02010062 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
• BUILDING ADDRESS: PERMIT NO,
7955 WOODLARK WY WAGNER ROOFING CONTRACT RS INC 02010062
OWNER'S NAME: APPLICATION SUB DATE
STEVE BRONSTEIN 12242 SARATOGA-SUNNYVA RD01/15/2002
PHONE: SANITARY NO. CONTROL NO.
I (408) 777-8331
LO O ARCHITECTENGINEER: BUILDING PERMIT INFO
L ser BLDG ELECT PLUMB MECH
�¢d
v z LICENSED CONTRACT'OR'S DECLARATION Job Description
1 hereby affirm that 1 am Returned under provisions of Chapter 9(commencing
;m1_w with Section 70001 of Division 3ofthcBroarm ritdProo,immCard,.4mylicense REMOVE LAYERS OF COMPOSITION/ INSTALL NEW
;yES i,m ,eClawand eraei. x faW Z,1/ CLASS A ELK FIBERGLASS SHINGLES .
is.K w¢ Date a Claw U M
}LL C v Dal[�_/- ` S 2rc[In
ARCHITECTS DECLARA ON
1 understand my plans shall be used as public records
i Y
I p O Liccntd Profn.innal
y e LL OWNER-BUILDER DECLARATION
d=
to I hereby alarm that 1 I.S.exempt Business an the Conlrns Co License law for the
E F¢ following reason, emit o]831. .tlm, and Professions Cod=:Any city w county
o which requires a permit m con.aruct,abet,improve,demolish,or repair any strvcture
se
au pnnn 1: %saince.also requiresih PPI ani for such licrn uofleas goad statement - -- . . -
thaih sl ttn. Jp nuennothep wsio sof the Comroctors License law lCeepler9 _ - ---- - -- .._. ._._._.. __._ ....
Isom =ngwm.sect n7qp)oroivrnnn3prmeBaame:smianorea,iai.coae) �(}ti: qfy%4Sq FItlFsloorQrea; `y`ti Valuation
or that be is eumpt thcrcfrom•and the basis for the alleged exemptron.Any violation
-of Section 7031:5 by any applicant for a permit subjects the applicant to a civil Penalty
of not mom than five hundred dollars(1500). APN Number Occupancy Type
❑Las owner of the propcny,or my employees wiih wages as their sole compensation, 109 - FRAME
will do the work'ead the'xhu mrt is nm intended oroffertd for sal=(See.-7014,
Business and Frofcs mics Code:The Contractor's License law does not apply to an 3 07 - I NSULATMOTired Inspections
or da
r of properly Who Wilds or improves thereon,and who does such work himself
or erosgn isl own employees.providing cont ten improvements are not intended nyear or 601 - ROOF TEAR OFF
'coerce for:ale.H,however,the Wilding . _- tis that-within one r .. .. . - . . -PLYWOOD"
'- -' " "' _
gunmprovemen y=aro 602 -�-� ROOF PLYWOOD NAIL � � '•-L'• '
completion,the owricr-W ilJcr will have the burden of proving that he did not Wild or
improve for pnmose of sale.), 603 - ROOF BATTENS
na - - _ . ._ ._ . ....... -- -
'oLazctfilernneepmlx^yams¢sinessyeommfssions Ranudantrctorsio 604--L --ROOF -IN-PROGRESS
ROOF 'IN-PROGRESS . __._. .,ice:. , .......... .. .
Licamem thee (Sec.7844,Business and Professions Code:)The aes the..,
project
License law docs not r such
w an war of progeny who bulice m improve thereon,
..and who 's muds for mch.prolecb.with a commaor(s).li<emcd pursuant to die-
Cuntwo e.cs Licende,law.
