00060127 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
7607 ERIN WY AMERICAN BUILDING & IMMS00060127
OWNER'S NAME: APPLICATI IJ L
LAU/SHIPLE P 0 BOX 3326 2000
PONE: (408) 741-1124 SANITARY NO. CONTROL NO.
- ,
W❑O ZO ARCHITEC"DENGINEER: - BUILDING PERMIT INFO
g m HLDG IiI.Eci PLUMB MECH
1= IJ lUJ I_J
z S n LICENSED CONTRACTOR'S DEccwHlhembyef . miundroions ery feon.menaing _ Job Description .
O4tO wi,h Senion70R).fD,,i,io 13 ofine BminessanJ Prnl'csiore Gale,undnry license
s
is in rtm line aw efrcet. RE—ROOF
License Class Lic.g .
y�3 s U Dale Counter
LL a. ARCHITECT'S DECLARATION
�'.O g 1 nndersmnd my plans shall be used as public mock,
C p O Licensed Prnfmsinnnl
Hat I a.tU nitnt II DECLAIontractN
ul I hereby.(Sect o nl 1 1. eBusinl from IPC Conlon,Cove(:Acme Law fur InC
C?a following ream.(Section 7031.:Business end Profesions Cade.Any ,city lar county
F e wit ,reltim,ispetual, , , he,applicant
p Jc lithaffect.,statement prion , issuance. Is requires p pili 11 hie ors fit"seasigned smlemem V'L'
mash r n.with
.. .1 m p nn c I 1 e L La ( Cod) S Ft. Floor Area
ort e g IraScc om an Division l fII l c 1I mission,G:ion q'
of Inst he m 31.5 b tncrefrom and Inc hast,forthesubjects
that exempnt to a civil l penaun
of Section m0h n by any applicant fora perm')cubjens Inc applicant to a civil penal)
of not more than fvehunJmd collars lE51g1. y APN Number Occupancy Type
°I,asnwnet oftharaers,arm lass with wa et a..theirxole mm 3592001.6. 00
P P Y temp y g penmdon.
will do IM1c work,land the ode: re Is not ettendaLor offeree due,
sole apply 7fIJq.
U neref and any W is Cale:TTm Cme theses 1:ant Law daex tint work
h to III,� RReequired Inspections
owner ofh his oy Who builds ar ovided.hat such
'unit veo does such work himself 3Q15 — FRRME
orthroughhis own however.
t provided that such improvemrns am not intended
ar or
comm)for sale. w howuilder w building it improvement enofProv is that within one year of 307 — INSULATION
completion,nn,the d:va of lsildcr will have the harden of proving that he did not build ler
improve lbrpn�ixenrxale,). .. � 601 — ROOF TEAR OFF
01,as owner(if the pmprlt am exclusively contracting with fcenud contractors to - 602 — ROOF PLYWOOD NAIL
consumer the project(Sec.]BW.Business and Prefeninns Gds:)The Contrucmr's
Licene Law does not apply to an manor of property who builds or improve..thereon, 603 — ROOF BATTENS
Contractocontracts e•`r such projects with a commcwds)licensed pursuant ra do 604 — ROOF IN—PROGRESS
°l am exempt under Scc. ,B&1'C to'lhi.sreasmn
Owner Ilam
WORKER'S COMPENSATION DECLARATION
1 hereby aftirn under penalty of periury one of the fallowing declarations
J I have and will claintain a Ceritm-to of Consent to self-insure Sir Worker's
Compensation, as provided for by Section 37M of the L.1s, Code, for the
perforamlue of the work for which this permit is issued.
°1 have unit will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Cade,for the perfcachhee of.ne work for which tits permit is
isued.My Worker's Cmupenation Insurance carrier land Pnlpicy/numbcryyq�/
Cancer:
CERTIFICATION FEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('I his section meat non he cnmpladd if the punnil Ix for one hundred dollars
($10to or less)
I versify Na.in the perfammnm of the work for which this permit is isui I
A shall mol ianft1oy.ajvason in any nommor so as In become subject to the Workers' _
Compena ran L.a I G lifnni a Ua e
Applicnnl
NOI'ICp TOAPPLICAN'I:If.after nmking thin Cersifcam nl'2xemplion,yon shord
Z become xubjttl n the Workers Cmuserwtion pro vision a find Labs,CnJe.you must
0 0 forshwith comply arilh such provisions or this permit shall he dame)revoked.
z
H
CONSTRUCTION ano alma
AGENCY r
a Iber for which that there.is
ossued(See ladingagency for the perlilm.ance ,
W Q of LeLha work for which J.Is permit Is issued IFec.31197,Civ.C.)
A. Lender's Name
7 Z Lender's Address
U 0 1 anify that 1 have mail his application and am hot the above iafo..mind.is
ka+ ELI rnrrect.1 agree In comply with all coy nnA county ordinances and store lows relating'
0 O m hn JJi ng construction,nod hereby mehoris n ce,,ntntwe,of Nis it,to veer upon
} Ia7 the alvwe-mentioned peopeny for in.specdon purposes. '
E• ly (We)agree In save.indemnify ural keep harmless the City of Cmpersini against
h city is ckjudgme a mss and expenses which may in any play acerae against said 9�
U Z Caryin const judgments,
grantingen this permit. . '
A ERSTANDS AND WILL COMPL TH-AC:CNON.POINT
gOURC S. /t Issued by: _ Date
�ii ...[Applies ' actor Date Re-roofs
ARDOUS MATERIALS DISCLOSURE
Will.he applicant or them budding iccmpand store or handle naxlrdams material Type of Roof
as defined by the Cupertino Municipal Cale.Chapter 9.12,and.he Health and Safety
Calc,Scotian 25532004
Cres No All roofs shall be inspected prior to any'roofing material being installed.
Wi 11 the applicant or future building eccapand use equipment or de ices which If a roof is installed without first obtainingan inspection, 1 agree to remove
emit brordous air com:mnomemd tied by the Hay Area Air Quality Management P g
indAr all new materials for inspection. Applicant understands and will comply with
❑res xa all non-point source regulations. .
I have read the hvallons material%requirements under Cnapmr 6,95 of the
Califomio Health&Safely Code Sections 25505.B533 and 2553'-1 undersand liar
tribe building Jces not currently hares tram.that it�s+�sy�nsilihiry to notify to '
oven rm}T ns which mus print m issuance of n Cenifcam of
o tial.<y. ar Signature of Applicant Date
o ince agent /
Data _ All roof coverings to be Class `B•'or better'