02040113 (2) CITY OF CUPERTINO - � ' -"• " w" Aft a -•
BUILDING DMSION PERMIT 4MNTRACT0Rr.IlVFOR14fA1'ION �
BUILDING ADDRESS: PERMIT NO.
82.11 KIM T 02040113
lb OWNER'S NAME: APPLICATION SUB DATE
BELLEFEUILLE ROLAND E AND JETN 04/19/2002
PHONE SANITARY NO. CONTROL NO.
k O o ARCHITEC7/ENGINEER: BUILDING PERMIT INFO
Ei BLDG ELECT PLUMB MECH
fn�y u [_I L. u
C v Z LICENSED CONTRACTOR'S DECLARATION ]Ob Description
Z E.4. I hereby aRrm the,l am littnud under provisions of Che t«9lrommenciny
y�q with Sccd.7000)of Division 3of1he Bulirev Prole/ssi`ons ode./an_d license REROOF
a m:2l License Cnu is in full f end'<Rejt.�/> Lie, I �Uy�
A. li:/-I T/O EXISTING ROOF, APPLY 111/2 " PLYWOOD,
LL`OBD A CHITECT'S DECL-ARATON 30LB FELT & PRESITIQUE PLUS 50 YR. SHINGL
,3 g 1 understand my plans shall be used As public records
i�
�O O Licensed Professional -
a'� OWNER-BUILDER DECLARATION
1 hereby aRrm the,I oro exempt from the Co.oanor s License law for the
C?< following on.ISack.70313.Business and Profmion+Cade:Any city or county
I ❑ whichmquircs APenni,mcaro-«.-1111.imhanc.demolish.or¢pairanyorneture
3$ -Prior to its issueme.?h.equins)�Divi ionJofuchev inn funs«Code h �,;'\'t l s 9.'a...Cr. s.. l r l t•` _ _._...___ _--_.____-.__...._._.__._-__»_�...._._,.—.
Ppp pemdno file signed wmmem
dvtbegFifisidpunid.n 7,he ll f DiA,sof the,h1B.fucAA9henx law Che
(comm heIs excerpt
iWefr 0(q - t 4 S Ft:Floor AreaL-,.,
yy s Y'dPrc ) ti ..: 1 ••f•'i'�'t(3''l $95� Iption
or shut he is exempuhertfrbm aifd the basis fm the alleged amorblion.Any violas,¢
-ofSudan7031S by thy applinnifor a permit subjects she epplicam,oa civil penalty' ,ApN1�l
'af nui amie than fivfhundred doOd,S5(10). 359= ATbF0 Occupancy Type
❑I,as owner ofthe properly,on my employees wi h"Ages 0 their sole compensation,
-brill'dnihe:work..-end the niuc,urc m not inert or'i4firedfirsale(Sec.700.1:
'Bus rie3s And Profession,Code;no Connector's License Law does not apply to an 305 - FRAME Required Inspectidns',' •f'1,+r:•.
Owner of property Who builds or Improvesshemon,and who does such work himself
_or,hrough hl;own employery Provided Na,such impmvemem,me not intended or, _. -- 3 O 7 INSULATION _
id!(ercd f rale.If.however the building or improxmem is+aid"shin one yevr of -_._
completmn,the owneo-bmlder will has.the burden of proving,hat be did nm build or 601 - ROOF TEAR OFF - •• ^` - ��:•• -•.: t.
602 - ROOF PLYWOOD NAIL
improve for purpo+e of ale.).
❑1:Aa owner of the ro rl em exclusive) contracti., — - ---------
P a Y y gwuhoaevcdeomncmn,o 603 - ROOF BATTENS w,..'t r:�..
construct the prosect(Su ]10 A,Business and Profusions Code)The Conthem.a ,,.l
License law does hot apply to An-sonar of property,who build,mimprovu mercon. 604 ROOF IN-PROGRESS'"'_
`._ d.whoromr-cu forsuch.poj«u-wi,h.e convx,u/s).licenud.punumt.arthA ---------------
an .______._ —.
ContanoA p,order
Law. ,f .,,_, , ..
