00090027 (2) CITY iv N
RTNo
]BUILDING - PERMIT CONTRACTOR INFORMATION:
•
BUILDINGADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
7605 ELDERWOOD CT LOS GATOS ROOFING 00090027
PHONE: SANITARY NO, CONTROL NO.
MELINAUSKAS ADOLFAS AND VICTOR 1771 SMITH AVE 09/08/2000
O Q Z ARC]HTECT'IiNGINITEIL BUILDING PERMIT INFO
m❑ BLDG ELECT PLUMB MECH
t;a6 (408)358-1233 .. o
z s y=q I hereby"Morel mm I..do��)mo provisions o Chap Chapter 9 ce°mmencin Job Description
F=!'W with Section IIXXgof Divbaon3 oflbe Busfnessand Pmfessionx Cube.andmyllceno,
7 in tall fnrco and el1.1 _
s a Licemv CI 9 Lic.p
3 LL y Date_ Conlmcam
9 ARCIHTF.CPS DECLA
°g Ianc"Imada,,parssnaFnelinebltsin accord. TEAR OFF ONE LAYER OF SHAKE, INSTALL 3e
c`o a"""dp 'f"`i°"°I 1 /2 CDX PLY AND 26 SQUARES OF .30 YEAR
OWNLRt BUILIn him
o.w= I hereby.(Seco that 1 and eBusin from tba Contractor's C :Any c law fnr the
F z< fallowing reason. ernialnt 703 1.5.Business and improve.
de Professions Code:Any city.(county
I s O which rrquwa a perm.m construct,alcor,improve,h penlish,or repair any.stmnurc
µma- $ prat.to its 1ppawd&zhoreyoithe lheapislicunt fnr wchractouoicense aw(Chapter
Chaptem -
mo(commencing
tion10iofOs axion theComusinesLic Prof..om,pler9 Sy. Ft. Floor Area Valuation
(commencing wit,t hanct]0,;111 ehasi,for
the Business amt Prof An , Cafe)
or Slat hu is exempt therefrom and the per for the alleged on.In Any lineation '
of Sectiono,mn]Ilatby vanydred ollforapermit suhjecn the applicant macivil penalty
.r no,more man five...arca dollars(1100L - -Aped Number Occupancy Type
D L sex nwnor ol'the pane...onny empl.yccs with wages us their rSe cnnqu•.asudon, .'
will do the work,and the structure is not Intradal or offered for.ale(See.]oast, Required Inspections $7400
Business and Pmfessiuns Code:T e Contractor's License law uses not apply to an
w r of..otomy Who bandits or improve,thereon,and who does such work binowil'
or IM1mugb his own however.s,provided tont such vem nvenmms are not one year
or
or hin for sale.If.however.,. building or improvement is soldma, within one year of
completion,the.wner-builder will Lave the harden of proving that he dm not build.r 3592901 5. 00
icon t t u of I J.
❑1as on,t r (the..(eery a4,exclusivelycontracting Code:)
contractorsto305 — FRAME ® �J
construct the.. 1 n(S ]to u B cs 1❑Professions Cnde)The ve nr error's •'r ,f0
.tar L does not ouch 1 owner a opertycont.whobuildsse improves thereon,
307 — INSULATION ®�
amt h contracts for such projects with c t t rest licensed pursuant m IM1e
Cnmrucmrs Licemae Lnw. - —
❑Itmax
, elnpl.imersen. .B&rcE,rtlllarcaw, 601_ ROOF TEAR OFF
Owner Date 602 ROOF PLYWOOD NAIL
WORKER'S COMPENSATION DECLARATION 603 — ROOF BATTENS• '
I herehy atfiml under penally of perjury one of the following declarations: 604 — ROOF IN—PROGRESS
. O ❑ 1 Lave mel will nialocin a Ce.ill"ne of Con...I ,, sdt insure for Workers -
Compensation, as provided for by Section 37N) of the LiZ Code, for the
' perfl once of the work for which This permit is issued.
1 hove tmJ will maintain Worker'.Cnnipensminn Insurance,as reyuircd by Section
'
.f the LoMyOtibe.for the performance of the work for which this permit is -
issued,My N'nr Com n,u I`.umnce cam d policy number arc:
A-Fra�.r�c A� ywirMo,Sra ,e, .,T.,OD
Curti /-R$ Lo policy No.: 1,V L �'fY/ .
CF.RTIFICAI'ION OF[XEMPTION FROM RS'
COMPENSATION INSURANC17
(This section need not IN,completed if the permit is for one hundred dollars
($I00)or IessJ
1 send,l"in the..error a sxk o w chthis permit is issued.1
shall not empl y person in: abject t°the Workers
Cat f u.
ppICalll '
NOTICE he Work ,aft ma g t no si n me of Exemption,you shoulst '
become levy the such
Compen.a IN.....visions.(the Lahr Coile,,d. mint
O fimh amply witL inch prnvisi.ns or this permit shall he Aeetnal revoked.
F 14 ` CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a conswction lending agency tar the performance
of the work for which tills permit is iswal S. .1097,Civ.C.)
0. Q Lender's Name
Q Z Lender's Address
V C 1 ceril'y that I have read thissimumma and ecim thin the ohtwe information is '
Wr. E. correct.I agree to comply with all city and county ordinances and state lass relating ,
V to building construction,and hereby authorize representatives ofthin cityto cam,upon
Wj the nMwe-mcmloned property fur inspection purposes.
L (We)agree romve,arkmarify and keep honnls.the City of Ca,dam against
N liabilities,judgments,cases and expenses which may in any way accrue against said
C,J
City inrma,c,ucnce of IM1e gruntingar lhis..emit,. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issuedb
SOURCE REGULATIONS. y: Date
Signature of Applicanl/(7onlocror Dom Re-roofs
HAZARDOUS MAT13RIAI S DISCLOSURE
Will the applicant or future bundiag.eeupam star or handle corrNsas maemd Type of Roof
a.defined by the C.parinn Municipal Cnde.Clarets,9.12,trod the Health and Safety
Calc,Section 25532N)1
°Yr All roofs shall be inspected prior to any roofing material being installed.
Will lot applicant ornl�ilehuuding°n,Holm ow,enaipltletil is,dnvlcc.which 11'a roof is installed without first obtaining an inspection, l agree to remove
emit havardom air romamimmils as defined by the Bay Area Air Quality Management
District' all new aterials for inspec ' pplicant understands and will comply with
ElYc'` all n - in source re ul'
I have rcaJ the hazardous mmerials requirement under Chapter 6.95 of the
Colifomia Hcalth&SafcryCrdc,Secdnns 25585, 533 and 25534.1 understand that '
ifthc buil ' • iesn°talrently hoveutenua is my raspon.ihllity to notifyte ;9
occupy fin requiremrnrs wti at ante of a Ccn'teal ul'
D"a "`y nature of Applicant •Dat
a.mni;=ed agent All roof coverings to be Class `•B"or better
OFFICE