00080123 (2) CITY OF CUPERTINO
BUILDING DNISu3N PERMIT CONTRACTOR INFORMATION:
1{UILDING AJDRISS: PERMIT NO.
QWNEWSNA7II}92 x v ADVANCED ROOFING
AI'PLICA}IOK SUIT DATIi
J
ONE/ MR. & MRS. YAN196 -- SANI'I'AR5'N . cnN%N51 0.
OO AIiCHI'11iC1'/ENGINI?ER: ' — BUILDING PEItMI'I'INFO
BLDG ELECT, PLUMB MECH
u�l IJ 1_J 1=1 L_I
Qat
zs V= Ihcrch Rrmlmm lam liensed undo revisions of Ch�ppter q lcummen<m Job Description
whh Section 70(y))of Division 3 of the Rmincc,and Profcrinnv Code,and my license
m S I,in full I':mre metildria
Li -ter
z K< cense Class_II Lic.xC—/�/_r-4 1
xPa Date_ .Z—eo— Cold mtm.'G1 SHAKE TO COMPOSITION
u 5 ARCHITECT'S DECLARX50N
I un lcremnd Or,plum-null be n,cd uv pnblie recon, ,
se Y-
•y d p s Licenced I'mfcssional
OWNER-BUILDER DECLARATION
I hereby:dlir:n mat I:un mrama from the Commanr'e Licen,e Law for the
C Z fallowing teavnn.(Section 9(131,5,Business and Ihvfcssionv CnJc Any oily or euunty
Hc which relit a permm=on,wa,alter,improve,demolish, v
pve, or repair troy rvclure
co prior to aprom
it ksuence.also requires the applicant for such p= ino file a signed statement
mat he isd.emed anoman¢:the pmv:,nmvanheContractors LicemeLaw tehamerq Sq. Ft. Floor Area Valuation
(<ommoncivg air Section 91X10)of D'okioa 3al'fe Bnsime,,sand 11 heaviom Cod d)
or that he is exempt forefront and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty
of no more than Eve hundred dollars(S500). _ APN Number Occup: iC e
01,as mina of the property,ohm,employer,with wages av their,nle compensation. -
will Jo the work,mad the onature is not intended or offered for sale(See."!0141. 36230tOeS.
Ifuvinesv and Prolecvioav Code:'1he Contractor's License Law does not apply,u:an Ulfed IntipCCIIOnN .
n1Property Who build,nr imp..ev,Ih— 1,and woo docs such wad himself
ar through his own employee,.provided that such improvenonl,are mol intended ur
olTeml for.sale.If.however.the building or impovenrcnt i,,old within ane ,.,at 305 — FRAME
completion.the ownerbuilder will have the burden of proving that he did not build or ?07 _ j,NSULAT I ON
cinpn a ,,Imrpo of sale). a
O I.a,owner of property,am exclusively contracting with licensed contractors to 601 — ROOF TEAR OFF
m,muel the project(Sec 91UJ,Bmineev and Proev%ion,Code:)The ContmcmrN
L :, snarl m,a,anm..l h,,build, anor c,herein, 602 — ROOF PLYWOOD NAIL
Licence Law do' apply Proper y w
and who<ontmaefar such projects with a<nno-ace,gs) liacnacd parvuum m,me -
cmnvxmr,LiameLaw. 603 — ROOF BATTENS
❑Iamexempt under See. B&PCto,this rcaum 604 — ROOF .IN—PROGRESS
Owner Date
WORKER'S COMPENSATION DECLARATION
Iherebyu ud p kyfp lO ltl I'll ' , !char
CC 1 h i d II ro I'n C y t t 13 I lo, elf-imlae f W Ache 8/
Coope t provided f M1l Section Aql f m 1 a Code. f the '
pert ofthe irk f which tl :p t I.
01 have and will maintain Workers Cmmpen,mion Inmrun,,,to required by Section Q�
3'11X1 of the Laar G for the perfannance of me work or which this permit is
i,rod.My Worker',( e:Peneutio Insu a,i,c.artier and Policy uumar are -/ 0
'Crosier: _ Kdicy Nn: I'q
CfWIN A3'IO. :NI1, MON FROM W'ORK'RS'
COMPENSATION INSURANCE
(Thi,section need not a sample¢1 if m=Perron is blame hundred dollars
l51 W)nr IcsJ
cattily thw in the Perlimne el,0 me work for whWh this per it Is""IL I
,hall out employ:oy pram in any manner m av to ar,n,subject m the W..l,ra,
Compensation Lars of Calion ia.Dae
Applicant
NOTICE 10 APPIJCAN'p l7.llflcr making tel,Ccnlfcae a hxentptin r,you should
O Qaatme subject to the Writer,Compce-lion Prov,i sm of the Labor Code.you most
forthwith comply with such provisions orthis permit shall he decanted revoked.
CONSTRUCTION LENDING AGENCY
' 1 hereby affirm that there i,a consmvction leading agency lot the perfonaanm
of the work far which mi,permit is i...od(Sec.3097.Civ.C.)
(� Lendor's Name
Z; Z Lender's Address
U O I crod, full l have mad this ap,f,ahbm and ,are that the dame information in
Wo P comet.1 agree to comply with all city and county ordinances and store laws relining '
Q V mbullion, n.atuctiamnnd retch,nnn,mnee repreenoM1ve,of mire city n.corer apron
'. fa,] the above-n¢mia d Pmp.ny lot inn,crou pulp....,.
F„ y (Wr rcem .2.indcmnily and locp hua les the City of Cupertino against
y but, iii ludgmcnly costs anA exlz,,ny,5� rich may in any way
nor against said
UI� pity can.egneacc r oro grtmmg 6 verba
r A LICANT ON BSTANUS A'D\ LL OMPI.YWI'rH NON-POINT Issued by: 'U Date
U .E RE'
.ATIONS. y'
Signature a(APPlicnm/Cu hra,,w Date Re-roofs
-
IIAZARDOUS MAI'ERIAI"S IIISCLOSURIi
Will meapplicanl or more buildingeorti,el,core m handle hwallon,matedal Type of Roof .
m defined by the Cupertino Nuniripal G,Je.Chuprer 9.12,trod me lieulm and Safep
Ctsle,Section 25532(n)','
0 Y,, 0N All roofs shall be inspected prior to any rooting material being installed.
Will the aPpbcnorm.mfr=aodms occupant use equipment or dea;as whim If a roof is ' led without first obtaining an inspection. I agree to remove
tit huaadoux air cnntaminnnts ax Jdncd by the Bay Amu Air Quality Managmmem
:gdcl? all rte 3ateri s for inspe 'on. Applicant understands and will comply with
0 ve. 0No all n-poin .ource reg ut' nS.
1 hove a ha/aNuu,materials requirement,under Chapter 6.95 of the
Calkbni 'In al'ct,Cad.,Seaton-25511.5,25533 rad 2,534,l undcmanJ that
if' JJing Jtea mcumen0 ncalenan60ot ll is myosmoodilhymnotily lbc
Pam of the rc around
ich must be met our m issuance of a Certificate of
us,
euxuay` rem ignature of Appl' ant Date
0%net ar aatadeed agent g� Date — All roof coverings to be.Class`B" or better