01100048 OF
CI BUILDING DIVISION
RTNO
ION
V PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20366 TOWN CENTER LN REINHARDT ROOFING INC 01100048
OWNER'S NAME: APPLICATION SUB DATE
HUNTER PROPERTIES 8250 ENTERPRISE DR 10/09/2001
PHONE: 5107137014 SANITARY NO. CONTROL NO.
C 0 0 ARCHITEC iENGINEER: BUILDWG PERMIT INFO
re C BLDG ELECT PLUMB MF.CH
u
h Z m LJ LJ LJ __1
y i LICENSED CONTRACTOR'S DECLARATION
J z o I hereby.%firm that I am licaysed lor p
serovisions of Chap erg mmci
(coenng Job Description
:LCm with Section701)0)ofDiviion3oftheBusinessandProfessionsCoe dntylicense REROOF.
Smsu ism funfoxeanaefl'echn.-�(' (T/O & INSTALL 4 PLY ROOF)
m < Lieenx
' a V Date / /Convomur
3 3 LL G ARC CC'S DECLARIA ON
j 1 understand my plans shall be used as public mcorda
3 d p z Licensed Professional
OWNER-BUILDER DECLARATION
I hcxby affirm that 1 am exempt from the Coronations U..Law for the
t?< following mason.(Section 7031.5,Business said Professions Code:Any city or county
O which requires a permit in coninnuct.aller,improve,demolish, repair ny structure
i3w-pnonmtsraxueraeasoreq the pplic iforsuchpe tt fl 'gmisomment- - - - ....
that he s licenced pursuanto the p Chapter -- - -
- Division of i ff,he mama. i Ice (chs 9 S '.rFt Floor'Area nation
(comtheisxwithSecr )000)dfD basis o stheligtac.sata Pref nova code) Y ;)'s+ p.; hie, t,!'ya. S:G.: + taxi.\,.( .'�`•
or Net he is exempt themlrom end Jin basis for the ellegcA ciemptbn.Any violation '
of Scction 7031.5 by any applicant far s permit subjects the applicant o a civil pcntlry
A umber
°rnotmamthan elondreddollars($501h.
mOccupancy Type
°I,as owner of the property,or my employees with wages as their rule compensation.
will do Ne work.and the structure is not intended or offered for sale(Sec.7066,
Business and Professions Code:The Convector's License Law does not apply to an 307 - INSULAT]R$))fired Inspections
nor of pr°peny Who builds in improves thereon,and who does such work himself
through his own employees provided that such improvements arc not intended or 601 — ROOF TEAR OFF
.offered for sale.If.however,be building or improvement is sold within one year of 602 — ROOF PLYWOOD NAIL''
completion,the owner-builder will have the burden of proving that he did not build or I
impmKfmpurpnaenfsale.). 603 - ROOF BATTENS
OLas ewner or the property.arn exlusively contracting with reenxd contractors to 604 - ROOF IN—PROGRESS . r
construct the project(Sec.7041,1.Business and Professions codc0 The Contractor's r .
License Low does not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a.commemrfs)licensed pursuant to the
01 am nth pt under
Sec. 11 pA L
❑lamriemptunser Sec. ,B&PCfor this reason e� ® •
Owner Date
WORKER'S COMPENSATION DECLARATION NOV 2, 6 2001
I hereby affirm under penalty of perjury one of the following declarations:
° 1 have and will maintain a Cenifirale of Consent to self-insure for Workers
40 Compensation, as provided for by Section 3700 of the labor Code, for me BUILDING
performance of thy work fm which this partial is issued.
°1 have and will minimum Worker's Compensation Insurance,or required by Section
3700 of the labor Code,for the perfomunce of dm work fm which this permit is
issued.My orkere Comp notion lnxmnce c' _n/ad a /Pat',/nu�mlbe^r am-
Caviare, , f m • PolicyNF/J� V V .0 J V-7V t- ,*j.V_r^• • .... ... , r', I. .. _ ... _
tb CERTIFICATIONOFF..%F-MPTIONFROM�WORKERS'I t' L t ?'^�'a �� '�'`• y� 3 fx ••,�ti'r •{-i•Y'•
COMPENSATION WSURANCB . .-.....__-- ..-... .. _.. ._....... _._.... . ___ .
This'annu 'need rw be'completed if the permit is fortune hundred dollars
(SIW)or less.j
l[employ
that in the n in my..of the work for which this permit a issued,I
shall not employ ono person in any manner see ez to become subject to Urc Workm'
Compcnsmimn laws of Celifomie.Dam
Applicant
NOTICE TO APPLICANT.It,after making this Ccninsof the
Laboron,youshould
become su amp y the Workers Compensation provisions of e d lamed Cwk,you most
Q 0
forthwith comply with such provisions or this permit Mall be I I revoked.
wZ"
LiG CONSTRUCTION LENDING AGENCY '
1 hereby affirm that them is a construction lending agency for the,performance
of the work far which this perm,is issued(Sec.3097,Cr,.CJ
Y Q lender's Name
.D z Lc ider's Address
UO
I cagey that 1 hely cud this application and sum that the above information is
C'U toren.I,grey to comply with all no and a repo,ordinnncrs and acme laws relating
�:V rebuilding coalimedmn„ n,fahereby auttimiempxxnmtivcs of Chia city minter upon
the above-mentioned propend for inspection purposes.
F:0. liabilities.
)dgme to save,indemnify and keep hmayinthe woof Cupertino against
-Z City inc o sequence costs and ing”`expenses which may in any way accrue against said
U rz City in ANT U[vre R the granting of r it.
'^ APPLICANTUNDE0.STANOSAN ILL OM LY WITH ALL NON-POINT Issued by: Data
I CE REGULATIONS. rot GL YI ^
Slgnotumof Appncanuont
cractor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
...• will the applicant fir future building mcupam store in handle haznNons materia - Type of Roof
as confined by,the Cupertino Municipal Code,Chapter 9.12.and the Health end Safety .z4 ,
Code,Section 2553Ne17.�,_ v !t ,,r r s -i .''. : ' j f 11- .;'-•l ifs .`.^ t s •. s:
❑Yes ' ,'; El No' ,, ,„ t r !' . . -,_All,roofs shall be.inspected prior to any.roofing material being installed. -.....
Will the applicant or future building°ccupem use equipment or devices which If a roof is installed without fust obtaining an inspection, I agree to remove
,.it hazardous air ommminants as defined by the Bay Area Air Quality Management
District, all new materials for inspection.-Applicant understands and will comply with
b . °No - all non- rat so rce regal tions.
m
I have ad the hazardous materials requ.25533 under Chapter 6,95 d the
Caifpbanl m,lth due Safety anlyhave.r ental.h,255331respoad 36.1undemand that Q
'if the building dm unmanly yhaveast lin met ois.1responsibilitytonmify Ne U
' &cupam of th equirem is xhich muse be met prior to issuance of a Cenifica¢of
Signature of Applicant Date
:r All roof coverings to be Class "B"or better
_ Ownv or Date
- i OFFICE