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02060100 (2) CITY OF CUPERTINO ' BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: eTJI LUNG ADDRESS: PERMIT NO, 21681 COLUMBUS AV MARCO ROOFING 02060100 OWNER'S NAME: APPLICATION SUB DATE ISHII YUSUKE AND YUMIKO 43230 OSGOOD ROAD 06/17/2002 PHONE: SANITARY NO. CONTROL NO. (510) 656-6400 G O ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO m BLDG ELECT PLUMB MECH I'--1 LJ I._- 1=J Z 5 y i LICENSED CONTRACTOR'S DECLARATION Job Descri [ion OZ- I hereby affirm that I am licensed under provisions of Chapter 9(commencing P F_LAs with Section 7000)of Division 3ofrheBusiness and Professions Code.and mylicense REROOF �H�J sin Intl torte an eq�4 LiOA c�o 29 fo f T/O CALSHAKE: RESHEET 1/2 "CDX & O m 6 Licenx a°i y D9C ° cDECLAf $ PRESIDENTIAL COMP . SHINGLES CLASS "A" ARCHITECrS DECLARATION / ,g 1 understand my plans shall be used az public records dO O Licensed Profesai.nal OWNER-BUILDER DECLARATION I hereby mb.Out 1 aexempt from shma e Cuaor'a Lt...Law for she C Z a m following reason.(Section 7031.5.Business and Profeaion Cash,Any city or county E t=-❑ which requires a permit to construct.alter,improve,demolish,or repair any structure. --Prior w its issuance,also requires the applicant for such permit to file a signed statement, shut he,is licensed pursuant ra)hp porlil ons of the Comacmis License Law(Chapter 9 }G (commcncip'ggwith5mion,�000)of DivisionJof the Bnim and Prpf�sa' ns Code) l' JI�YO::-ls`A ilii,Fr-DrItl'3:#Tial li. $gg��luation ."hot he it Lienipf thcrtfmm'ar,d the basis for the allegdi cemgbn.A^Y violation _.of Section 7071.5 by any applicant fm a permit subjects she applicant to a civil Penalty Occupancy Type '�nf not more than five hundred dollars($500). 3 5 6 APCi-NJatff`6g5 .,r,, 111.as owner of the Property,or my employees with wages az their sole compensation. 112233 I[lL.SS..77• v VV will'do he rY and the structure Is not intended.,'offend for sale(Sec'101 ---- - --- - - - -- --' --- - - - - - - ,- B nd'Dofcss ons Cndc'Th.Conuacmr s License Law does not apply t 305 - FRAME Required lnspectlons'1� 'i+ +• - orr of property Who builds or improve,maim,And who does such work himself through his own employeesprovided that such improvements are not intended or 307 - INSULATION "-:offered for-sale.If;hbwevec the building or impionrieni ie sold-ulthinone year-of -""_-"-- ----' '"`" " '- ---' '--- '--'--------'--- ----- ----- --- -- - --- completion.theowner-builderwill have the burden of proving that he did not Wild or 601 - ROOF TEAR OFF " ' >o- • improve for purpose ofaale.). 602 - ROOF PLYWOOD NAIL rope-- --- --------- ---' Chas_..liner of the n,am eacwsivel contracting -------- ---- " 1IS,r r swithucen.ed,Contractsm 6.03- - -ROOF`BATTENS----,--------..1::;-ri -- cicense Chep sectISalytoa ownBusieroaMProwhonCale:)TheComnmors 604 - ROOF IN-PROGRESS License Lew dines not apply m mj owner of property who builds or improves thereon. "• . d :. and.who„commas forsuch.pmjcas with a.convacmr(5).licensed.pursuant m the ....._.. -. ____..._.. _ _.rope_.. _.... C t t a License Law. '- OI ,.Pt wide Sa. c- s” B&PCfar thin rmomIl„t,s- - Q I' WORKER S COMPENSATION DECLARATION ,I1�gp�f -� have d Kinn d K ItY of Pel rY rte ofaef 11 gdeclarano .