00110027 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bun.rnrvc Gts�9 JANICE AV LINDY ROOFING CO INC Pr:RMITNo00110027
OWNF.R'SN.} nAQ PHILIPPE E AND CARRIE Y 5554 HARVARD DR APPLICATIOTV�l�'�./2000
)Nli:
(408)269-2025 SANI'T'ARY NO. CONIROLNO.
Z00 ARCHI'I'ECRENGINHU: BUILIANO 1117RMI'IINFO
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Sv¢ Lrat deaEUCo,VIRACre,pr stjo.ARA PION Job Description
rO Z 1 bcn:by 0)of that 1 am oftheEl ander rmvisiofs of Chapmr9 k try license
r_�J wnhseennn9aNunroiak.n,n3a.r.nannakewxnmlrmrexionxeede.andmyrren SHAKES TO 40—YEAR COMPOSITION SHINGLES
¢a4� o full lar and clic".
K ce i U Licaee Clms Lia.# ;
Dia Co dor
ARCHITE 'S .CLARArio.
O g J J II . "itr an acs public rect4ds
aE. a T ..sed
ti ac,Qo ac` /
X OW iR.BUILUERDECLARATION
W`—� errant.(Sect than 1 .npl . n:"be Cumin,C x e:An,c ty o for nm
e.
C Z Q ,hiching.cavum.(Section 9onstr constBusiruct..[,a,.
and Pmimsloli Calc:Any airy orco,am
5xo wM1icb its issuance.also
rerore%the altar,improveh snot Ire a siganyawcmre
t. [hien t " ' L y pr pt.... "t such pe I t , signed(Ch nam r I''
[hit he with
n d p . ITh t 1 ,, ]'coitus
1mr9 Sy. Ft. Floor Area ViVJW' nl5
trimmincingwul Semonon, aofhe vision3of the BwbuwatdImfus Ins PMc) Y74,fC>l1
or that M is 31 S bl thc¢fmnt and the hasis for the alleged caemption.Any violationnaty
of Section 90hat by any applicant for a pcm.it subjects the applicant m a civil penalty
it an man tae lntimred douam(5500). AP N 7�16�4E, 00 Occupancy Type
❑1,asownerofthe proper,m myemployeewithwagesm that.salet iipcnmlion.
will Jo the work.and the suuc ute is not intended or offered for sale(Sec.9(44,
1lusincns and Profession,Code [he Contractor's License Law does not apply m an Qyuired Inspections
of[rept Whu buim,nr implme.,mens....and wen chew .,It wits hhnaar .3,05 — FIRAM�
ofthroughdfor his own oweveees.provided That suchmpr vementeis sol arc not intended or
offered for sale If,however,the provided
or improvement is sold within one year of 307 — j rdSl.11_AT I Ohl
.......lotion,the nwnerbuilder will have"hc harden of proving that he did not buile na
hapmve far purpose of sale.). 601 — ROOF TEAR OFF
0 1,-ovirse,ofthe pai,wny.aid exclusively conirming
withlcnsed contractor,m 602 ROOF PLYWOOD NAIL
nw" I project IS ince Business I 1 i il )ntp c
d2n I d I nt ..fpropertyHolm p demon. 603 ROOF BATTENSand contracts such p twith tt a:) . J pursuant tthe ESSCtmowi L ft 604 ROOF IN—PPOGP
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unJu lc. .H.F P C lir.this rcasnn O
Owner Data
WORKER'S COMPENSATION DI:cLAkATION
I hatch at'tin..undurpunul"y of uar,u,ourol he l allowing dcclane to 1, '
J I have and %ill maintain a Certificate of Consent to self-insure for W'orker's
Conapen%ation, as prnviMd fur by Section 37N) of the Labor Cixle, for the
pd'anmamc of the will,fns which Thi,panni"I,ivnued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section '
3900 of the Lahm Calc,tla the parfor n Ice of the work far which this permit is
issued.My A")
o kin's Contpclnsatinn Inwr:aica cwricr and
/pololicy nunther Ire:
carrier:��.Ly�L—EXi!�1Pi1i)N�on(W�11-11/1(aOMIII. SA'I'ION INSUIRANCH
(This eeniun treed not he camplaed if the permit is far one hundred dollar
n100)or all.)
1 sanity that in the parfurrance of the work for which this pannit is iswed,I
shall an employ any pane in any manner so as to sternum subject it,the Waders
Cotnpunaution Luwx of California.Data _
Applicant
NOTICE:'i O APPLICANT.11,idler making this Cenilicate of 17xemptner,you should
became subject to the Worker's Compensmion provisions of the Labor Cock,you must
Q Q fnnhw'uh comply with such provisions or this prmil shall be deemed revoked.
r
Fz COt them is sons LENDING AGENCY
> I hereby allich that Them iss mind(See. knifing agency for the per(omtame
W of the work for which this purmil is issued(sc.31191.Civ.C.)
ALender's Nnnm
z, z IsnJcr'w Address '
L.I Q I.anify,hal I have rend this application and 4me then the above interaction is
eormo.1 agree t comply with ill city and county ordinance,urd.aam laws reL"ing
Q V to ruildan,ernotructinn,addhrns,nalionix representatives ofthi city to tupon
Gs1 the.b i d property f pain..
We)after tit save.indemaily andkeep h I.,the City ofCupi against
(A ahilt jtb I t 1 as,i whinity a.:t4,way acetic abint said a
U z Gly Is msT NDERlne NDSA of Oiapant".
APPLICANT HNU[RSfANUSANDWII IPLY WITH ALL NON-POINT ��L /7.v79n t/CC • Date 11—d—�J
)ukc ul. Issued by\/
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"gnaure of Appnsa c-"ra."ar l''ti,—� Re-roofs
AZARDOU. MATCRIAUS DISCLOSURE
sen me.[[heart ew future building«aupnm 4nre m namlle hat wwa net Type of Roof
is defined by me C..panina Municipal Code.Ch..ptcr 9.12,and the Health cad Sal cry
Cale.o,, i 25532(a)? � �.
0 ye, All roofs shall be inspected prior to any roofing material being installed.
Will the appfcant of future building occupant use cgtdpnient or devlecw which If a roof is installed without first obtaining an inspection, I agree to remove
oma hurerdnus air anmami....aA by l he Bay Aum A.,Quality ManagEocm
Douriar ; ' all new materials for inspection. Applicant understands and will comply with
❑Yea 0N all non-point source regulations.
I have read the ha incous"Islands myuirentcmx under Chapter 695 ad the
C.Inamia Health k Safely Cale,Sections 25505.15533 and 25534.1 understand that
if the building does not currently haven mnanl,that it is my rs,,weihili"y to notify the
occupant
of the mquire.ne whir mum he ntE " ancenface .ficam ofv
Occupant
Signature of A n Date
iX nurfn7itn,a again - �.� All roof coverings to be Class `B'•or better
OFFICE