01120009 (2) to CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
f s BUIL IN DDRESS' PERMIT NO,
15��0 JOHNSEN DR. ROOFCO OF SILICON VALLEY 01120009
APPLIC IONS B DATE
o�NERTN�I�ALITY/KATHY LEE 844B EARLE AVE 12/03 2001
' PHONE: (4 08) 795-3335 SANITARY NO. CONTROL NO.
0 O O ARCHITECTMISGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
e$N= LICENSED CONTRACTOR'S DECLARATION
o, 1 berehy affirm mal 1 am ficenud ander pmv&fon.or Chapter 9(commencing Job Description
:ytw w;ms«/art788olnroivsaio 3ormeBaameasindProc.aiomeode' a y «nae REROOF.
y J iainranm�ean � ? 73 COMP. TO COMP-
z z< Licenu C _'�$ � Lica a
i?i 0 Dae Contractor A
a a Fi. ARCHITECT'S DECLA A ION
,g I understand or,plum shill be used as public recoNs
f�T
y d c O Licensed Protensianal
s. o OWNER-BUILDER DECLARATION
1 hereby Blinn that 1 oto exnnpt from the Contractor's License Law fur the
F 2 a following reason.(Section 7031.5.Business and Professions Cade:Any city or county
I F c which resp Permit iconsumer. Iter,improve demolish W any stmcmre
3 w poor t Isartt .th ppiiceo for mchpermnt fk grcduatemenr.
morn xf«nuep rsua itom p .onn=conimmoraL Iawlcnaptm9 ,.._., Sq:F, ,Floor Area,,,, k Valuation
(commencing with Sect 70l fD son 3 of the Business dProfessions Cade) �, Ilii i. J'•' s
or that he Ls exempt tncrefrnm and the basis for the alleged exemption.Any violation
of Section 7031 S by any applicant fur u permit subj«B the applicant m anvil I I.,'
or no more than five hundred dollars($508). APN Number Occupancy Type
01,as owner none prop=ny.or my employee,with wages As their tole compensation. 305 — FRAME
will do the work,and the sOWrum is not intended or offered Alii sale flee.,tau, 3 0 7 — INSULAT
Business and Profession.code:The contractor.License law does not apply to an Lired Inspections
rth
owner of property Who milds or improve%thereon,and who does such work himself 601 — • ROOF TEAR OFF
or through his awn emPloyecs,provided that such iinprmcmcros are not intended or _.
'complarorabe.lr.htv. error=lhavedeburenatprotia.mathedidnotWildor s as s ..... .602 ROOF-PLYWOOD—NAIL.... _-__._
iimpletione the pose of Balder will have the burden of proving that he did not build or
mpm.e tar purpose of sale.). 603 — ROOF BATTENS
— --- - -o 604' ='ROOF IN—PROGRESS __
O Las owner of the pmpe.7 am Business a contrxtisi with licensed m
onswct the les n (See.700.E Business and Professions Com urpr Contractor's _
License
Low does not apply i pan owner or progeny who builte seimproves thereon.
❑n rayl aminens for Such projects a )licensed pursuant m the ... sass._ Bas s_.... . .... .. .... _.. ..__._.. .
end who c with cantm<torls li
Convanoh 4«me Law. FINAL
exempt under See .B&PCfor'his maveny)It'
° Dense
DEC 0 6 2001
WORKER'S COMPENSATION DECLARATION
I hereby infirm under pc..try of perjury one of the following dod.ndimA
❑ 1 have and will maintain A Cvmficam of Consent to self-loam for Workers BUILDING
Compensation. as provided for by Section 3700 of the Labor Cade, for the
performome of rhe workk for which this permit is issued.
01 have AM is ill maintain Worker's Compo f Insurance.as res r red by Section
37(10 of the Labor Code for dhA perfarrwace of the work in-which his Aden is
issa=d.My W kerker's It1.6 In j nk /
cam,G IIPolicy N 2 DO 20,Y b, — -
ATIONOFEREMPTIONFROM WORKERS' 4._ .. — ._-._ - ..
COMPENSATION INSURANCE:
uA
' (This section need not the completed if the permit is for lire hundrsd dollars
($Hty orless.),
r 1 certify that in the Verform ncc of the work for which this permit is issued,l
shall not employ any person in any manner sat As.to become subject to the Winr1mrs
Compensation Lows of Californle,Dam
Applicum
NOTICE TO APPLICANT:It,after making this Ccoftcate of Exemption.you should "
z h=rome subject to the Worker's Compensation provisions of the Labor Cole,you most
0font.an comply with such provisions or this pmmit shall be d«mel.,.keds
r 0 i -
11 "'I CONSTRUCTION LENDING AGENCY _
I I h by tTnn that therea construction l JG ager y f theplerfort ancd "' s
a > the I rk r which th Wrtn t edea is 3897.die.c)
.. —"-
'a Q Lenders Name - - -
p z Lemd •Address
t.7 1 minify that I have read this application and state thin the above infortomion is
correct.1 agree to comply with all city and county ordinances and state laws relating
to building construction:and he..by anionic represnnatives of this city to ether upon
gsj the above-mentioned properly Int m,pcnion purposes._
k. pe Wo agree to save,indemnify and keep harmless rhe City of Cupertino against
4 rat liabilities,judgments,costs and expenses which may in any way acme against said
V.Z Ciry in nuquence of rhe Bmming of Nii permit. - -
_ AP R 'NT REG`U OSTAiyDS O\P+.Y WITH ALL NONIPOINT Issued by: r Date
the applicant or ffoom buildingcaliaarm store or Iliadic comdaus m Re-roofs
S awrcu Appine.nUCommctor are
.. o s DISCLOSURE" twrvl _ .Type of Roofi
' HAZARDOUS MATERIAL
C .Section
copc
edCun Municipal Code Chapter 9.12.and me Health inti Safety
Codi. 25532(.)?.
0Yes 255321x)
All roofs.shall be inspected prior to any,roofing material being installed.,
Will the applicant or future building occupant use equipment ordevien which If a roof is installedwithout first obtaining an inspection',agree467emove
emit oind as air commorams As defined by the Bay Are.Air Quality'Mavgemem
Distort? all new materials for inspection. Applicant understands and will comply with
❑Y<A ❑No' .. .. .. sass.
. _ all non-point source regulations.
I have read me humanism,mamrtaH requirements under Chapter 6.95of the
Cillmarm.Heald&Sapety Code:Sections 25505,25533 and 25534.1 understand than
Hit building dao not curtcmly have a meant.that it is my responsibility to notify the
c r of the rcquiretbenrs which maxi be and not to n,rance of a CertlficAm of
S Signature of Applicant Date
it
._ a thnnaedagcnt .. - .( ate All roof coverings to be Class "B" or better
.�-. '. •.. :._. . � - "... .: . OFFICE - . .