02040148 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON'T'RACTOR INFORMATION:
BURRING ADDRESS: PERMIT NO.
22106 DEAN CT CASTO ROOFING 02040148
Oa1'NER'S NAME: APPLICAION SU DATE
THOMPSON RICHARD AND RACQUEL E 1938 OLD MIDDLEFIELD WA 04�262002
PHONE:
(650) 961-8922 SANITARY NO. CONTROL NO.
0 0 ARCHITECT/BNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ
Z
LICENSED CONTRACTOR'S DECLARATION lob Description
i=0 ebony aRrm,M1mlam oftheasines pod Profsof sins apter Code9(commencing REROOF WITH HEAVY SHAKES
w
C. with Nation]000)o(Division 3 of,h<Buziness and Professions Code. dm license
m g= is in Full fMc d eI{e_t.
o:,scJ, < License Cla.. l:�-1 Lic.x > O�
3 Daw � 'CNL TTEiontna
S DECLTIOFI NA.
n
u I uAdmsmnd my plans shall W used as public records
an O Limr,ad Pm essmnal MAY 0 8 2002
x e" OWNER-BUILDER DECLARATION
A,=w I hereby aRnn that I am exempt from,he Contractor's License Law for the
F ta Following reason.ISec,ion 7031.5.Business and Professions Code:Any city or county �*
xF O which requires a permit to construct.alter.imprme,demolish,or repair any structure p�' y 11 0 0 0
na- "prior to its isamnce,also requires the uppli4am for such permit to file a signed snmmcno - C7 --
thSLDIN
t he is licensed puisu5n7,o Jr ,provs4ons of the Commet.ea Limn.Law IChaptcr 9 ,,.,. p1frnx�1 e,,.�., -
(marrencim,wish,Saaw.:]000)of Division 3 of'he Business and Professions Code) � `' 1"'3'3-1/V9�9oS!�'�i i:J ;�. �''„ Valuation
x.e.'
O'Sec he'7031 rape m.y.pom and the basis for the alleged eiemptirm Any violation
'
-a/Section]OJ I:S by eny applicam for a pemdt subject the apPlicanrm a civil penalry-,
!ofinet more than five hundred donna(SSW). 3 0 6PN NPRh F 1•`q <''' Occupancy Type
❑Laswrnerofffi r" eny,ormyemployeeax5,bwagesasthd...1,compensation, 3 0 7 - INSULATION
will,do the-overK:"and the structure is not intended or offered'for-sale(See-7[Fal,-,
Business'.and'Prefessions Co601 - ROOF Tde:The Contractor's License Law docs not apply,o an Elt4uiak14nspect10n5" v SL:t r:'L.
owner of property Who builds or imprmcs,hermo,and who does such work himself 602 - ROOF PLYWOOD NAIL
or,hrouggh his Assn employens.,provided that h improvements q intended or
to(fcrea(or sale If,howevertobola _. - --
g pro vigtha anon -)ear or 603 - ROOF--BATTENS
mompinion the owner-builder will have the burden of proving that he did not build or ,....•i'
prove for purpose of sale.). 604 - ROOF IN-PROGRESS
- -
0 1:as ownerpr the progeny,am�IalBuss n Business
d Praaisi with licensed:)Th C contractors,,o G I! .:!I L
construct the project(Sm.
appl IDU,Busies and Professions Cade:)The C memo's _""
?�: License Law does not ki,-suytuan owner of progeny who builds or improves thereon, Vi it
.and who.contnet fa-mch.projat withCon
son LicenseLow. n , ._ .. _......... _........
_
OlameAp, dergee , - B&P ...___
C fa this
:. .: Owncr'.,.; .' ..�..:�.,di :Date,
WORKER'S COMPENSATION DECLARATION
I haebyeRrmundcrpenh f g
y o perjory One-fib dcclarationx: -
O 1 had'e and will maintain.0 Ccnifica,e of Consent to self-insure for Worker's
i, Campenami,m as provided for by Section'3700 of the labor Cade. for the
performance of the work for wnich,his permit is issued.
