02030058 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10378 KRISTA CT CAL-PAC ROOFING 02030058
OWNER'S NAME: APPLICATION SUB DATE
BRUCKSTEIN ROBERT P AND SILV A 36 RAILWAY AVE 03/13/2002
PHONE: (408) 874-0784 SANITARY NO. CONTROL NO.
W�00 ARCHITECTIENGINEER: BUILDING PERMIT INFO
g w F BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
i Z L Z I hamby.ffrm thin 1 am licenced undor pmvision of (commencing
Chapter 9 Job Description
mi�s with Section]000)o(DivisionJof the Business nIF f itty,cadc.endmyncense REROOF.
sin full orae and cB t. C
awe OVERLAYING DECRA TILE OVER SHAKE.
Coatrus'
S DE;2R -�
ARCHI'T[CT' ATION
y 4 I understand my plans shall he used as public terrors
Y
i i,o Licensed Professional
S OWNER-BUILDER DECLARATION
1 hereby affirm that lain exempt from live C.smmwtm's License Law for the
t?a following reason,ISeetlon]031.5,Business end Profellmns Code:Any city race IF
I O
which requires omit ns constmct ober int roes demolish,or
( B ) lean
and " ..�_ .... ... ... ...
a pe p ,epau any mm�urc
.prior toitsissuaw<,also rtquiasthe applicant fw tech permiuofi '
Ilia he i6eing nit pSectioi 7M)p!onstonsof of
BgitssL;ttnscllewons Code) ,S .-Ft..Floor Area,\ Valuation
ommencin wird Section B(KKI of pivisianJaf the 0yencs{ Pro(essinns Code) [ r 1'w� .m 9 �.� \ I
or he is exam I therefriom'and the basin far the.111 eE 1! motion.An `\ \ 1 e3"re'v`-' I:: \. ! CLI S'".!+�:K.,�k t.i-TI -,
=
of Section 7031.5 by any hundred
d ll for a permit subjects the applicant m.civil Penalty- Type
:of nmmaratnanfvehaaatwdnnar:(ssrlo). umber ,'."I o Occupancye
01,as owner of the property,or my cmployeas with wages as their sole compensation,
will do'he'work,'and-the stmnure'is nal intendedor'.trend for late Sec.701
Bmineka add Professions Code:The Contractor's License Law does not apply to an 307 - INSULATHWired Inspections •
owner of property Who builds or improves thereon,and who does such work himself 6 01 - ROOF TEAR OFF_
ar through his own employees.provided than such impmrertic t,arc not intended or - - "
__ _.-. __ __ ____ ... _. ._. ._.._.__ _ .____. .__.__-._. _... _
loomprter,sale ILhoweverethe buildnge impmvclovmstha ed o, year ar 602 - ROOF PLYWOOD NAT <
'completion,the owner buJJerw 11 have the harden of prov ng that he did of hiuM or
improve far purpose orade.). 603 - ROOF BATTENS
_.._....- -
❑I,mowncr of the pmpcny,am<wlusively commaing xdm Tanana wmmaors to 604 - ROOF IN-PROGRESS' ,:.-----. .Loot
conarucf the projca(See.10,14,Business Oad Profeseiona Cade:)The Contractor's 8 .�
License Law does not apply to an owner of property who builds or improves thereon, •I, -
and.who contracts fnr.such pmjans,with a.intimations).lacnsed.p.mmost m.the.. ...._..__ ..........-. .,._.._ ..... ... .......... __ _1__...,, .. _ ....
O l an exempt under Sec. t - B A P C for this reason
Ow r i t 'Datc ` . .,.
WORKERS COMPENSATION DECLARATION
s' I hereby affirm under penalty of p' jty'oar.fae(allowng declarations:
0 1 here and will maintain a Certificate of Carioca to aelf-insure for Worker's _✓���{\
Compensation, as provided for by Section 37M of the Ube, Code, for the
performance of Ne work for which this permit is issued.
01 have and will'maintain Worker's Coinpensa bo'b eurdnae,as required by Section
37M of the Labor Code,for the pciforinance of the work for which this permit is
issued.M CL'RTIPIO ATION OF P.XEM NFROM�,WORKERS Oe.,
My pc Ii n surantt carrier and
Policy n bar
ana`STa rc au 1PouarjL3f71 OOO,�S� r�{nt a' .•;,t...
- COMPENSATION INSURANCE'
(.PNi unaioiic_..,.
'•':I'o nncd not tie complaintiflhe per mit is far one hundred dollars "'•I '.':i.t 'IT':
(SIM)or less.) '
l nen fy that inth,pelf e of thework for which this perm t is issued:1 t •k._ x i b - � _ _ • _-
shall not employ any poison in any ma ter so as to become subject,o the Workers
Compensation Laws of Califomia.Date
App] _. _ ._y __ .... _ .._...... _..__. .._..__._.... t
become sTOAPPLICANTIf after Wakingn ,fafthe <npt youshould K\•.! i m.
become subject the such rvn ns or provisions he[]
LOM Cade,you mdsi
Q Q forth th c ply with such provisions i or his permn shell bed« d revoked.
z' .-. CONSTRUCTION LENDINGAGENCY - - - - - - f I.
I
he by uffitm that tl ,is.m atiuclon_]ending agetey(or the perfmm`li ca
•
ILI -Lender's Name_e-`- issued(Sec J09]'Cis,C.1 'i' '-
sr of the work for which this`perms is,_" c.3097,Ci ...._.._...... ,.. c.. .. .. .... ...___..._.. _—.. .__.....-. _.- ___..._ .__...__.- ..._.
Ltt- Under',Address' - -_
V • 1 ciao aha 1 have raid this apphicnion'and nae that the Obovc information is
fsaLFs noir"oil I agree It comply with alicity and county,ordinances and state laws relating
�SLJ to building comamcbon,and hereby dmilitarize'representabres of this city to enter upon
>,s.W am above-menlioned property for inspection purposes.
F.:0. '(We)agrce tt sae d comfy and keep harsaless It Cny of Capentno".&.Iran
rw IA liabiht es judgments,c i and ,asu which may any way ace ad fast said / /�
U City rtconsequence of the gm t &of mis pe V
ApPLICANT'U W Np W L IMP Wh'iI ALL N --VNT
s'
URCERE LAT1 Issued by: Date
ignoterc of AppI msContibemr .,-. ,: `. ,•. s' DaI ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF -_
' W 11 th ppllsam f t rc h Id g p t Itm; ha die haiard'u t In nal Til
pe def d by Ih C pen no M p I Code Chapter 9 12 and the Health d Safety s' ::J yfd GC i )T -� w
Cdde Section zssJz l) // Zj• ; r - g Jt;•
❑Yes
All roofs shall be inspected priorito any roofing material being installed.
Will the applicant or future bild g occupant use equipmentap which If a roof is installed without first obtainingins ection I agree to'remove
emit hazardous air contaminants nas os refined by the Bay Area Air Quality Management an 13 g
District? " . . _ all new materials for inspection. Applicant understands and will comply_with
Dyes— iin
- all non-point"source regulations
I htiread the hazardous mataleiids rcq Rem nI1 order Chapter 695 oLthe
C.Itfom nHe9lth&Safety Code,Stations 25505,25533 and 25534.1 understand that
-ifthe tiu Minhdoeanm cprrentlYhave versant:That it ismy rcspaiuibilitytonolify,he """-'"" ' " '
'occupant of,he rc ents which must tie met pros m isioance of a Cmi dem of
-- upancy i -
- Signature of Applicant Date
", op'ae res tett:«lagena All roof coverings to be Class "B"orbetter -
_.
r.
OFFICE._-.