00090187 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUILDING ADDRIiSS: PI?RMI I NO.
OWNER'S NAME: APPI.ICADON SUB DATE
7540 MC CLELLAN RD SHELTON ROOFING 100091011.87
up(NE: SANI'I'AltlNO. CONTROL NO.
LUCCHETTI JEANETTE E TRIISTEE 1988 LEGHORN S7 09/29/2000
O z 6 ARCHITIVIA NGINEIR: UILIIING PERMIT INFO
O O BI.1 ELECT I'XMB NILCH
(650) 961.-7699 _I L J _t
I—N jLICENSED CON'FRAMOR'S DECLARNNON Job Description
oL_C 1 hemhY nllirm that 1 am licensed under pervh;on,ler Chapter 9(commencing
F,=H to x ith Section 701)(F of Quo,, l of'he Husfns,and Professions Code.and my keen.
I,
in tall A� — ef_tij — S
S z,�U Liccnw C/N '.)T)—/p—^'I Lic,p
O d Dude �, Coovucua
AHcirri.Cl' I). I.AR ON
d
Iandenmmd n.>'plan„nan Wlewd a,publicmeleNs INSTALL FELT MEMBRANE/ REINSTALL TILE
ol
ac
a O Liccmct I'rofcs,innal
1 OWNER-BUILDER DECLARATION
Irl I hi affirm dial III exempt from,he Coam,or',L ieonsc Low tor the
C<Q following termor.Becti...1703 I.S.Bonin..,nut Prutea,inna Cale:Any city or County
F o which rcquirev a rymtit,o cunswc6 eller,nurture.dnnolish,ler repair any somemrc
6C. m priorto its issuai also requires the applicant lot such pcmtitlo fle a signed stational
%—
that hc is licensed pursuant it)ithe provoims.of the Clioractors Licrow,[-low(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section Mill of Divi\inn 3 or the Business and Producsinm CNe)
or that he is exempt therefrom and the hasis for the alleged exemption.Any villation
III Sect 7031,5 by xry upplicart to,a tenon wbjec,n the "d Want In it civil Inrtahy
III m,tmme dtnm file mlemnm dollar.(S50 ), APN Number Occupancy Type
X6620
❑L deves,ofthend he y,tror my is oree.withwageras leheirole compensation.
will to the work,and the lit:: a i,not intended q m olibed for wot apply 7U W.
Boners and erlere,ho)1,yodp:Tnl,nice nth tea uanw,Law dost not apply no an Required Inspections .
of property win bonds.r mpmv t mercnn,and vele diner such work himwlf 3591.9@43. @@
n,heuot hili a o'cleces. ouldm,,M1nt wen re ems n no,;mended of
(it
completion.the
itowpvc,ins auiave t or int en Elf seem role he did one year ler
mmpklia¢0e owner-builder will have the harden Elf proving Nm he J;J nm nail)or
improv<em patpow lervl<.1. 305 — FRAME
El 1, n< fthpro,cry.on r,xcla,ocly contracting with licensed commiclary,a 307 — INSULATION
t,n t,I j t(S 7044 B J i t :( I )Th C t m c
L',r 1 d t'piyt III e h I If 601 — ROOF TEAR OFF
and ho counarl,mrLa at pn'lemn w,I mrmd,l r d pamyam d. the 602 — ROOF PLYWOOD NAIL
C , , /
Contractor,1 e se
Olmin evemptan&,see BaPCbthis mawn 603 — ROOF BATTENS
Gw"" Date 604 — ROOF IN—PROGRESS
WOR Kliit'S yDMPDate IIDN DECLANA'I'ION
I hcrchy affirm'order penalty of perjury one of the follnwlng declaration,:
1 I have and will maintain a Cenifcate of Consent to wl4inwre for Worker
'.
0Comp<mu,ion, as pmvldW or by Section 3700 of the Labor Code, Sir the
pe fommocc of leu work III whlch ink smolt is isrnd. -
I have and will nu;mo;n Worker's C...n""atinn In..ur:e¢'e,a,required by Section
1 ftNl of the Labtr Calc,for the pJerformance of the work lin which this I couil is
evannive
oil
.he
Carrier;,IyCourtA IBEx'rHinIrlts�-2;M4_94i
_ CUMI'.NSAI'ION INSURANCE -
(I his section need not be compli it the permit is lira one hundred dollars
61W)ur It'sI
1 ocnify that to ffi Iwdroure ace of the work ror which,h;s permit is issued.I
,hull nn,employ any p<rwn in any duan ler xt tw ut hwuma n lbi to dile WmkbE
Cleo,nmdon Law—I Culiknnln.hate '
Applicant
NOTICE ITI APPLICAN'r,If.of"'making'his Ccnificom of Eabnp,ion.you should
beeome mhject enthe Workers Cnmppnanion prnvisinns el tM Labor CNet you must
Qfonhwim comply with such provisions m this permit droll be deemed revoked.
F ^ CONS1RCC I ION LENDING AGENCY
C 71 hereby ulLmt that there Is a construction lending agency lot the"fl'onn:mpe
of the work for which this pentyl is i—ed(Sec.3097,Co.C.)
L Q Lender's Name
:5 Z Lcndcro Address
V 0 I certify than l have raW,his appllnnion n
and am' ,hat the above i ouroodk r i,
(1 F coli I I agree I IIy I,th all y aid countyordiou,nuci and TI fw,afnng
V In1 , I JI by IM1 p . ry
trust ftl' l on
Intel up
.1bo -
tae d t , dppmt :peel prpo awl g , , c led E" keepJn :lacCity ataslid 1 ah linen,pJgmemt ane ant comIN ae Inch 'Y n any Y aia6 netl slid W
U Z Chy'm conw,c ec of the Framing of this p<nnd,.
^ APPLICANTUNDERSTpry9S+ttI1 11•LCO LY WITHALLN POIJ�T Issaedby; - Date
SOURCE kGGULATIO',AS( If NON-Pi .
Signmmeaf Appian' uninemr, [ Date Re-roofs
HAZARDO ;AIATIR A15 DISCLOSURE
Will the applicant or huture holding occupant som,or handle hairoodours material Type of Roof
ms echoed by the Cupleinn MuNcip:d Code,Chapter 9,12,ant,he liellth kind Sole,
Ctxlc, pY<e 2553X07 �
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant or future building occupant use equipment or d<vicn which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmatdum,am conmmiwms m Jefned by the Bay Area Air Qualov Management
C1,T/ all new materials for inspection. Applicant understands and will comply with
oyes all non-point source regulations.
I has-e read Ire hmallous mwenuls of ircmen s under Chapdcr 695 of the
California Health k Safety Code.Sections 25505,25513 and 2551.1 outbound that l
if the building does not eueremly have n tenant.that it i,my rolnm;bility to notify the
wcmpant ler the reyli remcit mw be met or I;..nonce of a Ce to ,f
G""p11ey' Signature of Applica Date
Y29/6 All roof coverings to be Class "I3" or better
Owncnnaut ori,dagent Uwe