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01110065 (2) F ' TY OF CUPERTINO BUILDING PERMIT CONTRACTOR INFORMATION: ' DINGADDRfSS: PERAfIT NO:10�FT BAKER DR CAL-PAC ROOFING _ 01110065 WNER'S NAME: - - APPLICATION SUB DATE -- _. .. NAOKI & EVELYN SHIMAZAKI 36 RAILWAY AVE 11/ 14/2001 PHONE: (408) 369-7444 SANITARY NO. CONTROL NO. Qp .ARCIIITIiC'fIENGINEER: . . - BUILDING PERMIT INTO z W. t...__,:1. - BLDG ELECT PLUMB MECH '¢u. s.z¢m 5_ 1 LICENSED CON-FRACrOR 5 DECLARATION t ]Ob Description. N f:i hC an,alTWnm 1 ml cn.dunclep i n.of Ch pf _9(o mencing , E� ,tinM1$cCh s7000)opQpts on3 of th BL51 ers and Pmle- ons Cod ' ❑my license REROOF mE tn:I qI(lyFe amt eryen !`.1 C. '{ GII 7..11 f - ppu Lenu Clan l.J Lica b0 3Dam Comnaar IL a.O G ARCHITECT'S DECLARATION 5 und<mand mY plans snag be Bud as puhlic rtcoNs - wrE . x o c ucena<d rroreasiawl OWNER-BUILDER mDECLARATION L' f naso atlinn that 1 1. exempt from he Coli.i,C s a:A.,c Law for rhe .. c.Fp z<' whichallowre requires scroll)t mals.consumer,alta n and Proreamoli Csde:Any eay or<auure $117 5 6 o which reyuirc>npermit rerestheaper,improve,n Pearit1 or firepairanytWment w 3cc c. prior to, tkc 1 q to applicant for mcM1 peon uo fl g ed statement vu pidis.liatmod parscutimm the firmi,brioof the Contractor.License' La (Chapter 9 cimureasin,withs la )000)ofDivision 3ofthePrf. 'onsCode) �i39`b Y+V•Y1PJ,.'nVEhe]Y r't Valuation o,that be is exem t thcrefmm and the basis finite aIle cd exem'ion.An P 8 P iv 1penaan of Section]031.5 by any applicant for a permit subjects the appticanno a civil penalty of..,more man five hundred dollars(S500). 3 0 5PN PORAME Occupancy Type El[:as owner of me propen,',or me employces with wages as their sole compensation, 307 — INSULATION -win do'tho work,and the'srmpme is not intended or offered for'cale'IScc.7Ula, 6O 1 — ROOF TET iw 'Business and RoC ressions Code:The Contractor License Law does not apply to an AFquHl7alinspections .... .. - _. alio,of Nope-Y Wh,Wilds or improves ibercon,and who does such work himself or mrougn his own employees,provided mat such improv-ements are not intended or 602 — ROOF PLYWOOD NAIL bfrcrcd'for sale:If.Koweverahe buildingpr"- '---603--- _._ _ ar imen of prove idd-wi did not ld r 603- — ROOF' BATTENS- n — eompletion,pm,i f,ith,erwinnavemebumenarprovingma,n<eidoatbuseda, 604 — ROOF IN—PROGRESS .. inp,ro,e red pumas<arsme.). [. Ol vdner of he op., I ely ractng with to ficenosi comu,atim, commuct the project(Sec.70,,L Business and Pedress ons Code)The Contractors License Law does and apply matiownsor.fitimparty whobu Ids on, mProse,thporn: .... ._. . .. ..__. ._. ... _.. _. _.. . _...._ . ...._. _ __ . .. li _ . .. a 'who o wcB.fuchproj a with a comvnor(s) --- pcenud pursuant m the S Cinctrap amara Lmende Law. .