01090037l
OF
CI BUILDING
CONTRACTOR INFORMATION:
DIIVIISIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
5975 SUTTON PARK PL
DAVE SMITH ROOFING
01090037
OWNER'S NAME:
CHEN KATHY K AND TSUNGNAN N
1052 KELLY DR
APPLICATION SUB DATE
09/10/2001
PHONE:
(408)973-9427
SANITARY NO. CONTROL N0.
Z ARCHITECIENGINEER:
BUILDING PERMIT INFO
DG ELECT PLUMB MECH
ONTsedtraderLIENSED p
m,
Job Description
oDEC
I hereARATION
by affira the I am al cheap er 9 (commencing
ee
e,amylkm
E with Section7000) ofDivision3oftheBudmuandPmfeuion,Co,lM
REROOF.
is in fall ionic and effect.
License aa.. <S g U,.n SGS {3
T/O SHAKES & INSTALL 1/2 CDX,
Dae 9-rn..sit 5 Ar _ eY�
I -i,
INSTALL 40 YR. GLADSEQUAIA.
ARCHITCCuDECLDECLARA ONd us puhlie rccordc
g 1 undemmd my plain .hall he used
OLite sed Pndesximul
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
afollowing match. (Section 70315, Businns and Professions Cade: Any city or county
O which requires a permit m cmnwct, oiler, Improve, demolish, or repair any structure
c, print t ire q N plc tl suchpe it1 fk .,rad suntanned.
- - - _ -. _. __ ------_ __._..---- ...-__ _ _.__ _ __
- Nmk n d purailmin Ne pro sons of me Commences License La (Chater9(�
laminae 7IXp1MD 's nlofN Bs dProf inn Coder
.).-. 5q'.Ft- Floor-Area-i,
(1Je12}tkl':
ation
B_lM1 Sttt
or that he is exempt thexc6anni'and the Facia lin the alleged c, wi pl rev. Any violation
gx-l.yy \i p.kl•xl lT
y100f!-tY""
- of Section 703L5 by any opplicam for a permit subjects the vpplicnl m a dull penalty"
I ofam Prom than fivehundied dollars 6500).
37F}9
Occupancy Type
❑Las owns or Ne property, n my ciartoyen nidi wages as Neir sole compensation.
- will do he work-andhe woremrt is not int«d«I or tT,md for sale (Sec: 7044, -
' BuSinesi and Professions Czdc: no Contractor's License Law does not apply to an
3 05 - FRAME Required Inspections •" "T
owner of property Who Wilds or improves thereon, and who does such work himself
3 0 7 — INSULATION
or Nroo h his own employees. provided than such improvements ore not intended or
_
offered r ale. If, however, he Wilding n, improvement I, sole whhin ane year of
601 — ROOF TEAR OFF .. .. • ' • ' •.e
completion. the owner -Wilder will laveur, Nods. of proving the, he did not Wild or
I
improve for purpom of sok.).
602 - ROOF PLYWOOD NAIL
ofNnam«.. - - n----
mawnerpra funic. Theomrrnimrbo rn
.. .... _. _.
603- - ROOF BATTENS
Business arta Pmre„ion, areae:)The
(Soc. . Business adcontacted, ns Cosi
he pmsa rsee.
lice improves thero<.
604 — ROOF IN—PROGRESS—”, ,
mves thereon.
moa pro t no who ) ves
License Law docs ntv apply man owaar with s
and h traces farh p ) t with I ,ar(sl.f d p unt.m the
CmdracohiLissiceLaw.
0 mauemM ander S 1' B&Pcf this rtason
('? 1 I
Owmar Dara
WORKER'SCOMPENSATION DECLARATION
-
li, declarations.
