02010097 (2) BUILDINGDIVISION PERMIT
CRACs 19R'INEURMATION:
f•s..g,•' ,
G ADDRESS: - ,r. x4 ,•` PERMIT NO,
10802 GASCOIGNE DR ROOFMASTER OF SANTA CLAM02010097
OWNER'S NAME: APPLICATION SUB DATE
FRED EAGLE PO BOX 2711 01/24/2002
PHONE:
(408) 741-4900 SANRARY NO. CONTROL NO.
a�ARCHITECIFN'GINEER: - BUILDING PERMIT INFO
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IJ J L._l L_J
.Z in Z LICENSED CONTRACTOR'S DECLARATION lob Description
Z`-"p I hereby a)of than 1 em of
tl under provisions of u,Chapter Cad,9 q mmcnci se p
;mFm wiNSation]000)olDivision3oftheBusinessWProfessionsCode,a my license REROOF. '
exert full Band t
xodu Lee., Licc< T/O TAR & GRAVEL, CHANGE TO COMP.
3 u.t Comreaor
ARCHITER'S DELL
,5 I uOdem d my plans shall be used m pJ6111 records
dO O Lmenud Pro(esnonal
Izi OWNER-BUILDER DECLARATION
='m 1 hereby affum tum 1 Am exempt from the Contractor's License Law for the
"Z< following reason.(Senn--703 1.5,Business and Professions Code:Any city or county
F❑ which requires v permit to construct,alter,improve,demolish,or repair Any structure
�u3m
Prior to ia.0-ntt.also rtquirtsthe epplicam foruch,aomiuo filaesignW atmemem
dual he_is,licensed PursbiAl m thepitrvh�orn of the Contractors License law(Cheptn9 - - '_"'"' --'- -
(commencing with 5enign,]1100)of Division 3 of the Business pad Professions Co,!,) ';'sSCI:Ft:Floor/\Xea Y, i , Valuation
or than he is exdmpt thoefrom'am)the basin for the Alleged exam tion.An t '
-of Section 7031.5 b r a licant fore g P Y violation
-fa-nmmamanrAnndredd.Iry,,,An5w)tt:ebienatne.pprantma-i.ilpenalty APN Number
.� . Occupancy Type
°1,as owner of the Property,or my employees with wages as heir sole compensation, -
will'do the work,'and the 41ucmrs-ifllot'intended or'offdrcd for sale(Sec.7064,
Business and Professions Code:The Contractor's License Law does not apply to an 3 07 - INSULAT RQNired Inspections "
owner of propeny Who builds or improves thereon,and who does such work himself 601 - ROOF TEAR OFF
or thre.ph his own employee..provided that such improvaments mnot intended or
offered fo7sale-If,however;the building of bnpmvenmm u sold within one year of -'" PLYWOOD- ._.
completion,the owner-builder will have the burden-(proving that he did not build or 602 - ROOF NAI'.L:.:'.r
improve for Purpose of sale.). 603 - ROOF BATTENS
_ ...... _o....... ............. . _.. ... _ . .._ 60-4' - ROOF' IN-PROGRESS FINALED.
°Las owner of Use p(Sao 7".Business
conrfeisi ns Coicensede ontracton Contrast
conswct the does
project(Sec.]066,owner
end property
who
Cade:)The Canoence,
-_ License Law dose nm apply men owner of a cony who builds ser improve l.to'h,
C
and welef.Liactsme(m.svch.projecta.witha contractors)licenud_pursuant.to.Om .... ..
G-mm�or.Liccnre law. .
0.4..20x2
- - °lam uempt under Sec. ,BFEB:k PCfor Nis reason � 1. � i ,.l: it
'
or
'Pohl.' BUILDING
WORKER'S COMPENSATION DECLARATION
``- 1 hereby aRlrm under penalty of perjury one m the following dkc,unda.: lel
r '9 ° I have And will maintain a Can IM.I.Of Consent on self insure for Worker's
Its•Compenutian. es provided for by Section 3]001 of Ne labor Code, for the
performance Of the,work for which this pant,is issued.
0 1 hive and will maintain Worker's Compensation Insurance,u required!by Section
3]00 of the labor Code,far the xnfarmentt of the work for which this peanut Is
h,uAd.MY W., race. midon'Im-mni
ncecaerand Polic umbereu
:
:..Polk � .. i� ._. .. .. .. . ... ...._
EXEM 0 RKERS ,. ., •. .. .
.. COMPENSATION INSURANCE
., ........ . _ _..... r-' .-_. -
'(This section need not be completed if the permit is for one hundred dollars
(EI00)Or less.)
P Yat in men'Ino. _.. .. .._. - .. ..,• .'. _
I ccnpl than in We pe any ma n the wart for become
this permit a issued,l •" """"" " "
shall not em to p any manner so as to become subject m the Workcdi I •. .
Compensation Laws of Califdmiv:Dam
Applicant.
. . . .
NOTICE TO APPLICANT:theWorker's
It,Compeer to nsation
this Cenifieta of Labor Code,you multl
become subject ly the such
Comm-1 tius provisionll the Luber Code,you must
�Q Q forthwith comply with such provisions or Nis permit shall be tleemed revoked.
CONSTRUCTION LENDING AGENCY 1 '
a ' 1 hereby affirm that there is a construction lending agency for the performance
G>) Q of Ne work Leme which Nis permit is issued(Sec.309],Civ.C.) 1
0. ndeh Name
.•. .. . .... .:.... _. _.s: ..,
� Z Lender's Address'
V_0 1 cenify that 1 have read this application and state that the above information is
0 [-d 'Oren. roean
I agrse to mply with all city and county ordinances end se laws relating
0 V to building consruelbn,and hereby authodie repreudmtives ofthiicity to emerupon
Ou aWyc-mcntioned property for inspection purposes.,
wFi Y (N'e)-$Me td eeve,indemnify ead@ep hernias the City of Cupertino against
y liabilities,judgments ossa and aapenus'Alen may in any way accrue vgunn said
U Z City ret conn ucnyy of he gaming of dh'/permit.
_ APPLICAYC I'NET 'T DSA:D' ILL COMPLY WITH ALL N'ON-POLY Issued b !/
S,VRCr y ate
a a qpp canvcomnaor - . ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE^ ."" ''
.. wl tun PPhcant orfurore Wilding won start or hertlle herardoe mturim Type of Roof
u cat nW A Cupenin.Municipal Code,Cheptar 9.12.end the HeIN And Safety -
Coda;Sation
❑Yes• - 1, c•'. No.�; . . ._ ..:' ..::
All. oofs shall be inspected prior to,any roofing.material being installed.
Will as
air cc m inant. building by the Bay Anam ipm Qualitm or y
vie',which If a roof is installed without first obtaining an inspection; I agree to remove
emit huWous air ronuminvnm defined by,he Bey Ain Air Quility Menegemem g
Di,tiiel] all new materials for inspection. Applicant understands and will comply with
" all non-point source regulations. .
v "I beve'¢a the Meardous•malerials requirements under Chipar'6.95'of the
x,alifomie He.ln Safety Code;Sei'doas 25505,25533 and 25534.1 understand that
•ifthebuilding runny hem amnvnt, On it is my responsibility the .-
occupant of ,circ ends ch must be et pilar to'is;uentt of a Ceniflcme of
O'cupanc- ••
�a ignatureofApplicant Date
net a Wnaaa ge ,e. All roof coverings to be Class "B" or better
._. .. .,,. . .. ... OFFICE