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CITY
DIGoBSIONo
BUILDING N
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS.
PERMIT NO.
7529 WATERFORD DR
JIM KRAUSE ROOFING
01060072
OWNER'S NAME:
APPLICATION SUB DATE
RUSSELL H AND NADINE R T
2310 DIANA AVE
06/12/2001
0BOTH
IIONE:
SANITARY NO, CONTROL NO.
(408)779-0704
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
-" tJ G..I
LICENSEDDE ATION
li under of
Job Description
1 hereby shim lam ensed pr ions Chapter 9 (commencing
wh r Section 7W0) of Division 3 of the Business and Professions Coude, and my license
11
' in full tame an f I
.e m �— 4 acts 43 5 1
RE—ROOF
ate can,,
ARCHITECT'S DECLARATION
1 understand my plans shall he used as public records
Parfica
Licensed
OWNER BUILDER DECLARATION
ffir
hereby
1 hereby .film 1 1. exempt ham the Contractor's License Low for the
following reason. (Sectionon 7031.5. Business andProfessions
o Code Any can m county
Q
/
which requires a permit m nm9,ucl. ahcr, improve,
vet de
demolish. repair any zwcwrc
priorI t-': a I rry th tf each ' t fl
h Penni' file.
._
f. Sq. -`'t I'lool Area,,
�a�
y��aY, n
Ua11011
.isvmn
Nm he t1 -d, u nlmc ills.. t ill C In t t- 1- (Chapterode)
(a, agwllt rlonvand
vs JImcBosla JIn.suoCtion
} H�..'bl_ lyi•.
TI,
andfD
or thin he is
ianyeffom and the baso for the
the exempuoo Any violation
-
of Section 703n by snYapplicantfor a500). bject theapPlicam toacivil penalty
703 kJ b subjects
or not mare man five hundred aauars (Ssoo).
3 6 6A/A�Iffi 2v'H¢lft
" Occupancy Type
11 L ars owner office property, or mages y employees with was ther ... le compewticou
(o —,,t 0
will do the work; and the structure is not intended or affemd-for sale (Sec. 7044,
Business and Professions Calc: The Contractor's License Law does not apply to an
-
305 - FRAME Required Inspections''
owner of property Who bolds or improves thereon, and who does such work himself
307 — INSULATION
or through his own employees, provided that such improvements arc not intended or
ob improvement
-oliconcl for self If. Iwwever, [be buildingt is sold within ode-
year of
- --- -" '-- -'
completion, the ow'ncrbaildcr will have the burden of proving that he did not buil) or
of pro
`mprove
601 - ROOF TEAR OFF ' '
for paron.e distinct.).
602 ROOF PLYWOOD NAIL
❑Las nwncn,Rhc pmpcny,ameAClusivdY contracting with licensed contractors to
603 ROOF BATTENS
construct the project (Sec. 71),44, Business and Profession Code:) The Contractor's
— -
License Use does not apply to an owner of property who builds or improves mercers.
604— ROOF IN—PROGRESS'
.and who contract for such projects wim.n eonwemns
ds) licensedpursuantto the
Cmaoirctot's License Law.
❑ 1 am ucmpl under Sec. , B & P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm it penalty of pejury one of the following declarations:
❑ I have and will maintain a Certifcme of Conscnl to self -insure for Worker's
Compensation, as provided for -by Section 37W of the "No Cade. for the
perfom... of the work for which this pcmit is lauded.
7have acid will maintain Worker a Compensation Insurance, as mquired by Scnidn
of the Uttar'Code, for the performance of the work for which IN, pend is
issued My Worker's Compensation Insurance canter aria Policy number are:
uric_ Policy No �.OM
LCERIIFICATIONOFEXE .:
KGRSo'
.Z.,s•C, � � �i::.X .
YOR j
COMPENSATION INSURANCE
-
"(This �sectiddnced not be completed if the permit i.0 for one hundred dollars
I51 WI or less.)
1 certify that in IMperformance of the work Por which this permit is issued. I
shall sat employ' any person in any manner so as to becomeeublem m the Workers
Compensation Laws of California. Date
. Applicant ... . .
.. _ ..-_
NOTICE TOAPPLICANT. IL after king this Ccnificmf
-,
rico Comp thExemption. Lahrde, you
Cdions.,tion provisionsp the Labor Coked. must
i&ouuolhe such
fnnhwltti nmiply colli such provisions .,this pennil shall he Deemed revoked.
r CONSTRUCTION LENDING AGENCY -
1 hereby affm that Ihere is o conswenon lending agency for the perfomwnce
'
of Ne work tot which this permit is issued (Sec. 3W]. Civ. C.)
'LeWer's Name .- '. .., .. ..
Lender's Address
1 ccnify that I have read this application and state that the above information is
ciordecIA "me or comply with ill city and county, ordinances and dam laws relating
m building construction. and hereby authorize representatives of this city to enter upon
the above mentioned property for inspcctiun purposes.
(We) agree hs save, indemnify and keep harmless tic City of Crica iso against
liabilities, judgments, cost and expenses which may in any way accrue against said
City In consequence of the granting of mlc permit. -
ANP 'NT UNDERSTANDS...yyy���'QQQWILL COMPLY WITH ALL NON,GIN
//
5 RCE REGULATIONS:. '\ I �, ` ry O�
Issuedb Dale lL QI
Y
/Una
/T,— "' Da
tgnaturenf ApplinnAC
,
Re -roofs
RD U
HAZARf�US MATERIALS DISCLOSURE -
11 the apple a I or future building occupant smut or handle haeardaus n,amrial
Type of Roof... --
as defined by the Cupertino Municipal Coda Chapter 9.12, and the Health and Safety
de.
CaSection 25532(x)',
it s
-.
t "[7 re`
...All roofs.shall..be. inspected.prior.to any.roofing material being installed...
Will the applicant or future building occupom use equipment or devices which
If a roof is installed without first obtaining an inspection,- I agree.to remove
snit hazardous air eonmninant as defined by the Bay Area Air Quality Management
Didt -
rt�n Ye.; -
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations..
1 have read the hazardous materials requirement under Chapter 6.95 of the
cridi ria Health & Safety Cade. Sections 25505. 25533 and 25531 1 understand that
t lye a mnum,thit h is my re...... hility to non fy the
' if the bull do', don mtahav
oceuponl of the m u. sets which must her met prior m issuance of a Certificate of
_ `op' `
L Z
Signature of Applicant Date _
All roof coverings to be Class "B" or better
Owner oraumnn, dagent al