❑lam sem , vd«Sa ' r ilLUll
P `B&PCfm Gus noon 'flii
WORKER'S COMPENSATION DECLARATION
v 1 hcrtby,R,m'uMu pm,ItY of pe'pory oiie.of the(allowing dmhhadhh'r_ F I� A Ig E D
�V 6�Glad
h✓a and will"m+mu Ccnifidi of C".1
runt`,o self-insoo for Worker's
3 Compmnuon a-PmvidW fm-by-Smion 3700 of-tha-Ubm Codn-forthe
pe'rfomunce of ihe'work for which this permit u issued,_. L
n APR
/t t]t7rft 2. +1002
. .. i.... `�
O 1 h rail wili�miimm�WorY,enfCempewnon Ineunnm,u mquiied tijSeniun
3]00 of the L-bOr Code,fdr iM per(ormanu of Ne work file which N s peimut n
issued .� oheh CompenuthdnlnfunMe cams and Polmy,number art De.
(.+' N'Nt IH,qt 4JCI l'2 oi- 'K 00�
. In C ATION OF EM QM',WOR[(ERBa' i', k f j L�.. -i (}v *'ti 1L\-+1 ri i l:,i
-Y; _• CQMPENSATION BgSURANCE'
:.
trh
Ism"ort randond be mmlik¢d n xhe pemdt is for one hundred dollars - .LJ IRi GCy 1,',(;cam
151001 orIusJ ,..:fro:.o..r:mr .mi: ri., 1
i':' Ittlufy.Uu,,iA the perfolmvntt urihC work fo hieh,hb pe iinissued,l
hhll nm employ nY.person,i nY minner so s m broume s b)«,_,o jha Wwken t t -
Com�
. .
OTICET AP%.IQANPI N11(m-f.ing itis Cenlfc-11 of Ek iup,on -----
-
on should
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Q
bicome mhseamme WorAeh Compensation pro nom of,hc Labor Cade yo'must f nhw m comply iih wch pros s m anti perm t shell be dttmed rcvok d
__ ..._ _..........
1 _
E,i .�; :i CtlNSTRUCTIQIJ 4ENDfNO AGENCY ° .'- '' ° t F' I FAMTT..:
Pl i' I he�rcby aflirin thn Nprt b a cPnaWetmn 4ndln�ajencY fpr die perforin4nce i i
Wpr Gr o�Uie wmk fa „hnh ihH perm),u W d(Sec 109] Iv C) ..r,+.w-,
I<"
,
LendwAddrcas v , - ,
PL Ir I comfy that I have ad this Application and state that the Above mfonn tion It --
h.r cbtien 1 agree m comply With 11 u,Y'ehd my-TY and n noes and mv.law,relating
W W' th build ng cony tion nil au,hb n kprtxnuuvle df flus sty m cont upon
,he abovq n ansa ed properlfar 1
y fqr nspanion purposes.
G:: jNe}epree,o n e lhdeihmfy and kuP h drb.;�lhh-Cry of Cunon against
ti y;
city.*
sudgmenf+.;cos,,And capers,,x high may m ony ay mine-Rainst:.id V
V �� Chi ecof_queviceofthegr,InAo 0, epnis -
APT�AOT�k�T37 Issued b Y Date
!anro;jMATERIALSDISCLOSUREI n411 Re-roofs
i• r Will fie dpphcan,of fumle building ottupant non or handlehararduus m„coal a of Roof - _
defined by the Cupertino Muninpd a Cheprt 9I3 andih<Hetlth me Safe TyP - g , i A --h , ! +_:__ -•--
Cade Senten SJlla a ,y;A ,a 1 J ^s.a � r}' r �' I t l.r ry• 1/�I:6'. .9I1
- r Yes �,. l ll o. r a! y^,�1 Yilh ♦ " ll \� - I' t,4. �,i,.r� -- 1.
v All roofsshall.be inspected poor-to,any.roofing.material.being.installed.. r
Wi11,As Air sant contort"fintui bud .YF%P.,,ux gmpm mane ,ea soh ah If a roof is itisfa]led�wiifiout fust obtaining an'ins ectioh;I agree' .to•itimove M..
emir haardo ser a m by YTeBry Area Air Qutl,yMangemm g (3
-_,all new materials.for-ins action..Applicant understands and.will cgmply_with
tY uf7 Y«t ;;If all non-point source regulations --
}r{1 ha x read do banrdom mantenJI nequircme u under.Cheidere-95'of the
California H IN&Sduy Cndc Suuoa,2550325533'and 25530 I Andanund ds
ifihebu lding doe,'ai cumenthy na e A tanant harry ft smisrulbihtym nasty
acs an,of the require
An hmh must me,pdm m Iuuan of•Ca i0 ,e of
T Oc- cy ..
Q gnat ' o . plicant_ _ Da e
_.....
Owne.fir ---. --------. .... _ _.. F --'
as All roof coverings to be Class"B"or better
i< s
OFFICE._
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