❑1 have and will mainiaio Workers Compensation Inimm.Fe,ei;.j.hca Ey Scefiion
3100 of the Labra Code foe t f the work'fo— which
Kelt `—
suermit is
d MyW Co nsa,on I
L7,k! mance r nE Policy ter a.pe
4Yt!^ Poli ON
_ Z
00
P. it' •' •r:. .. .... _. . . ;_11 _ _ .: ..
c
�t CERTIFICATION OF ONRROM.WOR S--S 1 r ,. 's , I ' a ^•�
COMPENSATION INSURANCE' - '-' � •
t fliton need not he completcd R on
the permit is for e hundred dollars . ps. : jk. ..._
Italy
or lax)
t ,
..... _ _... .�__�,._..._....._ .._._,._�_.........., .�
,( I ttmfy dot n N pe,fo ane it h 'Ark f h h,h pe -
ed.1
shilI t mP1 y .y pc n any m 'er so t be me b)<aJ jlre Work<rs
Compenseuon Lives of California Date
-A,licar, .._... .-.._.. . . ...-.__--. .. .. _. _
NOTICE TO APPLICANT If
haft r , NSC rt( , ofE p, youshId
Z bati6nie sub] t the veMmeA Cou pori,ionjofme Uttar Cede you most
- �;f..R-,
loon N comply with such provision,-1this Permit hall e ded ok d.
'--'---
re
.. _._ .___
'CONSTRUC710N LENDING AGENCY '. „ r , _ _ ....
.' " I batch ri
yAM.'that them a constructionlending agency for the performance' t
of Me Is fee which th,p h is j.6 a.309)'Cv.C. - "'
y:c UntilNme._.c.
_........... ........
U!0 17.
I cai fy that l have ad this inlific.1mo and state that the abovc,nformaion is
0; corrin 1 agree to comply with&I c,y Add county,ordinances And state laws relating s
,.0 to building construction,end hereby emhorixe rtpicainaMisa Df this city to enter upon
�sTLI the abovo-mentioned progeny for inspection purposes., ,
.Fn:G IWb(egree to save:indeinhify and keep hamJcss th.1
Cary of Cupenino egainx,
-lp liabilities,judgments,coat end expaas s which may,in eny way,accrue against said
City mconsequence- of the granting f this Ferran. . ..
APFLICA\'TLSpER$T \T9S ANiD N'p,LCOMPLY wTTIl hO\P 1
s P u'Ar0 �} Issued by: Date
tg,a rc of pphcon owacm y /
HAZARDOUS MATERIALSALS DISCLO '': '' Re-roofs
Yfll'the iPplicm,t a f rare build iiy annpant stere hmielle ha 6ii mmenal
As dcfindd by th C penmo Ma pal C de CM1 pre 9 12 d the H ehh aha Safety - 'Type Of ROOF_ .. ... .. _ __...
Code,Statism 25532W `,I h c.; , e .5 atti __...
S\
ppoccupant
p ` All.roofs.shall,be inspected.prior to any roofing ina[enal being installed.._.
,�.r wmme Applicant orf ort budding oc pin,n.equipment m devices wnch, If a roof is installed without obtaining an'inspectioti;-I agi'ee.to'temove -
nhersrdousair e tsmna, mde0 dbl,h Bay Aha Air Quality Mgement'
Ya all new materials for inspection,;,Applicant understands and will comply,with
t � �ho
all tion-point source regulations
ti '1 1 has.read Ne hazardous m t ala rcqu remit under Chapter 695 aP4fie '� "1"• ' ` '
C61/ora a He IN&Sarny Code Sea o s 25505 25533 end 25534 1 understand In,,
it 6A bu Iding doer rnu Ally ve mom that it A.artrcspo tb1ty to notify am
pow 9 to Issuen e of CenificeR or J-
P Y .
m o e rc ,rem nt; h mus,be m t or �^ Signature of Applicant
P^
-
Da
..-. -.. to
n r r too app_gent r - All roof coverings to be Class "B"or better
`' 'l . .': .`, - r: -OFFICE-...