-- ��s' -� p ❑ 1 have and will mmmnm a Cen rc t 1 Co "nt to self re for Worker's 2oQL Compensation, as provided for by Section-3700-of-the Labor Code, for the �� 0 C - Performance_7 , or to work forwhich_di peen t ed J ,J]IXh of theilLabor l'-Cud f the`peRormp` 3 f the work tar 8r-whuirad ich h thbpe`''i u !'.a d.My Wrnkat C m t Insurance - - d Policy -hr arc n'1 w I'Mis,N .: 3'7/ �J1LDING .-........._ _..._.__.. _-.._.... aI1 CERTIFIQACOMPENATION IINSURANC WORKER$(} 1., E "-�'I, � axlf i?-f �t�aT,\ ;\l y,1S.` ' ' �• ' _ 'COMPENSATION INSURANCE""� s , ...._..-.. ,... ..-_"rope... ............_.....-.-,.. __.. .. _ _rope _.rope. ...... �....,.r_-._.-.............�_.�.._._.___-rope_._.-.rope_._ (This'xcrion need not Ine amn,ied if the permit is lm one hundred dollars IS IW)or less) . S -. _:c - - .. _.:: - --:_..__ ... _ 1 c afY Ih a the perf ance f th k f which th Perim,'n invited.I ) ♦ < .: t.1; - - h II n.I employ any person in ny ma Int as to become aab3ml t.-the Workeri -` 1 `!- Connknaasion Laws of Calimmia.Dine , ..Applicant . .. , ... . .. ,. .,,. ........ Z become subject to the Workers Coniparnation peavinionk of the Labor Castle. .0 mon Zf6ruadldi comply wish such PmvisiOns or thin Permit shall be deemed invoked. of th I he for which this'the coalman lend - -- - - - CONSTRUCTION LENDING AGENCY > - g agency the pert mance , � permit s steed(Set.7097 C'v.Cl - y;G L7;Z Larider”Address I en fy drt 1 ba ad do appl c t n ad Itme that theabove nomination is so mply,with all Ctyd, mY ordinances ❑ rate l scion, ng r w so bubld g co t eJ p pcdty by f bo p x t I o f thistyro pen [. CL (W) gr! m indemnify and k keep theCtY fCDei .g m V] liabilities.judgments.costs and expenses which may in any wayitknme,Again t said V Z-- City q ce g f —0APPLICAM1T UNDERSTANDS ANDWILL Permit. Y%kTf"AlXNON L_ OI T' t UA soukcE RLGm.Atlons ..��, y ,. G/� jz Issued by: Date Signature0(APPI¢ant/ContmcmoYl-�-;7--7'— _, ; Re-roofs HAZARDOUS MATERIALS DISCLOSURE '. . irAII the xpplicaam oI tuil linsa t. indla: is minimal TrYPeOTf.R♦o'lofs the Cuiie Municipal Cud Chapter9.12,and the Health and Safety 1 by25 -532y) _... ..- -._... . .. ............_-,....-., rope ._...._. .. . _rope - .._. 4p _ Al] roofs shall-be Inspected prior to-any roofingmaterlal being,installed, " Will he eppl I lir t n ie g rpt use_q p nae w eel which byth-B Bay Quality evicesManagement If a roof Is installed without first obtaining an inspection-'Ilagree to remove - emlh N ammo t dfnd °i" et - _ all new materials for inspection, Applicant understands and will comply with ❑Y i -- .. all'non-point source"regulations '1 h rc d ih hA'. x rd m roti I eq ,rcments under Chaper 695'of th ' Cal fom a He Ith&'S fety Cade S coons 5505 25533 and 2553) 1 understandthat dtheh Iding tirosnot cu dy ha atuna t Nat t in rape ibthsym notify the - �_-1 --ter[— - mcup t f th ,untent ms x Inch must be ®D rid in a oLa Cen Fcate of /1' — (I Occ P y,� - 10 - fS� :� gnature of Applican Date _ - - m own .ra.th.rxeeagc I 3 ) Data All roof coverings to be Class "B" or better a ._-OFFICE. ..._... _. rope __.. _.._- - -- - - -'-- -- "- - - '