I thereby nder f aupcwhy operjury one of the dlowin
I have and will maimain a Certificam of Consent to self -insure for Worker's
Y/
Cotnpoinnumn, as provided for by Section 3700 of the Labor Code, for the
'
_ perfanianee of lk work for which this permit is issued. I ,
❑ 1 have and will maintain Worker's ComponwlLin lasurdncc,`ax acquired by section
37W of he Libor Code, for the pxc forma. Of the wmit which Nis permit is
kwid: My Woakds Compcnsmian lnsumnce canner and Policy.numbw we:
comae" 'rCi'1tGFow�a'f Policy No.' I,I.a•'y L6.,3_ Li�.t .,
_ •.., , - _ __ _ -_ _ __ _ _-_
w. s,= a )I}n�_:•'�j tXt...., .. ..).s•:'e iC •:!(Of•
�- a••
•....
,U ,CERTIFICATION OF EXEMPTION FROM.WORKERS'!
.�
t ' ' •� • a-�- k'' 1 i w
SAnONINSURANCE',t _' 1'
Y
_..._.�..._• _. _.._----
'- mpleted if the perm i, for ore hundred dollar
(Thaisectlrin need nmk co
L. i _ 7^,C! t t' •. 1•. i � If '
IS I(0)or less.) ,
_..
„rt T•I n fy i i in Me pee ... -' 'ref Ik 1 f hick M ct h e orke, l
person m may man « o a m beeomc subject m uk' W«kern
_ ._�_. .... _ .,_.. ... ...... .._..
17......v
J •: r 7'� h'•t .
shimnsidamoylny
Co t W fCalJormu Dam -
u
.Apel t
� NOTICE TOAPPLICANT. 1f after making hsCertificate fE 'pi you ,huld'
kcocom to the Workefs Cohi provisions of M Labor Code. mu,t,
,
forthwith cmplywith ivah provisions or this permit sM1all k deemed rtvolad.
"" -- •'CONSTAUCTION LENDING'AGENCY. ', •""
`'
1 hemby affirm that there is a condruction leading agency forth, perf mismoi
t t
oftk work for which his .it is i,wed (See. 3AD. Civ. C.) '• - -'
'tender's Namc.. - .... .... , .._.
,
ti1 certify that 1 has. read his application and sante that the above infomation is
correct. 1 agree m comply with dl city oadcoumy.ordinonc„ and slate laws oilman,'
in Wilding construction. and hereby authorize otpre.senmtives of Moi city to enter upon
i7 ,the above-menlianed paopcny for inspection purposes. ,_.., ,
4-
ity'af Cupertino against
ee to,wr! indemnify and keep harmless the G
y (We) dgrm
m
n liabilities, judgments, costs and expenses which may in any way am a ogoins said
r City in consequence of the granting of this permit' , ' ' '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT•'
Issued by: Date 0
y•
SOURCE REGULATIONS,.' , ,. ..
SiBnawretofApplicanJComranor.Done L
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Wil Me appiica t or f tort W letng occupant store or haaadle hvnadans matvsel
- Type of Roof : - _, --_ - ,.. ^. , _ •. .— ..._
_
creelOdbm be 2532m) Mun npalCM; Chapter 9RadNeI I;I. and Safety'
code,S m o 255320 /
t 1v_• ) r ST`., tf ,;, i;; %\'•nFt `• r rP 1•.'t
;
All
roofs shall.be.inspected prior to.any roofing material being installed.
. Winmeap.Lcomorfuturebuildt9Vcoenianluse nPipm rn devive,w_hich
emit hazardous air contaminants as tl by the Bay Aie. Air Quality Managemrnt
If a roof is installed without first obtaining an inspection; 1 agree to remove
Daniel. -
materials for inspection. Applicant understands will comply with
�att-nev� s a
-
°Y - �" '.
all non- ipQ nt source regulations..,/[,
✓ t I ha c rewl the haaallo materials requ rtmenu under Chaps« fi 95 of the
Calimmia Health &Safely Code Sections 25505;29537 and 25574 1 undenmad that
of th.e.buildin,docs oIc dyh amnanlNrt m P,pon..hlty to rfy the
I "o issce f C m fiche of
pass m of M quirtm nwhich-must k pct l
-
°ocup
Signature of Applicant Date
Al] roof coverings to be Class "B" or'better '
Owrlermgma...edag5nt me
"" - f OFFICE