01060108 (2) CI nut of c DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10482 MERRIMAN RD JIM KRAUSE ROOFING 01060108
OWNER'S NAME: APPLICATION SUB DATE
IARELLA SAVERIO F AND GORDON-AR 2310 DIANA AVE 06/19/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 779-0704
E 9 Q ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u- BLDG ELECT PLUMB M1IECH
y<� CJ LJLJ L=1
LICENSED CONTRACTOR'S DECLARATION
z 5„- Job Description
z-G I hereby )of that I am othelicensed under provisions of Chapter 9 nd mmecense
y 1_u with Section 7M)of Division Jof the Business and Professions Code,and my license REROOF.
�p.a
isto � °'>`j n S43 '` / T/O SHK. RESHEET 1/2” CDX
w;a F °"`_l�s C°n'r LA ADD 40 YR. COMP SHINGLES .
ARCHITECT'S DECLAR. ION
F'=v,; I undemmad my plans mall he used as Public overtax F'
NALED
w�p 2 Licensed Pndemmo.l
a caa OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contra<mr's License Law for the J U L 1 1 20 01
F Z a following reason.(Section 9031.5.Business and Professions Crile:Any city or county
x o which requires a permit to construct.alter,improve,demolish,or repair any structure
ash prat t also P the f ha 'tt 11 signedJtment - - - p���-�� - - tJ 6- -
- h' le <I t1-with
t d p la C 't '1 I' (Cl ace) T. SII..PL 1"lUO1 Fl.ICI ( I LYtY1LbiNd11
(cum enc tl lhl Section 9W01 ofD i J fit fi z ndYol Code) ' 1 3 `as_ � i%1 's t •`s ' �/�l �`
or that he is daimin therefrom and the basis sizzle allege)exa mpoon Anv violation
of Section 9031:5 by any...heart far a permit subject,the applicant m a civil pzhuhy
loinot more than five hundred dollars(55oo1. 342 F'60 iPrh:.. Occupancy Type
❑1,ll d owner of the and
the s,w my,is o ims intended
wages fe half sole< (See.701 ,
'Business
the work;oficisdlhe structure C not otia s Li or offered for sale(Sec."to an Required Inspections',
Business mdPij,Who b Code:The Contractor License Law Joss not apply m an 305 - FRAME 9 - "
owner ofh his ow Who loids or improves thereon,and who does such work himself
or htongn bx own em ever.t Provides that himprovementst tense or 307 - INSULATION
-offered for sale If,however the l lawa i s atwithin- e- f - - '- - - F "-"'-- - ".--"""'
'wmpin:an,he owner WJder will mea m<nade�nfpfnving that he Jia not tiuild or 601 - ROOF TEAR OFF i' '
improve for Purpose°f'sIt'i 602 - ROOF PLYWOOD NAIL
------ of - .,- --- -- - . .._.. _, --:--ROOF- -- ._ ...
❑I,as owner retsina pmpeny.a:aexdn.ivdy comraamg with licensed«,mmaorsro 603 -BATTENS
_ construct the Project(Sec.7044.Business and Professions Crile:)The Contractors 6 04 - ROOF IN-PROGRESS " " ' '
License Law does not apply to an owner of property who Wilds or improve,thereon.
„und.who contracts for,such projects with a comractmos) Iicemed porsuem.m the _... . _._. _. _.___ .........__:___,.._....._ .-_ _._ . . ._. ._..
C°mmcmr s License Law
❑l not exempt under Sec. ,B&P C,for this reason �•
Owner Dam'
_ - WORKER'S COMPENSATION DECLARATION
1 hereby mRrm under pendry of perjury one riffle following Jeclmations:
O I hove and will maintain a Certificate of Consent to self-insure for Worker
_ Compensation, as provided for by Section 37W of the Lmor Code. for the
'perfonwnce'of thework far which his permit is
2 1 have and will'mainiain Worker's Coinpcniation insurance,as require)by S.'am
/J]W of Be,IaWr Code,(or the p nmar mike of the work for which his permit is
C Issued.My Wmaas Compensation Insurance copper and Policy number an:
Cpolicy No.: ;Ly%Srz�_, V'.
CERTIFICATION OF EXEMPTION FROM.WORKERS's; -
.. ,, COMPENSATION1.INSURANCE 11' _ _.___ . _.. .._. _--------
I," 1" ..
(Thrs action need not be Lrn:PlemJ if the Permit is for one hundred dollars
100)or IessJ 1
s I'certify thai'in the pe formance of the work Iw which this permit's issued.l i. Stitt pttL t
,gall not employ-any person in any manner,so as in become subject to the Workers
Cmnpen.mtiun Caws of California:Dem,
..Applicant .. .. s. ....._.., _- -
NOTICE TO APPLICANT:If.after making this Ceniricate of Exemption.you should -
Z become
Q 0 fonhwiN subject m the Workers Compensation pnwso ns,if-thn-e What Code,you nws
comply with such provisions.,,his mi
is pert shall Jraveled.F'In rr "' "' CONSTRUCTION LENDING AGENCY - -
C_> I hereby aRrtn that here is a construction lending agency for he performance
li he work for which this p nnit is F ed(Sec.1097.Civ.CJ
0. Q -Lender's Name'
I cvabfy that I have read his application and state that he above information is
Cz':F., correct I agree fir comply with AI city and county oMinances and state laws relating
D U to building construction.and hereby authorize rep t Ives ofbi <tyt mcrupon
the br menti n d property f inspectionpurposes _
F.d (lV)give ms indemnify Jkeep hof I..the Cly L p n ruga n.a
-Ji
liabilities.judgments,coca J passes which may in any Y against said
U Z. city q cc of tit gr i y l this p t
SOURCEREG LATIONANDSANDR'ILLCO PLYN'ITHALLNONpOINT Issued b Date
SOURCE REGULATION' G/• a.—0 y y'
Signaturc.orApplicant/Coi r TWe . Re-roofs
�Vi
gas definedll the by the Cupertino Municuill Code,Chater9.l2.tand the He�'us Safety Type of Roof
HAZARDOU MATERIALS DISCLOSURE
PP8 Pan ..... ...." __.,._. . ...... . .. ..........
Cad 'Seedm 25532(W -I','. p
Safety
-.- .All.roofs shall,be inspected prior to-any-roofing.material being installed. .. ..
emI ,will the applicant`orfuture building occupant use equipment ordeviaes whim' If a roof is installed without first obtaining an inspection; I agree'to remove
ithazardous air conmminents as define by the Bay Arca Air Quality Management
Ont lee. . -all new materials for inspection. Applicant understands and will.comply with
_
.13 ye, " all non-point source regulations. •.(•. ,l.
I hdl3�omm he ha J r«' I,ba,mooned,mdrr Ch,lim,6.95 or the
C.1ifimm.Health&S.fctyCal Section,25505.25533 ad255aq.I.understandthe, -
ifilae haildir,doe, at carmad,h Ate i t n it is to,rep o hltyt ufythc - s• 6
cec p t of the requ ms which must b t p' m issuance of a Cemfic t of
r
�.
Cement , � nature ofAPPli an[ Datee6 , 9SigOwner of gado, cd agent Date All roof coverings to be Class"B"or better
-Vs .",.• ' - OFFICE
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