01070135 (2) '11-Liu otitic oiRovN® CONTRACTOR INFORMATION:
F
DING ADDRESS: PERMIT NO.
351 S BLANEY AV EXTERIOR SOLUTIONS 01070135
ER'S NAME - APPLIsATION SUB DATE
GGARD SABINA A 1771 SMITH AVE 07, 26/2001
1 PHONE: (408) 358-1233 SANITARY NvO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
ya� L_I GJ 1-7 LJ
Z 8 y_ LICENSED CONTRACTOR'S DECLARATION Job Description
o z_= I hereby offtm,that I an,licensed ander provision,of Chaper a(commencing REROOF.
F��m with SCc11m7W0)tdD,,i,im 3oI lnL Business and Profeainm Code,and my license
Cex s 5 UouseClasin fail s effect. REMOVE SHAKE . INSTALL 3 0LB . FELT &
z a License Class Lir,q
X a,n F ,Date., Contractor , HEAVEY DEDAR SHAKE . ,
u E. ARCHITECT'S DECLARATION
F_ '1 anderxmnd my plrA shall be isca as public records
�Y
wp p License)Professional
z OWNER-BUILDER DECLARATION
w a I hereby.(firm that 1 am exempt from the Conoutcher'sCats License Law for the
C z a which ire reason. emit to
]0315.Raciness tend Professions Code:Any city orrounty.
I x❑ which requires n perm¢to eonsmot.alto,improve,demolish.or repair any ewuure
i3= prionoin iasuanm,also requircsthe applicum for such penniuo Ele.signed statement
that he is licensed puroilart to the provtsram ohne Commences Licence Law(Chapter 9
mmmSq. FL Floor Area _ 2 0 0(yOluation
aenaing with Senior 7000)of Division 3 of vs the Businelad Pmfesston,Code)
or that he is escript thzreEmor and the boric far the alleged eaimpti.h.Any violation
of Section 7031.5 by any rpplleem for to perms sobiects the apprlemno a civil p,mny
of sot mato mm Bee handled dollrm asao). 3 6 9 3���4NYm��I Occupancy Type
❑h as owner of the progeny,or my employees with wages as their xrle compennntim.
-
will do the work:nod me aroctnre is oat intended as affergd far sale(Sea.7U.I, 3 0 5 — FRAME Required Inspections
`Baiiness'aid Profcssimu de:CoThe Contractor's LiwLi.nse w dom es not apply an •.
owner of praporty Who hueds or improves hereon,and who mary such work Idm.alf 3 07 - INSULATION
or p m t is sold ,thin oaendcd or _
-bffeTrd"for s5lh his nit M1owevc�ms.e luilJini rovided that stop vemmvememr, are not sena_ f ____ _. . OFF--- — "-
_ _ .._ _ __...:. __.__..___.__
ample,ins.then ner-hadder will have the at of proving mot he dal a.tnaia or 601 — ROOF TEAR OFF - ., , t
mprnvefarpamoaeofsale.). 602 — ROOF PLYWOOD NAIL
" 0 1,1 owneroftnepmPeny~.tneaausvelyaanbracrng 'thl ecotia
dGarorsm ........ .. _6.03._..-..ROOF--BATTENS .__._
construct the project(Sec.7044 Business d Proffewinvis Cod D Tire Combustor s ) .• ._
License Law does nt ppiyl. rowneir dfarper,who hard,,,, f Menace.. 604 — ROOF IN—PROGRESS
. .
aid Who contracts for_ h p Jees rh a mortrunrl)licensed p cwam tome
Conarrovesun,License Laos
13 mr,ee pt under Sea B&IsCfou this account
Owner Dr
WORKER S COMPENSATION DECLARAI ION
It 'tor affirre underpenalty I pa t of ante foil g 1 1 rat oar.
