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00060067 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PHRMI'INo OWNERS N.n ;75t JOHNSON: APPI-CATKOO 1n-067 HONE: SANI'T'ARY ICr1�Ct4//'Cr2@�` �KO. BUILDING PERMIT INFO o ARCIiITECT/ENGINEER: 11LUG IA.IiCI' 1'LOME MECH xc r i IJ IJ. (=1 IJ m¢i y z LICIiN51iD CONTRA(]DR'S DIiCLARA1lON Job Descl'IpI100 O z—O 1 hereby dTrm that I um L coed under provioom.of Chapter 9lenunmoving _ F_F 7 with Senimn 7(00)or Division 3 of the Rnsinen and Profc,simns Cale,and by heense m j is in full force and effecl. Y,_ 6 LicenseClass I.ac.a XDi r Dae Commoner _.`O v ARCHITECT'S DECLARATION RE—ROOF I undeeimnd my'plan\shall be,moil us public naoNs ze-y7 s x a O Licensed Professional c L_ OWNER-BUILDER DECLARATION I hereby affient that I am exempt from the Contractor's Licensc law for the =za Rdlowing maxim.(Section LI3I.5.Bu%ino%and 1'rofich%ne,CINe:Any city or county C which" ims a permit to construct,cher.improve,demmlisb,or mpuir any structure x=o prior to its issuance,also requires the applicant forsuch Permit it)file a signed.aatement s 3'� that h:islicensed pat.uam to the pmvioons of Contractor.,Limme Low(Chapmr 9 Sq. Ft. Floor Area Valuation (commencing with Section 7(XXp of Division 3 or the Ru%iness and Professions Code) or that he is exempt therefrom and the basis lin the alleged exemption.Any violation of section 7031.5 by any.,loon,foe a pemdt object, he applic.m it a civil Penaer OCCUber of not more than five hundred dollars(S50(n. APN Numf4irS6ypC . ❑1,as over,of the propcoY,or it,oo,k,cav with wage,.as their wlc compcnsufon. will do the work,and the structure is net intended or offered for sale(sec.70.14. ' Du.me,\and Proms%ions axle:The Contractors License Law does not apply Io an 37531057. 0L%equired Inspections ' owner of property Who builds or improve,Ihemon,and who does arch work himself , through his on employee,.pmvlded that such in.pn,vemm vs Bre not intended or offered For hale IL however,the building or innprovemmal is sold within one year of completion,the ownei-huider will have the burden mf proving That he did nm bold or 305 — FRAME mpmveforpnmowo,d,). 307 — INSULATION ❑1,a,owner)fine property,am eaclnavely enmmcthng with h<coved contractor,n, 6@ 1 — ROOF TEAR OFF clmsnnet the project flee.7044,lin\InmI es,aPmfe„i) nr Iis Cote)The Commo , - Llcone Law does not imply Io an ev oar of property who buihk or Improves thereon, and who cotnorcu for,nen nrojeel.with eoar.,aods)hemsed I,In,aam to tine 60?_ — ROOF PLYWOOD NAIL OmtracEl arnexcoptrtin\claw 603 — ROOF BATTENS _ ❑I nm exunlpt under Sce. .If h I'C Inc This reason Owner nate 604 — ROOF IN—PROGRESS WORKEId'S COSIPENSA1ION I IIiCl,A11A I ION I humhy ullirnn under penally oI'pe Jerry oma of We rnllowing declmaimns- kI have and will antnin a Cntiliane til Concert Io odflo nm for Worker', m, vr,.e nn, a, providedfur by Seelimi 3700 of IIt, I.uhm Code, lin dm pcdonnun a of the work rnr which ILI,permit I,inowd ❑I have:md will on lnuin W(Ha's Cn n,n oil Inwrancq ns required by Scelion 3700 mf the Lulxrt Cnde,fol'Ibe perlbnna nee of the work for which di,permit is koa,d.My Workers Compcmntiun I...umncc carne it N licy tmmtcr ate: Carrier: Policy No.: CERTIFICATION OP E%Eh1Y1'ION PROM WORKERS' Q COMPIiNSATION INSURANCE This section need not he completed if he Permit is for one hnndrcd dollars V ($100)or less) 1 cenify that in the momminave of the work for which this permit is ,wed.I shall not employ any person in any manner so us It,hat subject to the Worker.J Compensmem Inns of Culifumia,Dam Applicant NOTICE TO APPLICANT:If.of c,making this Ceedlieae of Exemption,you should Femme subject a,the workds Compensation provisions of the IaM,r Cade.you most O 0 forthwith comply with such provisions or this pemnit shall be deemed revoked. ZF Z f” CONSTRUCTION LI"I... AGENCY 1 hereby u�Rml that them is a co.,um'on lending agency for the perfommm'e of the walk for which this permit is issued(Sec.3097.Ci,C.) S Q 1<nder's Name .5 z Lxnder's Addnes U C) I rani fy that I have mad this application and%true that the alnewe information is fi ;: cntmcl.1 agree to comply wih all city and county ominance\and state laws relating O U mFvildimgcommmtion.and artery authorize repta\entmives ofthis city tnemer upon } W Ibe alum-mentmned proif lin inspection pmpne\. rr Is. (We)agree to s..x.indemnify and keep harmless the City)I Cu,sedi m against Z liabilities,judgments,costs and expense,which may in any way accrue r,mml wad C„) Z City in consequence of the granting of thus per it. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. y' Sagnamre.1 ApplicaMCnnlmem, nate Re-roofs IIALARDOUS MATERIALS DISCLOSURE Will the applicant or future hadding occupant slim or handle levalloo\material Type of Roof as defined by the Cupertino Mmdcipul Code,Chapter 9.12,and the I lmlth and Sarov Code Section 25532(u)I OYc' • 0 N �y All roofs shall be inspected prior to any roofing material being installed. Will the applicant orfuture boildimgocrnpannmepilasont ILevies,whmt It'd roof is installed without first obtaining an inspection, 1 agree to remove moil brmnlnm til,ennluminants us defined by the Hay Arco Air Quality Munugealent raceme'? all new materials for inspection. Applicant understands and will comply with ave, 0 N all non-point source regulations. . 1 have nod tire htzrol a rialk requimnanls under Chapler 695 mf Ile Culdornin Ilndlh k Safety Cnde,Suction,2550.5,25533 end 25534,11 desladthus if the building dem nal anmmly hove Burman',lhm it is my rtxpnnsi bit lly)..miry the ' - c,aprnl of the rcquimntenla which moa be lout .for w issuance nl a Cenitis:ua fit cuporay. ' Oc - Signature of Applicant Date Ownermamo.Dedagau, Date All roof coverings to be Class"B" or better