01020037 (2) CITY OF CUPERTINO
BUILDtKo DIVISION PERMIT CONTRACTOR INFORMATION:
BUILI)INn ADDRB.SS; - PHRMI'r NO.
10520 JOHN WY CRL—PAC ROOFING S N MATE001020037
OWNER'S NAME APPLICATION SUB DATE
MA HAN—REI AND AMY C 2515 S EL CAMINO 02/07/2001
IONF. SANITARY No CONTROL NO.
O (650) 286-0450
WOO NBC)[] BUILDING PERMIT INFO
c❑❑ BLD6 171.1401PLUMB MECH
FEW 1- 1 L_1 I_1
¢a
z N 1.Irr,NSeau1,1111dudres ,ol oRAnDN Job Desc prion
1 nonny mllol�In:n 1 inn u'olh,w miner prodixlon,al Chapter 9(emmeen,g
F PJCm is in full iareaxll nfllivi,inn BufthaBwinc,uuW 1'n,ltxaiunx CuJc.send lay llac .
ayy; ix in lu111Lme:serf 'a. (g2. COMP TO DECRRTILE
g
'co Liccn,c 'lax. Lice g
3 7mc_ Commaor
�• �1fRCHITECr'S DECLARA ION
C= I undentaW my pldnx shall M used ax Puhlic rcaoNa
w O7
Licensed Prolnsiu,ul
c Ro LL OWNER-BUILDER DECLARATION
s—m 1 hereby affirm that I am exempt from the Contractor's License Lam'for the
lid4,wis,rea,nn.(Satin.7031.5,Business..it Profession,Code:Any city or county
E x o which nquims a permit m conaruct,after,improve,demolish.or repair any structure
to prinrm its i...ance.also pa,insthenm,
pplicant for such peinn fme
le a signed statement
that he i,reensedpnr.mmmmtheprn, orrimf dicCnmr-a<mr.License D,w(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with section 7000)of Division 1 of the Business and Professions Code)
$10000
or mm he exempt therefrom and the basis for me alleged exemption.Any violation
of Section 731.5 by any applicant sera permit subject,the amplicam tea civil Penalty
ml col n,om'Iran We hemmed dollars(8580). A PN Number Occupancy Type
M 1,ox case a.onhe pr....ly,or buy ermlmee,with wa,u,lax nho'o sola,ompmxatlon• 35918054. 00
will do the vak,z I 111Imirmb I,but'nobodat ,, Alaral Zara;dc(Sec 7044,
Buil : ,dlta,i4 Cod the Corse is ll, :e Lan sec's not apply to an Required Inspections '
r orh hi,emty win employee,.
,ore hafmves.,aam are wenn dot,,asn work nmodf
e n entered nix own however.t provided seal supe nen all issue ata innoneyeer of 305 — FRAME
cB'red ion ode.In however.the.nave t or ire burden
n,that whom one year of 307 — INSULATION
completion,Ire ownc"nauder will novo ma.area of proving that b'dm mot broad o
lnl'r'weforpu,,,e"'`ale')' 601 — ROOF TEAR OFF
01.asonriroftheproPery.amaadusivelycontractingwimBcensedcontraemrsm 602 — ROOF PLYWOOD NAIL
iconsumer the prgeat(sat.744.Business and Profession,Cede.) Me Comment's
ia..,,La.does no,apply 1.anwnerofpmpenywIf.build,orimhprova'he1rom. 603 — ROOF BATTENS
and wbo commas for wen projects with a contracuM.n licensed pnnuatn re the
cont^ero:^License Lw, 6@4 — ROOF IN—PROGRESS
❑1 ash exempt under Sec. .B&1•C for this reason
owner, Dam
WOR LI R S COMPENSATION Df CI \R ION
Ihereby lB J Pe 'Ity fPelry fm felto : gl 1 t hs:
7 1 hb,b 1 I will uaifain a Certificate oI Consent to 11' far Woiser s
Aunpearsatprovided for by Section 191111 of [tic I.alicr code, f the,dh.ssiuk1 1 h,l':fbrora, ned.
�Ibxvc tI f b I Worker',C teen t I . r ec I J by Sealant
'
Dale t1 Labor Cul p f mu fit 'k twhichtl':Ixrnt Is �3
sued Mqqy��WrAun Co,Pen t soman 11'n1icY hl ,
Carrico✓t11-��j F Policy No,
CI!RI FICATION Olr EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE7
/
('This section need not he completed if the permit is for one hundred dollars
151010 nr]a,,,)
1 certify If.,in the perfommnce of the work fpm which alit,permit is i...oil.I
shall not employ any Person in any runner m as mh bccume subject n,the Workers'
Compensation Law.,of California.Data
Applicant
Not CH 10 APPLICAN P If,after making this Cc"i0cate nl Esenptinn,You should -
4mmasubject n,the WorAta,Compnwtinn pro,imonn of the Labor Code,you nest
•O fironw;m eomndy with such pro,srors or miss poem shall en doen,ed revoked.
Z
F ^ CONSTRUCTION LENDING AGENCY
nonny mllmt mat mere is a coned(Sea
alh h097.0 s.C.) fa..the purr nl,ance
of lee wink far which Thi,permit Ix i,nucl f8a.3o9].Civ.C.1
SA Lendeis Nnme
D z LcnJerk r\JAlesn
U C I cattily that l time rcoJ this application and N:na that the alms,infonnntion is
I.. rr creat.I ugme it,comply with all city amt county ardinanas and name laws relating _
U rebuilding consunclam.and hereby authorize mpresemativesof Ihis city re enmrupnn
} W m' those mentioned proPeny for in,paton purposes.
E.r a (We)agree move.indemnify and Aap narhde,x the City of Capnmo against
V] liahilitias,jar heals,ensu and exposes which may in a way acme against said
U 7 Cityins a 'recut the gmminr,71'LPemJt.
APPI .A" UNDERSTAN AND WILL CO WITH ALL NON-POINT Issued by: /
SD F:o' ON� i>.'T/n /lam Y• ys� Date
Signature of ApphaamfComrncmr (%!/� Mate Re-roofs
HAZ\RDOUS MATERIALS DISCLOSURE
Will the applicant nr Imree building eccpam store nr handle hvaNnw mmeriul Type of Roof
a a ined i,Ibe Cup"in,,Municipal Code.Chaffer 9.12,and the I Iedtn and Safety
Cd'.Seen...25512(ap'l
O Ya" 0N All roofs shall be inspected prior to any roofing material being installed,
W lltm afpliatm orkro chuddiugo"m"aal a,,ac,biftabut ordacka,which If a roof is installed without first obtaining an inspection, 1 agree to remove
•Toil 1a annonx d.e....Ii ,awii os hon,al by the Huy Area Air Ouant,Mamagaoein
nl,nicrl all new materials for inspection. Applicant understands and will comply with
°Yo` °No all no E source regulations.
1 nave or,al me ha,.nlo..ataferials meyuiremens..,it chapter 6.95 of 1 �-
CaitornialleallppXSufdyC«les$eetinn.,255115.255p unJ 14.IunJcnmod that
him,MhilAi Olaf,bat cumcnit nine n t.aha it ism ' msihilitym nndly the -lam Q 2- � LVIJ
ecupon f 6 requiremcmn whi vat M mel prior i uxna of a c ain a:nc of
Uceu nq'.
�c CG � �, ' Signature of Applicant Date
ow micro aamoi,ed.gal Dale All roof coverings to be Class "13"or better
OFFICE