❑ I h d'will I n a�Cby F t Y C sent t tr for works Le
C rap t as provided ❑rz by Section I]BO of tireLaborCode, for the
- _ pedmmance of the work for which this permit is iesnpd,l •
❑I have'ntid will rommuin Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of lie work for which this permit Is
iskued�Ny worker's Contpmwtinn Irsumncs canierand Pollcy'numbe iric,
._. Car seri - Policy No.: c - [ '.T,`:' ,• :I't
CERTIFICATION OFEXEMPTION FROM WORKERS', - -
:.;_ COMPENSATION INSURANCE __•�r'_ �.
(Tit s'see'm iced nor be en npbtcl dd.c perm r as boron,h,,dad dollars -
(SIIXI)orless)
.. I etfy that in
th
thcpn mu aforekf i Ie pe 'tis..: ed;l . . _ •. tr _ c.;i ,Ito l
,hal l n rt e'mriby any ia.¢ n r -n any"'ae
r on.s m bene nr a Inner to the Workers' r -
Compensation Laws of Caloomla.Dare'
NOTICETOAPI 11 It -kK hi,Certificate fE
yr sould
Z boo6onevubject in the
Worker C tI P e.
you must
Q O from rhI t Willi CONSTRO tons his gems tall he de
she d ked.
Pvv cis
CTION LENDING AGENCY
a ' rftfork or"violuch tthh'is:1their itisis
issued n 3097.Cis.C.) for the perfumrmce
a.z L red AJJrcss
G'O I renify that I have rend this replication and late he,the above Infumnrian is,
fir+,Ea correct.I agree It)comply with all city laid county ordinances and state laws relming
m building tWn3trveion,and hereby authorize representatives of this city to enter upon
in above-mentioned property for inspection purposes.
Ct (We)'urban to save, odamnliy and keep hdrmldsthe City of Cuperuno atumb,
t�i�Vl
liallilitice,judzurents.coisti aid expen h cls may in any - y acerric againgst auto
V.Z Cu, nc egenre oftl Fri,t,art colfbi,pe h '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL SON POINT'
SOURCEREGULATIONS Issued by: = /!/ter,. �.,_ . . _ _ Date
. $igmnre bfAepl aart/Gm�mear Date - Re-roofs
.HAZARDOIIS MATERIALS DISCLOSURE
.' Will tneapp0vrav ovo future ail ,p' t tre. handle haz'behm,material Type of Roof .. .. .... ... .. _. ..
as defined by he Cup n'ro M n Tal C 1 Coal 9,12 1 theHealth and Safety All roofs shall '1
El Yes
be in
Code.Section 25
n 53 ( t _ ; . '
inspected prior to any roofing material being installed.
Will dto ails t far funding p r e eq p t d nen If a roof is installed without first obtaining an inspection; hrigreevtd remove
I'll"M1 J Marc tram uacdcr Inc rM1e Buy AreaA QaI YMmabe eat,
D t t
❑Yes ❑No all new materials for inspection. Applicant understands and will comply with .
- -
• �� - �� � �• - all non-point source regulations:-.,.
I rr H&IIII, the ih.fSafety
Code. ectionsli 505,2 mems d oln,255 4,1 tan 695 nr that
fdrbe
eoorder,
der codh&SafetyChave
L1550Ait ,ic4f,.mai.l,undcmtandtn;re _
occupant oft he risnotcurrently have and sm.mm'dtr toy response nil ity Certificate,
the —
Ocuptof,rhereq- r'which purr t e'fu CiniEmte nr
p •I, w mob t m "
r p. cy „
r
Signature of Applicant Date
owner m o n lm,lo d ag5of Dole . All roof coverings to be Class `B"or better
:.-_.
,_.,; _. .. _ _ .x OFFICE
Building Department
City of Cupertino
Cupertino,
Torre Ave.
Cupertino,CA 95014
F�
To: Leticia (Exterior Solutions) From: Connie W.
Fax: 408-295-5669 Date: 07/27/2001
Phone: Phone: (408)777-3220
Re: Change of address(Perrnits:01070135) Pages: 2(including this cover page)
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CAME TO SEE YOU WILL CALL AGAIN
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RETURNED YOUR C L SPECIAL ATTENTION
MESSAGE o t Q
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SIGNED
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MADE IN002AW