00070129 CITY OF CUPERTINO
BUILDINO DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGAI�.l`84 VIA CAMINO CT WAGNER ROOFING CONTRIA&TdRS IN 00070129
. ,
OWNER`NlitRRY HAROLD E AND BEVERLY M 12242 SARATOGA—SUN IW"hbINu�%21/2000
IONS` (408) 777-8331 snnrrnxY No. cotvruol.NO.
'C ce% ARCHI AICIIIiNGINEIiR, IhDING PIIItMI'I INTO
W^00❑5 ,DG ELECT' 1'LUMII NII'CII
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S H 7 LIC13NS1?DCONTItACIOR'S DCCLARA'IION Job Description
y m„ 1 haamy afllnn thou I am Ilcemscd under provilhms mf Climax,9(nnnnencing
wirnseertrnnxXgnfnmii i3naheRa,am,,artPndic„inmCode.m,dmynec,�e RE—ROOF
1 y
is in ILII Bores and effect.
z z 6 I.iccn.w Close I.ic.a
OD Dane Contractor
V3'=G ARCHITECTS DECLARATION
t- 4 1 undemmrid my plans sbull he used a,public rea,nh. .
c'O Liccmed Prafc,domd
''w o
OWNER-BUILDER DECLARATION
affirm hereby an Inas I am exempt from the Contractor's Li[amc Law for me
I 6o- followreel
on.rean.(Section 71131.5.Bosirm,and Professions CM,Any coy or roomy
Yxp which I pe om,1. .muct, II improve,dl:h p v unable
end
print
n r–,o I I. req 'the applicantf hpe n M8 d,t.ic
3- van he I,licensedp . II he p < l he Comirc,ale,1 Law(Chapter 9 Sy. Ft. Floor Area tyt� 4
(ur g w'th Section 71XX))or Division3 drhe Ittn, +d lrml, Code)
n,a
,it scr M is cxcnrpr,Ihcmrrom and Ihe 61x11 Ibr theas th d exempriI to Any violanlon
ul'section 71131.5 by unY upplicam kora Ixrrnil suhjecLv the uppllcant to n ,,it penally
ormIina.< 1Inn,vE: vital dollar,($500). AP.�I�u1t)he6r09. 00 Occupancy Type
OLnnowne—raI.pmrperty,nrntr crnpinyce,who wages as their sole compensatnm, od `to
will do the work,andthe frecom;,not intended or offered fin vale siI,7044.
Businere and Pod s%ions Code:The Connacmn�Lleeme Law docs nor apply ,,an uired Inspections
rv,I property Who builds ar ill r veth
x ereon,and who dao such work him,ctf 305 — F RAII'It='
mthrough his own employees.provides ma,,rich in+provement,am nal intended or 307 — INSULATION
offered for sale.If,hmacvcr,the building or impmeenanl is sa1J within one year of
immpleion.the roe erbuilder rill have the huNen of proving that he did not build or 601 — ROOF TEAR OFF
nnpmve Ibr mix cof,alc.).
❑1,asowner of the property.amexclusively contracting with rcensml contractor,in 602 — ROOF PLYWOOD NAIL
construct the pmjec,(Sec.7044.Business and Prafcslan,Cordes The Comment,I 603 — ROOF BATTENS
License Law docs not apply man owner of prnlcny who builds or improves thereon.
and who contract,for such project,with a comrarons) licensed pursuant m the 604 <OF IN—PROGRESS
Contractora.icen,e Lan'.
CI I:roti c,c,npt under see. .B A,PC for roil lieu,+
owntr - hale
W ORKI It S Cf1M PI NSAI'ION 111 r 1 ARANON /
I Immil,alpona I p Iq flee f Irl•loll yl Io,Win �}l
I I have.,,,I II m I C y'fnu f'3 t m s L t. r I' Worker's Vx
'++Iw 'I a pro J J t by Ser 971X1 I the L'h Code. for Inc
pedannunce of the work for which Ihis Perron r,issued. O
❑1 have and will round.Worker's Campenw ion Insurance,as required by Section
3710 of the Labor Code,for the Performance of the work for which this permit is
.sued.My W'orker's Compensation Insurance carrier and I'nliey number ars
Carrier. Policy Nu.:
CE RTWICAI ION OF EXENI PTION FROM WORKERS'
COMPENSATION INSr1RANCp
-('Thin section recd not he completed if the fallout;s for one hundred dollars
(8110)nr le"')
I cerlty hat in the perfnnnnnec of the work Por which(its Ixrrml is honed.1
limit not unrplay any Perron'm mry manner,o:w la hecone xab ,t ru IM1c Wn IN...
C....i""'Idi n[.awl of Curb mmia.Data
Appdrnm
NOTICE TO AP'P'LICANT.If.nitro making this Ccrtilimnc of Cxcrnprin r.you should
bttvm c,object ,,rhe Wnde”Cnnopenwdion pmvsin is el the Isbor Code,you must
Q O fimhwlth simply w,,h such psoisiom or this period shall be marred revoked.
FCONSTRUCTION LENDING AGIINCY
1 hereby union than them is a communion lending agency knife perfomounee
tzi of the work for which this Permit is issued(Sec.300.Civ.C.)
6. Q Is miler's Name
= Z Lender's Address,
r) Q Ieerily that l have read this application andstate that the above information is
ii, P cnrem.I agree ur comply with all city and county nnlmences and state laws relating -
Q V rm building conarvetion.:mJ e
hereby aburirc repeseneti%ex of this city to enter urym
rho nNox-mentionedp Innyf Pati i p l
rFa L 11V1 ugmeI ityand keeph' I.s rhCitye ty ICpeI oa,mor
Zhuh r j Ironical. J p c, h h any r any try av,no, E,iaa surd
U Z City +,+ns.y„tan Imemoral,of his p 't
lir APPLICANT UNDERSTANDS AND WILL COMPLY WITH At,[,NON-POINT Issued by: Date
SOURCE REGULATIONS. '
Sigrmmm of ApphcmllCmnraemr Date Re-roofs
IIA%ARDOUS NIA'I'ERIALS DISCLOSURE
Will the appucantmlllehmedn'ne'upaor,lnremhandle ba,adoa,muerial Type of ROO
n,dclirml by ill,Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Csdc.Schon 25332(a).'
Ole, 0N All roofs, all be inspected prior to any roofing material being installed.
Will the applicant or futurebuilding occupant use equipment ordevice,which If a roof is installed without firs[obtaining an inspection, 1 agree to remove
enti,hamrtm.,sir conteninamn a,defined by the Play Atha Air Quality Nlanagement
D;wrie,7 all new materials for inspection. Applicant understands and will comply with
Ore, Guo all non-point source regulations.
I have read Ine bmaNnus material,requirements under Chapter 6.95 of the
CCetipan;u health&Softy tS which
musts be me,prior to urvocr l a CervmnJ the --�
it rhe hnilJing Anewol currently hove a tcnam.lh:n❑Ls my respmninfity ur nmtlry the
enpum nt rhe reyuirenenls which mew Iw line prior ur Issu:vmc of n Ccnifcate of
Utt'u rune
1 Sigl wr of Applicant D e
Owner I, atiootimdngenl Dau ;All ro coverings to be Class "B” or better _