05090026 (2) CITY OF CUPERTINOz - mea • •^ C aa4:� n a aic...
BUILDING DIVISION PERMIT -,S , ACT R INFORMATION
BUILDING ADDRESS: LOS GATOS ROOFING r PERMIT NO05090026
C(lT T TN(,1S�RTN 4T
OWNER'S NAME: PERMIT ISSUE DATE
JOHN CROLL 888 FAUISTICH CT 62/09/2005
ONE: SANITARY NO. CONTROL NO.
408) 298-9399
ARCHITECT,ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION Job Description
❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
Z with Section 70IX)) !Division 3 of NC Business d Poufessieu Code,and my tied=is
D„ mmnfac ndcr Ls Lma 8°Q7� REROOF-T/O SHAKE, INSTALL SHAKES 30# FELT
z Liccnx act
n�� Dam tato eW C9rr4= INTERLAYMENT
ARCHITECTS DECLARATION aI� rP I'� (� (Y tl� per—
a 1 undersand my plans shall W tired u public ra rdt /l IIIY(y--' {UfU\,\VI{'I f/f/ �uC��' IL.`
,au Li
'Wt; Liccnxd Pmfiessiunal
' 3 OWNER-BUILDER DECLARATION
<S 1 hereby effort Bad I am cxcmp,from the Contractor's License Law for IW
CC following moon.(Section 7031.5,Business and Professions Code:Any city or county
K m�+ which requires a Permit to consume,alcor,improve,demolish,nr repair any rostrum:
poor In its issuance also requires LW applicintfor such permit u file a signed statement
t?'< that he is licensed puesuanunthe pmvisime,ofthe Contractor's LimnuLaw(Chapter 9 Sq. Ft. Floor Area �t'�p ryry 11nI'I7 In'I1 Valu$Ib8089
¢Fte (commencing with Section 7W)of Division 3ofthe Business and ProfessimuCadc)or IVj'I Il�il
i tat he u exempt therefrom and to beau for Ne alleged exemption.Any violation of {iffll�A (I
Section 7031.5 by any applicant fon permit subjects thc applicant to a civil penalty of APN Number " `_' "'—'Occti enc e
not mom than Live hundred dollars(SSB(1). 35617046 . 0 0 p y TyP
❑Luownn of He progeny,or my employees with wags uHeir sole compensation,
will do the work,and He structure is not intended orof rind forsah(Sec.7044,Business
Lord Profeadou Code:The Contractoh Liccnx taw does not apply to an owner of Required Inspections
property,who builds m improves Hereon,and who does such work himself or through bis
own employees,provided that uch improvements on,not intended cr offered for sale.If,
however.He building or improvement is sold within one year of completion,due owner
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
0 I,as owner of the progeny,am exclusively contracting with licensed mmraetors W
consumer the pmjen(Sec.70,14.Business and Professions Cade:)The Conmctols Li-
cense Law docs not apply to an owner of progeny who Wilds or improves Noreen,and
who contracts for such projects with B contractor(&)licensed pursuant o the Contractors
License Law.
0 1 Mn exempt under Sec. .B R P C for this reason
Owner Data WORKER S COMPENSATION DECLARATION
L hereby affirm under penalty of perjury one of He following declarations:
1 have and will maintain a Ccrtiecam of Consent to calf-insure for Worker's Compcn-
titian,as provided for by Section 3700 of He UWr Code.for Ne protionanm of the
Work for which His panni,is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Ube,Cade,for He performance of He work for Which His permit i&issued.
My Worker's C/ytoPC tin sumnmc and Polity nusm�ber are:
Cartier: �N 7 Policy Na.:;-L-7f-2-"�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Obis section need nm W completed if IW permit is forone andied dollars(5100)
nr less.)
1 eenifv Hal in the performance of the work for which this permit is issued.I shall not
employ any person in any manner an as W hmome subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcat,of Exemption.you should
become subject to the Work.',Ci mpnuetion Ima,un ns of He Lane,Code,you an.
Z foMMH comply with such prnvisimu or this permit shall W deemed mwkcd.
zCONSTRUCTION LENDING AGENCY
[-. I Wrehy affirm that Hem I,.coumactinn Lending agency for He perfoor ante of
a the Work for which this panni,is issued(Sec.3097,Civ.C.)
Ig1 A Isndcr's Name
Z Lender's Address
V Q 1 ccnify that I have read this application and sum that the above information is
ly torten.1 agree to comply with all city and county ordinances and sate laws relating to
0U building construction.and hereby authome representatives of His city to enter upon the
a above-mentiormd pmperty for inspection purya
ose
CL. (We)agree to sate,indemnify and keep harmless He City of Cupertino against
F•'N Iiabilities,judgmcnu.costs and expense Which may in any way ammo agmMt said City
VZ in consequence of the granting afthis Permit.
^-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SouR F YFcuy.Tlolys.6 Re-roofs
Signa rc ofAppli ntranor Data
HAZARDOUS MATERIALS DISCLOSURE
anType of Roof
Will the applict tar fure utWilding attupanttemterial
sm or handle hararrou s a
as defined by the Cu,rdino Municipal Code,Chapter 9.13,and He'Health and Safely
ode,Semon 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Fly. D No
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Dltrict7
0Yes ON.
1hvvcread the R,a uomaterialsrequirementsunderCaptor G95 of the Wilding
nu Fl ML Curti
2 armed.
s ed.not it
m 33 and 255ildy tW misand th recon Willing
does riot curtcmly M1atc a mnanl He,it v my repomibility to notify,W occupant of Bel
rc,i LtW h Wmtl Or lli lStaNee a fa CCNficdworOmpancy.
—� 7- ' i._ Signature of Applicant Dale
C y- �� ��� All roof coverings to be Class"B"or better
Owner or authorivn:d agent Date
Community Development
a 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY 0,
Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: 2-1VPCul � xYqj-r PERMIT #
� c .✓p 2� o �r a a'z-G
OWNER'S N •oG^. PHONE # g Z4`— X99
GENERAL CONTRACTOR:L'ar ei- a r,E' FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Class / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
L
CITE' OF CUPERTINO /
CRYOF REROOP7� 61Zf�6 ZZ
CUPERTINO. PERMIT APPLICATION FORINT
APN 3S(o_ I -7G 1/ Date:
y-6-05-
Building Address:
Owner's Name: 4Phone#c .
ro L614
Contractor: � Phone#:
S U7iWoS Y�gcenseContact: Phone#: upertino Business License#:
)
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes >< Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify)CEm o `14 Other(Specify) �2I� Pr�Gt �n f
Number of existing covenngs 'I ❑ Provide I.C.B.O.Report# Y
To be Removed )d Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com:)ly With Cu ertino's Te Off oli
Job Des nption:
t,6„d��e
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: i5
Cost o�Project: Type of onstruction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERN= Bldg Permit Fees BUILDING
BENERGY_ . .. . EneiQ .... . BUILDING
BSEI3MICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING