00110108 (2) CITY OF CUPERTINO
- BUILDING DIVISION pER1VIIT CONTRACTOR INFORMATION y
-t BUILDING ADDRESS: .. - '4 t/' PERMIT NO -
18691 CRABTREE AVE_ JNSJ ROOFING 'INC', ` R101. 1 d10B '
OWNER'S NAME: - APPLICATION SUB DATE
I' ROBERT MARTINEZ '299 D- SA SSETT ST. ] 1.1i?0t'c'Qt�4h
PHONE - SANITARY NO. CONTROL NO.
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4082796'J
- ....
. BUILDING PERMIT INFO '
O❑O❑ 'ARCHITECT/ENGINEER: - `
BLDG - ELECT PLUMB MECH
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LICENSED CONI under p DECLARATION
'. lob Description
0 I hereby dllnn Nus 1 licensed- c p of n,o , (c Icing - P - - w
t+w nh Seel on]fN)0)nrD ioflhe BlsIPmfces t:CrJa anJ nybeeuc '
aY. J IS inrwlroraand I�reS9. ' RE ROOF TAR .AND' •GRAVEL `
`4 6 Licence C L M
xe O w o Dino �� Lie _ -i_ '•
waw y '{�D�LARA
5y�5y� I de.t Jllyll . .1111 d .p
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Licensed ih f.....or]
OWNER-BUILDER DECl ARA910N , - '} f e l ///
u�M I hereby offian,ho l Pi( theContractor',License L lot the t
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following n.r. (Section 7031.5, s. I Pines Chad:A r ry entire,
�.❑ 'hichquirCapertnitttiuct,whichu p -d I'h en r:vnellltC'
a3� In ior to itsan also rryrimst ppl t for suchp 'n in file x dTterenl .a - n
main J p l l In p fol c l I 1 L Chapter9 Area Val app -
fco elwall Secao l 9000)of Division 3 of me Business d P .d,ocus Code) Sq. Ft. F7oDi
of lh l ns e npl theochoul and the hal ro, M1 neged escou,nish,A y violation
if Section 70315bya Y r1pplicaralf a prout. bJ ts theapplicalltoo civil pen lky
of iiii,ture than five handled dlln:($500) - t APN Number Occupancy Type
Elof the properly.or toy cuployces With wages!is Ili' p anon Or - .a g, .'+
will do the k J hea I,no,intended offered f 1 (Ser.9094. - A�
- Bu ne.': d P f ns Code The Clharactiar's License Lirw draw nol apply to an • Required Inspections -
rof men Who boll .c es Ihcreon and won Anes such work himself
mtI -
xhh°. y ply,. . ed(ht� m p l.' rt dedor r 05- — FRANE
offered Int vale'ir however,the building r p enol is cold w thi t one year of -
implebran.theowner-nuilderwillhave the burden ofpruvfngthatliedidawbuildor' ..-3107 — 1h'S:IL.ATIOh1 - .:+ ' -
imprwefiatpnryoseofsda). ,
6t�i. — -ROOF' TEAR OFF
cola. f Be pply an,inclusively lantactun, iffi lic,in,cd In ',
arn:l o p (app 7ly 0al Bnser ee r:. tc d> r c t- rrn Er02 — ROOF f-'I_YWfJQD NAIL; '
nd Who J hot for such of property whom funds p :lh the .. -
on n p License
r h projects wm t onmelorca)licensed P : and to Inc _ •F:uID3 .— ROOF•` BATTENS -
El I un een;pt underfice B&PC formi.reason 604. —w.
ROOF IN—PROGRESS
G,act Date '
WORKER'S COMPENSATION DECLARA'1'[ON J
I hereby affirm anna,pcan,y of pepup one ratio,followit,di,elamlionc
❑ 1 have and 'II*nutionsid r Certificate(if t nse t In self'rescre for Workers
Courper,atuar, as Provided for by Section 37N) of Ilio Labor Code, for he f
pprformance of Ihework for which this permit is fired. l - is
-
❑I hive and ill tnanianWnn',CnnPrean 1111.1.1ile,11 osialledby5 i n
3700(if the Lahir Code In the perfonna ua of the Work Par Which 0 r:Prophil Is - - .. -
ssued,My Workers Cenperuatfon luutvnec can and Policy nuorl are
- • Car' Policy No.,
CCRI II ICATION OF EXEMPTION FROM WORKERS -
I _ COMPCNSAI ION INSURANCE
This section need tel be aningleted ifthe penal is.for ire hundred dollars s vP e -
($100) Icss)r
1 cory hill I,,the perfort a of the work for which this permit is issued,l
shall not or In o as to_become subject to the Wrarkers e'-
Cintpenaat m UsesofCalifornia.bate mer - - -,
Applicant
WynCETOAPPIICANT Il aficionado, Ill C it t fL 11 yen dicald f D.
rZ Nnnaresublixthhew k :C ivionlionp the Labor Code,you mt9
Q O fmlhwlm wr ply with ,,,[I p y"ons I Ill,pennn,hall be declined revoked
N
F Z CONbeho,i ,on...inch LENDING AGENCY -
Iherchyafhrnmlme .t ci 1 ding age Yf rlha perfonnatu
= efor this P nl': mu.
eJ($ 3M].C'v.CJ
Lear',N y '
Q Lead N to -
� LenAAdd ss - - � •'
-f V'C) I virlify lh illi nd illike,licationand.tt dandle nove inficannatio.'s
kW,r. corral l abr.I c nd,wiIh all city and inainly ordinaries and late law,npladr, - I
0G :o building conslmalan and hereby authn s representative of this city m inter upon
r� Ilhe above hicanoned properly for inspection purposes
- - -
�,Gy (W)."ce to sEric indarldfy and keep l leis me Clyrf Cup"linn -
�':0) liab Iii ccjt db ne ale, lc and exp t.e'Which may n any way ai ue unl rnl said
Z City Inc nsequonceof the hano of this permia
APPLIONS. \ND WILL COMPLY WITH ALL NON-POINT Issued by: 'K Date
1 D .60
Did. Re-roofs
'H LARDo MATERIALS DISCLOSURE { ' '
Will the apylic' lorflaure buildinx n¢upanleoaa nt hwdlebuezMoas malarial, Type Of ROOF .
as defined by the Cupertino Municipal Coda Chapter 1).12.and the Health and Safely
Code,Section 25532(a)^'
ElYes ElNo All roofs shall be inspected prior to any to being installed.
' I won ppfiram m future building oner6iii,use enu'p f l .when' ' ;If a roof is installed 'without first obtaining an inspection,:Filigree to remove '
emiih d tern.Its as defined by, Bay AreaA Q Ity.M Oben t,
Diel t all new materials for inspection. Applicant understands and will comply with
0 Ye. El No
all non-point'sourceregula[ions, l
I
have :ul the ha7andrus araterialsq nn under'Chapter 595 of the
Cnl I 'In Ire&Sof ly C 1 S 1 onx 25505 25533 a td 5534 J w J Ilial r t-n- -
i[ build ny dres nil eutrenllY havevte gthm it's,nymp slbllily In notify rep ., .. -
e vpam o[the r' Ienls Which rens be met prior m Issuance of a Cwtifeate if -
° Signatan
ure Of Applicant Date
All roof coverings to be Class;`B"or better
D m t .
t•
OFFICE