01070004 <' CI aur DI,, DIVISIONNOPERMIT CONTRACTOR INFORMATION:
+ BUILDING ADDRESS: PERMIT NO,
10272 TERRY WY 01070004
OWNER'S NAME: APPLICATION SUB DATE
GERALD MOK 07/02/2001
• PHONE: SANITARY NO, CONTROL NO.
O ARCHITECDENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z N' I herebyarm that 1 am licensed under f chit t 9(crmmenem Job Description
O Z N O a provisions o p cr g
w With Section]000)ofDivisionJafthcBuzinecsandProfessionsCole.andmylicense REROOF.
Is In full force and effect
as ce< License Class L� u<.a 1 l l 1 34 2 REPLACE COMP.TO COMP.
n D i U Date Comracmr
ut 30 a.� �_a �I ARCHITECTS DECLARATION FINALED
y,u.O S 1 understand my plans shall be uutl vs public records
ce
S p O Licensed Professional
LRS Oat I am BUILDER DECLARATION
ION J U L 3 1 20 01
so 1 hereby affirm the 1 am exempt from the Commemr's License Law for the
following reams.(Section 7031.5.Business and Profession,Code:Any city m cam,
Ei0
which requimix Permit tcomoract.adtprove.droodish,or remiram,structure
�3z rul 1 sic of qu t5lh '(!IL tl I tt 1 E d.l-Icncn - —
dwhe it1 I, Ipf,warttttl flu,C im,luf,L L' '(Chpur9 Sq. Ft. Floor Area n BUILOWuation
(w ncng with Sect„7001)j ,f Division3of the Bonne and Prufessonc Cute) !� 1: , '+.:i .�•+
ur in.,he is exempt therefrom and the W,ix Sonic allegedexempoin.Any violation -
of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty Occupancy Type
of not moo:than five hundred dollars IS5W1. umber t
°Lax owner of the propcng m my employees with wages as their sole compensation.
will Jo the work.and the structum is not intended'or offered for sale Sec.JOlI. --
'Business and Professions Cole:The Cndmnor's License Law dal nor apply ro an 307 - INSULAT IEZ$*ired Inspections `
owner of property Who builds or improves thereon,and who does such work himself
or erect for
his awn employees. building
mm such improvements is sola are not intender it 601 - ROOF TEAR OFF
offered for sale:vi however the buildin - - tis sold within one f - -- _. -
ga,imvmv=m=n re4ri 602 - ROOF PLYWOOD NAIL'" '
'completion,me owannaim=,tutu have m=nam=n or proving mat he ata not Wild it '
impfnverorparpasenn:de')' 603 — ROOF BATTENS
.. : , ❑Lax ownerof rep penv '+.m exew<i+ely mmmmingwml'enn=d ramrn<tomm -' 604 - ROOF IN PROGRESS
,,. construct the project(Sec.7(N4,Business and Professions Code:)The Cuntromm's
License law docs not apply to an owner of property who builds or improves thereon. -
-and who contracts for.such.projects with a contractors)licensed pursuant to the .. —------- .__. _. _ - ... ._.... . .. . .... .... ...._ ..-___.__ .
Contractors License Law. .
O 1 am exempt under Sce .B&P C for this
Owner `Damn
''' --WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcnvlty of perjury one of the following Jeclamiums:
❑ 1 have and will'maintain it Cenilicote'ol'C(m.sent to self-imam for Worker's
Compensation: as provided for by Section 37W of the Labor Code, for the
Fed.donne of the work for which this permit is issued.
°1 have ant will miin do ntaimil by Section
37W of me Lida CMB.for the'performance or the'v ork for which Nis permit is
issued.My Worker i Compcmution Insurance cattier and Policy number an:
Carrier:. It• r 1'f,:.. Policy No.: - " 's i:. "s.'t ✓a+�s_.d . ll.d."; .t. .. .
} CERTIFICATION Op EXEMPTION FROM WORKERS'. - n
COMPENSATION INSURANCE`
" (Thsscctonri .J nn be etnplefetlf the perms in fir ,c hundred drllan
Similar lens.)
1 n fy t n th po f y T of dl rk f "ich th pe 1': tied.1 .• •
sM1411 t plo y ps - as a.to be-oat bl= to the Workers 1 - '
co ve' 'torcilA'_t -7z44.;f 02- J1go'�
na
NOTIC PLI'AN F It.afterryntifingth. ore ofExemption.you should
bee a the W k C pe :t p - of th LaborCoc
, d,you muni
Q lonh t c mp)y w nh h prov.inns of th pert,t shall be Joe sed o k=J
CONSTRUCTION LENDING AGENCY .s
1 hereby affirm that there is a construction lending agency for the perfu,mmiee �
W r of the work or which thispermit is issued(Sec 31an-Civ,C.) _. .. .. . . .... .. .... ..... ..__, .
L0 ' CcnJcr':Name.. .. .....R. s...: .:. :..-. .:-. a. .. ... .. .... . _. ...
Lender's Address
V 0 . 1 certify that 1 have read this application and store that the above information is
1 agree to comply with all city and county oNinancee and side at renting
to building construction.and hereby authorize represeatatives of this city to enter upon
y ] the bo' d Iumport,for im,wrims I rpa ..
F.rL IPIV - ndp1my andkp h,mle'.the City of Cupertino agai nst
N liub'litm J m n¢ t d e which y,n ImY Y cane again,said
V,Z City. q cetfd ran
yofth P t
APPI IC TUNOCII F, DWILL G0 IPL\WITH ALL NON-POINT Issue by: Date
SOUR",\ N f ' •„ QO2-O
sig Lo,.rAppl&WCrmrxxm1 Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will thicap'lplicant or future Wildintiocstipium incrocialWirdlehiscomfout,material Type of Roof
r JeOned by the Culsenion Municipal CWc.Chapter 9.12,and the Health and Safra L
Code.Section Z533264"..'
OYe` -'. r All roofs.shall be.inspected prior to-any.roofing material being installed.-
' W II the opplic to b future re IIJi g p tae eq p t a cos which If a roof is installed'without first obtaining an inspection,�I agfee.to''remove
emir h J air
c t: Jefin J by theB y'Are.A Q 1'ty Management
ITstrit. all new materials for inspection. Applicant understands and will comply with
all non-point source regulations'.
eildin
the hazu+dou-moment),requirements under Chapter 6.95 if the
cad &Safety 'e turns 25505.25533 and 25534.1 understand her .. _
if thnota ca tenant:met itis my nepinsibility to ready the
acequire a must he met prior to issuance ofa Certificate of
°" Signature of Applicant Date
02—d
oor authorized agent Date All roof coverings to be Class."B" or better
• ' „ . . . . . .' , { OFFICE'