- '"' ) pIa, e'—s d $ec - ,B&PCT this rtaaon - - k 11 WORKER S COA1PENSATION DECLARATION I hereby affirm under pnmlty of porpry one of the following declarations: 2 02 JAN3 � ❑ 1 have and will-mainmin a Cmifcam of Consent ,o zdf-insure for worker's Cornpcnsmlon, as provided for by Section 3700 of the Labor.Code, for the pmfmmence of the work fur which this permit is issued, 1313 1 have and 'll nm Wak Compemalion Insurance 3700 or he Lib Code f 'he pari...roo T he rk fo hich th npermit Us BUILDING issued My Workers ompc t -runt r d Policy - [ 11 ( ter❑� 3 o U ,+000a7sb Cariic S-1G e fQfa.4 Poli<Y No. �1 Q N - ___ ._ ....:.. 'CERTIFICATIONOF EKEMPCION FROM WORKERS'i. .. ..._.. ,. _ :.'_COMPENSATION INSURANCE],:""', ' r o t..ti . . (This uciion need not 6c camplemd lime permit is!or one hu„tlmd dollars r. 151001 or less.) - - , 1 pertly has in t T%pnarmommuce mann the work for which subject a issued;l u - •- _ ........ s'• —'- shah not employ any'penon in any manner m as to become sunjcn,o the Workers Coinpenzaion Laws of California:Dam NOTICE TOAPPLICANT.If, fter making thCcmfj ameofE p,o you.Would Z becnn n3 a 1heW k C p at p s tl. \ . ,f rhe b Cod y ' runt n z Tiptoedr.mPl, - such p sir m, p red,mull b<dca d e'akcd. O Z .. .. _..._ _. ..._ ... .. . . .. . ...... . _ F h ' `'11 -r CONSTRUCTION'LCNDING AGENCY CL h mby R that them i constructionlending agency,fo the pe f,r,iance' of the work for which fin perms in ssued w' ISe<3097:Civ.C.), Leotler's Addrtzs � .k, '.1.:.:'•.t" ._ . . r i Y h c PM a d m city and 6ba and ordinances that a bo - ( fo is Q [{. tobuil Ijcoint mP1Y' Nall ryandtmPreordmWesoa l cityI Ifoe .V the imm ng mucid pa,and hereby a ectuiu rtpossemevves ofth i city m cnmr upon Ls7 he ebovwe)air.iniproperty foody and keep 'impose" _ �:.6r (sx'c)5groc It sore.indern ape anJ kcey narmlcIs the City df Cupertino against _N bilis j dg ms,cosi d cape s wh ch ,' any slay ac gainscsaid V Z City in consequence of to g in, f this perm t • APPIACANTUNQERSTpU AND VILLCOMPLV f`H'ALCNON 016'- Q SOURCE REGULATIONS .11 IY / Issued by: Date ignmumor ApplicanVCnntncpor t. °• ^s / . .. HAZARDOUS MATERIALS DISCLOSURE�'•�' " Re-roofs tonin pph< t n f, 'b ld ng pant tort 'n dl<ncomandoonestion.1 Type of Roof as def ed by he Caromp,Mal Cade Chapter 9.12.and the Health d Safety Code,Station1 3553 1 .. ❑Y r 1 N ._All roofs shall be inspected prior to any rbofing.matenal being.installed. W llth ire oft buildingal occupant.Aequipmento devices If a roof is installed without first obtaining an inspection I agree'to'remove cmiStridulousted at ud<f cd b,the Bay Area Airp IryManagement District', f\ryas{/ i all new materials for inspection. Applicant understands and will tom 1 with oY all non point S rte gulations, - p Y" - 1 h e d to h aarh s' Is mq m m ode Chapin695 of the _ - C, In m a Healed&Safety Cod Seldom 3505 25533 ad 25534.1 understand that '�e\1 .ftp bu lA 'n ,c t1Yn ,nano lt . yresponsibilityt notify the upa,ofmquirimum hit arta.be me,pot, span fisc nficate 'Occupy cY t . Signature of Applicant . Date Owner_ur tumhunica age., Done All roof coverings to be Class"B" or better ' OFFICE .