle hwtdous unto1 Type of Roof. - ^••• a -"'- "'as defined by the Cupvn M o cipa'C Chapter 9,12.and he Health and Safety
Code Savon 25532( 1s• nn •,. 1 ..�{""j'✓ ♦ 'p t+s c: r r� Js,,,
❑Ys. t Iitl ..
All roofs shall be.mspected prior to any roofing material.being.installed.. . . .
Will the applicant'or future building occasret use equipment ordevices which If a roof is installed'without first obtaining an'inspection;Faaree:to remove
#I m haz'N it contaminants as reted I by IM Buy Arco Quality Mawg ret,
District? _ all new materials for inspection. Applicant understands and will comply with
- °Y" Leo " . all non-point source regulations.
I have dth h d materials 'udc Chapter6.95 of the
California Health&S t tyChile..S i 25505 2553)and 25534.1 d m dthatl (/�� _ __ •�
if the b 'ld' g locate tlyh local tthf ' my sP 'b'ltryt miry the 6 \ \ p /////y
secula n e,1 the raga cots whmh nut h onn prior m issuance of d Ceti ficme of .1�•�--•-l�� -
oecapa"` - Signature of,Applic pt Date
ownen.6,as horieed age t 7 Daim All roof coverings to be Class`B"or better
. . .. . . . � - OFFICE