00050189 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGAIII@9e MILKY WY ALL SEASONS ROOFING UNYL
OWNER'S NMASHTARE GARY L AND LAWI_ R DON 2640 PACER LN APPLICATION SUB DATE
'IIONE, SANITARY NO. C lL,
gioo
BUILDING PERMIT INFO
rc zO ARCHITIiCT/IiNGINEIiR: 4089724455 BLDG HLI PLUMB MECII
FO
F E 1=1 I=1 ] 1=1
h= I.ICI:NSED CONTRACTOR'S DECLARATION Job Description
Qz C I hcrehy.Prion than I ren Iian,ed under pownions"I Chain,,9(c.nuncncing
m l—w wish Section 7000)of Divi,ion Sof the Nmines,and Profession,,Gdc,andmy license
amgJ Iv in it',,fame unit dTu'I.
m z m a License Class Lic.a
3 d N Data Contractor
ARCHITECT'S DECLARATION
C=O S 1 undenmad Illy plans shall he used ax public rttoIlls
kap;;_ _ RE—ROOF
d a p O
Licensed
I'rofcs..innal
e' OWNER-BUILDE
R
rom the RAI Contractor
1 bonny aairrn ren I um exempt from the Cv,ion, o Licence law for the
T�< ❑illowiug rcmmt.IScction 711115.Bsninesx and Prolcnsi'nv CTxic:Any city orcnunry -
S s O which requires a pertain In consumer,aper,improve,demolish,or repair any swcwre
w y c prior to iu issuance,also regains the applicant fn such permit u,file a,Igmd statement
Ihalhei.Mcanoed par......ltodteprovisimt.,,nPic Contractor vLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
laummencing with Section 70x0)of Hilton.3 of the Bminese and Profumions Code) $6204
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
Ill Section 7031.5 by any app]hunt rnr a incondt ninjcax the app)icam a,a ei,il cally
Ill not more than rive hundred dolor,($50(l) APAN Y� 1 be 00 Occupancy Type
❑I,o r,ftlm pn,pery.o myc Po,,v,w ah w,,a,is rbeirwle v risomsatiom �b �a�f�f
will ne the cook. ssi ma ode The is not cto'JW or L nedLaw
for sole(Spey to am
Hominess ss and Professions WI ons n dc.The Contractor's License, Lawc,ss no,apply or an Required Inspections
rofh huscIywhonada,,.Ilnrided that
such
iandwontins,s,chwinkor
o ehmugh nix.If.mn,Imvhowever.the
building
than mpro vement mem,arc or intended year or
...fend for lute.If,however,rhe building nr improvement ro,i,sod within one year lir
n,Inpls,forntr nwnm-.nisi.wilu,Iwp ren Human nrpmving than by aid urn nndd nr 305 — FRAME
npmv' prrfs,a o
❑1.m owner of the prnpcny.ant exclusively eoroa,oai,wlln licenced a:mraetnrn m 307 — INSULATION
Lnsumct the project(See.70aYl.Business and Prlaosmns Cri The Contractors 601 — ROOF TEAR OFF
icense Law duo not apply to an owner of property who builds or improves thereon,
and it,,commer,for such pmjcc(,wire a eommmialmod to the 602 — ROOF PLYWOOD NAIL
ctoltO seeed p
Contractor,License law.
❑I ant excnro under See, ,B&P C for this reason 603 — ROOF BATTENS
Oscar, Date 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
I heathy uffimt under penalty of perjury one of me following declarations:
❑ I have and will maintain a Certificate of Conserv a,self-instar, Ibr Worker's
Compensation, as provided for by Section 3700 of the Lather Cade, for the
perfomunncc oI the work for which Ibis pennit is Ix,ucd.
❑1 base and will and ma Worker's Compemmion Insurance.as rMuiml by Scaion /
3700 Ill'the I,nhnr Cadth
e,for e prionn I,(it thWwaCd�afI which tris permit is
s 'dm
'My v/sr� l ON 01:0101:Polh/ITl(lNelliOM wDRK�EN���' �j
V COMPENSATION INSURANCE OO
(Thi,.action nttd non be completed if the Moral is For one hundred dollars
191 f()or less,.)
1 ovmd'man in the pmfamtnntt of the work for which this permit is iswed,I
("I"Ir"CETLAPPUCAN'T
not employ any'penin inany mm�ncr s,m n,heome whjcct m IncWorkers'
nollnn law,Ill C'lilbrnia Date
Card
If,after oinking this Certificate of Exemption,you should
h'ennte suhjano the Worker',Cnmpcma(inn im,",iom ol'Ihc l.ehnr Cad'.you n alt
O forthwith comply with such previsions or this permit shall be dpented revoked.
Z Lily CONS I'RUCI'ION LENDING AGENCY
7I hereby,firs that mere is a construction lending agency for the performance
of me wad far wmnr this nem,n is i,wnl(Sec.3097.Civ C.)
CL. p Leader's Name
a z Landers Address
V 0 1 certify than I have read this application and slam(hat the above information is
correct.I agree n)conipty with all city and county ordinances and,(ate laws relating
O V wnnildins e.nsmu'Ilon,and hereby nmboriec repnserntives of this city to cater alone
} ry] he duv>mentioned pmpprly far impletion polows.
F 0. (W'e)agree to save,indemnify and keep harmless the City of Cupertino against
fA Iianidice.judgmcm„,cm(,,i d cspcn,c,wltich may in any way uccruc again,said
U z Cily' aamequence of me granting of this permit.
AP .ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT IssHCdb Date Cie✓ v
5
RCE REGULATIONS.
y'
Signature of Applicanl/Comm'atr Date Re-roofs
HAZARDOUS MATERIALS DISCI.OSURF
Will the applicant or future building overpaid store or handl'hammom material Type of Roof
as defined by the Cupemmn Municipal Cola.Chapter 9,12,and the Health and Safety
Code,Section 2559260”
E)Ye, v�i All roofs shall be inspected prior to any roofing material being installed. '
win onearplivamnrm(arcbnminsoeerpm,itocegdmnlsminrdeviois'whi=In If a roof is installed without first obtaining an inspection, I agree to remove
emit hmeodom air contaminants as defined by the Bay Area Air Quality Manzgemcnt
Distrien all new materials for insppe�ction. Applicant under rids and will comply with
11Ycs D11 all non-point source re r"fa ' ..
I have read the haead'un material.,rcyuirennmts under Chapter 6,95 of(he
C
abin health A Safety Code.Sections 25505,25533 and 25534.1 understand that
buildingdoes not currently have a tenant.that it is my resWmibility to notify thePam of me acpdo'munt,wIodn nalat nn and pror unsmlo nce of a car iOsma ofpanvy' Signatur o (cant Date
er or unhurried agent Date All o coverings to be Class"B"or better
OFFICE