01100078 (2) CITYBUILDING DI'VISIONvO
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22095 DEAN CT MARCO ROOFING 01100078
OWNER'S NAME: APPLICATION SUB DATE
GEORGE KUO 43230 OSGOOD ROAD 10/10/2001
ii ^HONE: SANITARY NO. CONTROL NO.
(510) 656-6400
�00 ARCHITECTIENGINEER: BUILDING PERMIT INFO
« BLDG ELECT PLUMB MECH
r—1 O O IL7
•5 y 3 LICENSED CONTRACTOR'S DECLARATION Job Description
j Z rLI C 1 hereby.ff rat that I am lict mad under pmvisiass of Chapter 9(commencing
: l-� with Section 7M)af Division 3nftheBusimessondProfessinmC ia,andmylicense SHAKES TO SHAKES
Y�'qq" is is full force and d&csg 0 G 1
-as License (.� J Li,.N
a Data Contmnor
1 3 ARCHITECT'S DECLARATION
j m 1 undemand my plans shall h rued as public rtcarls
1 p p licensed Professional
R OWNER-BURDER DECLARATION
to 1 hereby ofirm that I oro exempt from the Contrsemr'.License Law(mine
C < foliowing won.(Section 7031.5,Basin.and Professions Coda:Any ciry w caomy
I which requires a permit to construct,alter,improve,demolish,or repair any structure $12580
Q ' P^orm it,issuance,also requires the applicart for such permit to fleuigmdwtemenn. __ _ - . ....._ _.. _ _ _ _..._.. ._._ _ __ _
Nm hdiidicedsod puisuint m flit pmvisrms of the Contractors License Law(Chapter 9 C'A(EaT� .( r ti Valuation
fcnmme«in8 withsec4on]000)of Division 3 of the Bpsipey Bert Professions Code) fi: j�3 ,'��'('F��.\U V':\`T:'k{ 1�/
or Nat fie ii uempl therefrom and the basis for the ell g abmptibd.Any violation
of Section 703113 by any applicant for a permit subjects the applicant to a civil actually
of n« a
roam than five handed dnnar(SSW). - 3 SAPN l l rE - Occupancy '7 Typ
Type
EI I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,end One structu«'is not intended or offered for sale-(Sac.]044. 397 !NSULATIGN
Bin ioeis end Pmfessiam Code:The Commatmr's Lkense Law does am apply to an 601 - ROOF TEAgtIj P nspeetions' '
owner of property Who builds or improves thereon,and who tl«s such work himself
or through his own employees.provided wt such improvemenu arc not unsound or .6.02.- - ROOF.PLYWDDD.._NAII4._... .. .__ ._ ._.. -. ._..
�cBered far gar.If,hmwever, w l how sh or improvement n cold he did nate year of 6 0 3 - ROOF BATTENS
completion,the owner-builder Mss she burden of proving that he did twt Wild or �. .
iropmveforompaenfaale.). 604 - ROOF IN-PROGRESS
O I,as owner of the property,as exclusively contracting with licensed cumracmrs w t .. . .
coronet the project(Sec.7044,Business and Profestiom Code:)TM Contractor'.
License Low does rax apply to an owner of property who builds or improves thane n,
and who cummums for such pojech with a mmeamr(s)licensed.punuant to the.
C new ars License Law... . . -
❑1 exempt under Sec. _,B&PCimflusrintom
owns - ' Data
WORKER'S COMPENSATION DECLARATION
` I hereby affirm under penalty of perjury one of the following declamations:- 7 I hive and will rnnintim a Cenifca¢of Consent m self-insure for Wotk«'.
.omprnuuon,-u provided for by Section 37W of the labor Code, for the
- (performance of the woh for which this Permit is ismed.
ql hnvc end will maintain Worker's Comperisaiion Imurance,ai rcquirtd by Basion
3 of tM labor Code,for the perfonn.vice of tM work for which this pumit is
issued My Worters Com n -naglnsur.nce c�mer�aknrd PoI¢y number art„ ., _ - _ _ / - _ ._ _ _ .
t :CERTIPI ATION F,FXEMPI'ION FROM wO
. .'' ('Ibis scaion«ed rot be e«nplaed if the peroses is for ane hundred dollen .L' •' .. ( s,.: � ,:^tj � ,t. . .._ __
($1000mless.)
..^ .. '.isi t . .s..t _ ._ __ ..... .... _.. _
1 certify thu or Ure performance,say am of me as 1 fu which subject
pemdt a iuued.I . ' •r
shalL Compensation
employ any f nn in any man«r.au u m become mbj«t m the Workers "
Compensation Laws of California.CDao'
NOTICE TO APPLICANT:If,after making this Cenifcate of Exemption,you should •'
Qbecome subject to the Workers Compensation provisions of the LaWar Code,you most
forthwith complj with such provision.«this permit shall W deemed revoked.
CONSTRUCTION aION LENDING AGENCY
F- 1 hkfor umrm that(erre iss issued(Sec.
lending agency for the pedormentt '
Le Use work for which Nis permit is issued l6ee;3097,Civ.C)
Lender's Name
.O Lender's Addresr' - I. ... t .
.1 codify that I have read thi,application and ante that the above iof xonatlan is
correct.I agree to comply with all,city and county ordinances and state laws relating
0?U to building construction,and hereby authorise representatives of this city to enter upon
(� the aborc-mentioned property for inspection purposes.,,
.QN (We)sgrte to save,indemnify and keep harmless the City of Cupertino against
W liabilities,judgmenni cosh and expo.which may in any way accrue.Baton said
f.,),,7a. qty in consequence of the gaming of his patine.
APPLICANT ' DER.q ANDS AN COMPLY WITH/ WN-PUNT
Issued by: Date
SOURCE .ATIO S. ! , .�, r 1191 1010)
Signerumof Applican ontmmot - t "' '- /' Date'" Re-roofs ^
HAZARDOUS MATERIALS DISCLOSURE
Will a.applicant«future Wilding ocrsFam dais orhandle husNws rwmal Type of Roof. - — -I-- -
as defined a me Cupertino Munlap.l Code Chepta9 11.end the Health and Se/cry ,. , I a t,l ),. u - - -
Code,0Y., 8, " tl stvt r •. / : .6,; iCtt4 .k,:l) CA .! }�l•; L' . "
❑Yea
,l Allroofs.shall be inspected prior to:any.roofing material being installed. ... _.
-
Will the applieam or fmum building occupant use top ipmem or devices which If a roof is installed without first obtaining an inspectio`ti,I'agree'ro remove
;.it harsdom err conuminsnh uZde=_red by Use Bay Am Air Quality Management
Diroia] all new materials for inspection. Applicant understands and will comply with
oYca ❑No all non-point source regulations: „• ;,
I have mad the hesardous materiels requirements under Chapter 6.93 of the
Califumia Health&Safety Code:Sections 25505,8533 and 25534.1 understand that - _ - i{ ) a `
if me builduponying d«s not currently have a rermnr,that it is my responsibility m notify me — V
acapam of me rtqui nh which.m be met priono iamma of a C nifica of
Sign re of A_ scant Date
owner ar.amoriaca an - All roof coverings to be Class"B"or better
Date
c l ; OFFICE