_ ❑lam exempt under Scc. � ' i � " r' .B'&PC for this rcaann
- -_ Owner' Dam "
WORKER'S COMPENSATION DECLARATION /O
/ 1 hereby aRmi under Penalty of perjury one of lbc following declarations:
f.�O 1 have and will maintain a Ccnific rte of Consent to self-insure for Worker's
11� Compensation, as provided for by Section 3700 of the labor Code, for the
_ performance of the work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of die Latins Cade,for the peRormence of the work for which this permit is
issued My Worl rs Co D<. ton lnsurancec carrier and Policy number are
cam�rYonylNo ��/0 -•.2oo'L a,f.z�. {;,pf1: --
i CERTIFICATION EXEM"IONTROM.WORKERS'; •3 I Tt `'. i< f.`1
_ ...-.-.
COMPENSATION
URANCEfor one hunareddo
11 This section need not W comp) Permitdollars s - Ifni -__ - ------ _
(1100)or
FI cattily YhanYn� rfurmvice of Ne work for which Thi; � - � " •- -� - � ' f"•-- - � •-��-�^_�� � '"
_ . . . - tis Wiokr,i
shall com,of em to to in is manner.io as to become.mb'cct to'the Workers
ComPcnsauon Laws of California:Date
NOTICE TO APothe WoriersIf. om,emter ingthisCmincarcof Eemiiptiode,you midst 1
for subjectywit such pr Compensation provisionsofee LvWr Codk you tun
O 0 fanhwith comply with such provisions or this permit shell M deemed rtsvkcd.
CONSTRUCTION LENDING AGENCY
•
CCY
' I hereby affconstructionthat them is aconstruction lending for a dnrmabce '!i
r of the work rot whicM1 this pemmt is issued(S«.3097,civ.C.) .
Limde .
rsNanne _ . ... _._..... .. .. ......-a._.. .--
Lender.Address ' .
C.7 O 1 anif that l have read alsapplication d n e mat
�- i >' rt ate that the above information relating is '
[U to Wild 1 agree to comply with all city and county ordinances and maty to en relating
>a to Wilding mentioned
mKdy foci Brumaire vas of this city to door upon
} �] the abovee)agree in se,my indemnify
and
lee purposes. -"
` 0.rf es,j agree ts,cost indemnifymJ keephamyinthe wao1Cupertino against
L V] liabilities,judgments,roses and expenses which may in any way accrue against said
V'z Ciiy in consequrntt of the granting of this pcmiiv
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONtpo1 g Issued by: Date
S 3URCE EGU IONS, i y'
'Si, rc of APphican nwa "" were Re-roofs
HAZARDOUS TERIALS DISCLOSURE
Will the applicant or fat re Wilding occupant nae or handle h Iia di3as material Type of Roof ,—
as defirsedi by the Cupenino Municipal Code Chapter 9.12.and the Health and Safety is r .d.vvyN � 'P,c' t
codes rmnus391a, ; 'z;ig',;rl.'r'..:' - ' 'V:'. !t i Y+'. 7 t'.e , f• i , • '
;,,�,r,;••' .All roofs shall beinspected prior to any.roofing.material being installed.
Will the applicant or future Wilding occupant use cquipmnn an devices which If a roof is installed without first obtaining an inspection;Dagree to remove
emit hazardous air contaminants as defined by the Bay'Arta Ar Quality Management -
Ditim7 all new materials for inspection. Applicant understands and_will comply with
-
by.t:_-, �, .: .,': all nori`point source regulations,
)p qL
I nave real-the Safety
Code.
ections2 requirtriwnts coda 4.1Chainei
un Ii.95 of the
if he ui6Health A,gdim,hofny Cody have Sections that
S533 and sar,re armild 1,to
eat
if he building eoes nom currcni Inch m¢hart.tem o is my ssurms 'of a m i Pica toe
occupant of the rcquirtmnns which man W mel poor to is;ounce of a Cenineme of
on ap'aey' PP
ature of Applicant D to
- -
en aedageni; i Dat All roof coverin o be Class"B"or better
- _. . . . - _ . . - .. - OFFICE - . .