00080068 (2) CITY UILDOF
DIVISION PERMIT
Ne CONTRACTOR INFORMATION: PERMIT No.
BUILDING ADDRESS:
SANII'ARYNO. APPLICATION SUBMITTAL DATE
LOS GATOS ROOFIN 0 ' 080068
4ARCHITECTtENGINEER
WNER'S NAME:
NIC CONTROL#
a+nvc: a 1771 SMITH AVE
08/09/2000
1
(408) 358-1233 BOLDING PERMIT INFO
oo
�a
O Q N Z LICENSED CONTRACTORS under DECLARATION
I hereby aRw than 1 w licemed sande provisions of r 9(canmencin
o z� cgwr g Job Description
wind Smlion]000)e(Divi9ion]of Ne Businne end Pofeviaaa Code,and mY licenle I[
y Y i Ii farce avd eRe 3-�-lfa 3 S
pia" OR couactm X7 TAR d GRAVEL TO COMPOSITION
t ty 0 5 "CHITECr-S DECLARATION $O T/OkU
y I undemtaal my plans"I be used u public rccoNs
Licenofessiorul
sed professional
u� thus I...."form
DEme Co..ON
!' a 1 greasy.(fere that 1 w nempt from Ne Convect s License law for the
o following lemon.(SectioneitoV313.c euaircss andmp Paofauiom Cade:Any airy m mune,
mwhim requires a permit to construct,after,imiwve,demalian,or rtpur any ewctme S Ft. Floor Area at tion
prior to its immuce.do requires theapplicatn formch permit to fila asigned[utcmtm q' _ i,
Net he is licensed intention to the provisions of Ne Conan s License law(Chapter 9
(commcooing with Section 7"),d Division 3 oldie Bell.and Prafeuimus Code)m
that be is exempt Haefuim and the brei,for the alleged<umptim.Any violuion of APN Number Oecupanet )MOO
Stereo 7031.3 by so,ii,bea e,for is pamor mbim,the ap,linnt to s civil petWty of
not am men five hundred dollars(55001. ,,D,�tl
❑I,aswner .Ne property,or kim, oyem wind wgmaa (Sm.
7044.Business,
3752^2&gF ioo Inspections
will do Ne work.end the he Cort it n nimrnsed proffered fm a apply
o sur Businea
ad Profeuiotla Code)The Common-,Liceme law soca atm apply to if weer o/
his o nY who build[or impove tMenn.pr who sora such work himself i mreuoa
his own owe eyes,buildings Nu ooh improvements sold thin not intended m ohumn.for 305 — FRAME
[da.If,however.sac Building un improvement is sold within area it t of completion,the
owner-wuaer will have the burets of proving Nnt Beale not bnim to impra[e for per. 307 — INSLILAT I061
01.asmomm of the prom".w exclusively contracting with licensed cm,.,to 601 — ROOF TEAR OFF '
construct the project(Sm.,w#,Business and Prahmlum Codex The Commences U. 602 — ROOF PLYWOOD NAIL
cense law dm9 na apply to an owner of property who huilds or impmvex Hereon,and
who commis for such pmjccts with a concretions)licensed pursuant¢ahe Convectors 603 — ROOF BATTENS .
License Law,
❑Iwamvaptunder Sec. .BkPCforthismeon 604 — ROOF IN—PROGRESS
Own r De
WORKER'S COMPENSATION D 71
1 hereby eRrm under penally of perjury orae a follwWe ore:
lhaveand will maintaineCatifica ofco to ort rWmkeraCompen-
waion,as provided for by$moon 3] of ,fm aha performance of the
work for which this permit is issued.
❑1 have aha will memui eskers notion Nutation,as required by Section'
3]fq of IaborC o rf nee of Ne wart ouw'ch i,p is iaaurp
My Wo n nsurance curie rein Polio n F).3
Cartier. policy No.;
CERTIFICATE OF EXEMPTION FR WORXERS'
COMPENSATION INSURANCE
(This metion residues beconple al ifthc pursuit is Toren hundred dolle9($100)
or less.)
1 certify Nt in the performance of the work for which this pemut is imued,l s1Wl
ret employ my person in any manner an e9 to become subject no Nc Workers'Compere
otion laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,efrer mdrng His Certificate of Exemption,you should
become subject to she Workers Compensation provisions of Ne Labor Code,you mutt
forthwith comply with such provisions or We parent mall M deemed mocked.
CONSTRUCRON LENDING AGENCY
Q (hereby affirm thin Here is a construction lending agency for she perfomance of
He work for which His pc mil is issued(Sec.3097,Civ,C.)
F. 4 undcrs Name
y j 1<Mer[Address
W I modify Nm I have mad Nis application and[tae that the above information Is
d correct.I agme to comply with all city aha county crdivncn and smile laws halm"an
U Obuilding coemuction,and hereby minnow representative,of this city to enter upon the
above-memioned property for inspection puryoses.
fat g.r (We)emu to save,indemnify and keep harmless the City of Cupertino against
0 V Iiabiliva' mg yys,ctvu eMnpena,whit meas anyw eagumtsaid City
lil ncortuque9JrraF 5ne grandngof His mmut
L) rZA
As 'MPI,) d4T . DERSfANDS�pI 41{ NONroIW
SDU NRS!
Si of ApplicantlComactor Do
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant store in handle hazsdou[material Re-roofs
as defined by the Cupertino Municipal Cade.Chapter 9.12,and me RW H std Safety
Code.Secure 25532m)7 Type of Roof
❑Yes ON.
Willaha applicant orfuere building mcupent use equipmem m devices which All roofs shall be inspected prior to anyy roofing material being
emit haurdous alrcontwinmm as de0ned by the Bey Area Air Quality Management installed. If a roof is Installed without I1rst obtaining an inspection
la r remove all e t 'al for inspection. Applicant
❑Ym []No
Iha tfleharudouxmatmi artq ' .93 ofthCali- Un rat gds and co pen-point-sou e r gulations.
(emu R m Safety Code,$ am SD tend Oam if the -
suildi d nm cone s y �i,ify Ne omd t 10
of 9which retOr
tore of Applicant - Date
r err auNarizeda t te
All roof coverings to be Class"B"or better
OFFICE