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00090113 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS' PERMIT NO. 1 sWNbIR S NAMif: APPI-TCATION SUB DATE PHONE: 10885 SWEET OATS ST SANrrARYNO.0009A1403NO, jVd1 M"11700 Faze ARCNI'fECI'/red t"''l. SON MARY A TRUSTEE HLDG ELECr'fN PLUMB MITCH w 2uU I_I IJ I=1 IJ <y ti LICENSEDhat CONIRACnGR'S DECLARATION. Job Description IO� Ili by a tl I I licensed u I f Cl Code,i r an unecense s- Cw 'mScf 78011 fI) J fthBus d1 f.. . day license ¢y�; ' int Ill ' J1 t rezre¢ Ice . CI. 4, Li M�rL 3 Date ce 1 'e E( AHCHI I FCr'S DLCLARA I zV // C a O'� I coulcrond Iny plana shall h,wcd I.,puhhc m.onh .H, Laea,edrmr...ioart SEM WOOD TO TILE 3 a,c e ae OWNER-BUIL UER DIiC41RAT1ON t�i I herehy al inn ma I um ewn,pt fano the Contractor',L cen.c Law far IM1e .^ F-Z>• fallowing reason.(Seaton 7031.5.Boston,,and Profensionr Clyde:Any city ar muni, F ow Huh oalretaint I I lter,improve.dernal ish, repair- any structure r y> priorm t 1st yo fu Npl,l. II ch pemsiu 'g J.t neat a. thae he is licensedTaranto t the Too,mines oftM1 Contractors, cloon Law(Chapter 9 Sy. FL Floor Area Valuation (commencing w'th Secuon]01)(11 of])is,iim 3 of the lied teas and I ale,.xions Codes or that he i.exempt therefrom and the basis,for the alleged exemption.Any violation of Section 7031.5 by any applicant ter a permit,nbjxc,,the applicant to a dviI"cal'y of oat Inure than five hundred dollars($500). APN Number Occupancy Type 01,as ownet of the property,or my employees with wage,as their sole corm enwtion. ,111 do the work,and the,lincture ,nal Intended nr off entl lit hale(Site.7w4• $14000 Hoduess and Profession,Cade The Contractor',License law docs not apply to an Required Inspections wnor of property WI hand,or improve,Htereon,nod who doe such walk himself or through his own employee,.p rvand tha such impmvanenta ro not intended ar olfemd tar at,,If.howwal.the build nr ln,pmvemunt I,sold wietin"an yea of • .1 v complcdon,the owncrbuildcr will have the burden of proving unit he did am build or 32651033. 00 nlpn,a rot pup,...c of cdc.l, ❑1,a,owatol i iexela,ivvlycoamaiogwith licensed mnoacmr,to 305 — FRAME construct then tett(Sm.9f Wr ,Business and Professinax eale:)'ne Contractor's celve Luw into,not apply to tinowator propen,who bum,e,im,not thereon, 307 — INSLILATION and who contracts for such projects with a enmmemts)Itemised pursuant u,the Coamnar,unel„e Law. 601 — ROOF TEAR OFF 01 vm aemp,m,dcr Sec. .B&P C Bui this r,a.nn 602 — ROOF PLYWOOD NAIL owace Dam WONKr RS COMPI!NSATION D17CLARATION •603 — ROOF BATTENS • IherebyaffirmanderpenahyofpnrjumtereonhemHawingdectamann.x: 604 — ROOF IN—PROGRESS 0 I have and will maiaam a Certificate of Consent I.>elf-inwre far Worker's Compensation, as provided Iia by Section 3701) of the Labor Code, for the performarec o(the work for which this pem,iu is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 5700 of Om Iaha GNe,Ior lie'I'd came of the work fo, bi,h this permit is hued.My Worker',Compenwtion Insurance canter and Policy number arc: CamanPaley Na: C17RI IIICA'I'ION(sF ENEMPTION FROM WORKERS' COMPENSAI ION INSURANCE ('This section need not he completed if the pconit is for are hundred dollars - 1$100)or le”) I corny,mal in the performance of the work for which this permit is issued,I - shall not employ any pcnnn in any Inanner an sIo hy,'.me whicct m Inc Worked Col,ll,envntinn l.ay fC.tlifotnia.Date_ �V Applicant_!<[L,_ NDTICIi TO nP L A i':I.a in this .e tifi..n of in<mption,ria mould nen,me.ubject m Inn worker's Compcnsmion pmvlsiuro al the tactor Cndc.you must Q Q forthwith comply with.such provisions or this Permit shall be deemed revoked Z CONSTRUCTION LENDING AGENCY l herrebykfit,affirm Thal there iso issued ce. haulingugnncy far the perfimnencc the wad ice which this pcnnit is issued(Sec.3(19],Civ.C.1 b Q Lender,Ndmc ,5 z benders Address (.7 Q 1 cenify that I have read this application and state that the above information is kL F. correct.I agree a,comply w;th all city and°nuray ordinun v,and dao law,hinting Q U rebuilding construction.and hereby outhorim representatives of this city to enter urym Cif] he above mrnunnnd property fol'In.pecdnn pamo,c,. } pmt (We)agree to save.Indemnify and keep harmless the City ofCapcnin,against - 4 luculitics.judgn,enn,cosi.;,.at expcmc,x whin,Italy in any way accrue against said U Z cityin CANT ND Rthe NDSA AND permit Y '" APPLICANT REGULATIONS. Signature WILL COMPLY WRl1 A1.1.NON-POINT Issued by: ` � DHIC CJ SOURCE RCGULATIONS. —e Signature of AppliessalConumctor Dam Re-roofs . BAZARDOUS MA'I'rRIALS DISCLOSURE Winthe aVplinaatarormrebondinganun pa,t,,ama ,andleba:�rdue.,n,"dial Type of Roof ' a,donned by the Cupenina M1Blnicipal CnJe,ChaPmr 9.1 z.anA ube Heahh and Safety Calc. ec25532(a)T Ym p No All roofs Shall be inspected prior to any fooling material being installed. Will(lie applicant at future building occupant use equipment or dcviccs which If a roof is installed without first obtaining an inspection, 1 agree io remove Distremitict? us air camaminantn a,delincJ by the Huy Arca Air Duality M"nngetnem 1th.. aI materials for inspection. Applicant understands and will comply with Ove, 0Na I non- lint sour gulations. I have real the hmanual eamriuls 1.,mo axns under Chapin,6,95.1 111c Cnlifomia Health&Safcy Cede.Sc,ion,255f1A25531 and35534.1 understand that if Ine hal zs nol,x,r y It amok lhln it is lily respan..Ini,y tonicity the twcupam f the u cents which must he met prior it)issuance of a Certificate of Cyd — OCeYn°" Signature of Applicant Date Ownnra mhoriaJa . Ali roof coverings to be Class 'B•• or better OFFICE