00120064 (2) CITY OF-CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO.
10775 Iv1INETTE DRIVE TAYLOR ROOFING INC 001.20064
OWNER'S NAME: APPLICATION SUIT DNUi
PENNY CLIFFORD 1.853 S 7TH ST 12/11/2000
14 LUNG: SANITARY NO. CONTROL NO.
1 c4081971.-7500
❑W Z ARCf11TECr/IiNGINEER:
BUILDING PERMI I'INFO
H,OO B D ELECTI'hUMIi MliCli
Hx. L 1 C.1 IJ I—I
¢n
F y YLICENSED CONI'RACIOR'S DECLARATION ]Ob Description
z= 1 much,fur on that 1 am Iicenxed under provi,inm,of chapter 9(commencing
"C.a withSe,lion 7l)O)d Divi,ton3 f he pushes,unit Prokxsio de,and my liccmc ao
mlroreeseals TEAR OFF EXISTING TAR 8 GRAVEL APPLY Bf
ieen,eQ '?�� q
oder Dare1 p;, conimeror GRAVEL.
ARCUITECrS UECLARATI
F m 1 unJer,,und inY Plans>hall Ire axed ns public Bennis
i aO O Licensed Profoxional
o u OWNER-BUILDER DECLARATION
1 hcrchy n1'lime Incl I um exempt from the Contractor's License Law for the
L z a following reawn.(Section 4031.5.Husine,s and Prauv.owns Codc:Any city orcoun,y
which requires o ismoilh m mnamot,able improve,demolish,or moub any amaure
w G ce poorI I c I...re,ims1m.,,filarm forlam,Ivenuilt file g ml witavemat
'[,at he licerroldp ,I h p if he Comet IL (Cil4 Sy. Ft. Floor Area Valuation
comemancinses r that he s emm here l mnwith Section na111 a
and basis lir NTo,don 3 of Ilie Busitics-and I
e alleged eecnmp t Anyviolation 3
of Section 7W I5 by any applicant lir a Irrout subjects the applicant lie a civil,vmilly
of not mom than eve hundred dollars(550(b. APN Number Occupancy`' ype
❑1,as owner of the progeny.or my employees with wages as Their wle comPen,alim,
will Jo the work. rid the suunure Is not mended or ulfcreJ for,all(Sac.7094, r I'
B.,inc,,,and Pmrcxxion.Code:The Commnor's Licmoc law, ot does napply m an 375320'71 • uired Inspections
ox r it p 1 ty WI h ll, it improve, hemor.tied who does such workti self
or Il through M1' p ddmbarrel
a such en t art tintendedor
red l 1 I .11tl building P m h
t :: IJ ' ' year ot 305 — FRAME
c uPp I, Ih holder
lit Ilhctl bas Ip 6that he did nor n 'IJ lir
inr,esoc for P m f ' ) 307 — INSULATION
olat n property. exclusively nI I Int edt er m 601 — ROOF TEAR OFF
cofisrmct11 p I I(Sa ]Iam BusinessandProlessioniGd
I lie Courricuarn vl
Lcerse Law does not apply to anoxmnof property x ho build,or improve,thereon, 602 — ROOF PLYWOOD NAIL r
and .1...contracts Inr suds projects with a unar,enq licensed puNtunt to the 0
Comtmcce,License Lax, 633 — ROOF BATTENS V
01 aa.c.vn,w order See. .11 k P C lar this reuwn Q
owner 604 — ROOF TPI—PROGRESS
Dal, ✓
WORKER'S COMPENSATION DECIARA'r[ON
I hereby affirm under penally of perjury one of the following Jcelaru,ions:
1 1 have and will nminhin a Cenilicam of Cement Io.ell-e\um lir Workcr'x
ompmealion, as provided ter by Section 37W of the Lahr Code. for he
Perfonmanelet the work for which this ,rail 1,ix,acd,
❑1 have and will maintain W..kur',Cnmlansution lic'manco,m myuald by Sent
371)of he Lubec Code,for he performance of he work for which his p[nn;t i,
issued,May worker',Compo Doan....Inmrmce carrmr a.cul1poolliiccyy aammber ore
y
Carrier-L//
CERI'IFICA N OP CYEMPI ION FROM WORKERS
MPENS "ION INSURANCE.
('This nation ne d or he rot lined if he perms is fob one hundred dollar,
o R)I lir leis.)
I coed,that a he ,for a of the work Ian which hi.,permit is i....d.I
shall nal oingloy t per n ny ci. ,m Io bee rum whjret m the Worker:
Oriental Le I al In Ic _.
Applicant_ a. r hunld
NO'I'Icl 1 'LI' '1'.II:ober making Thi, cru mora of lixnnpliba,You s
M1ecome,ubject oI Workers Cnlmpersolion gmrisions of he Lala Gds You ter„
C Ibrnwilh.Imply thwchprovhiui'or this pmorl,null bedeenmd rmokud,
Z (
F• ^ CONS'I'RUCHON[.HNDING AGENCY
CL — 1 hereby aBinn l them is a conarvclion hal agency for the p,donal
I.one work lir which un Penmi I,is,ucd(Sec.31)7,C,iv.C.1
0. Q Lender's
� Z hander's Poll _
U 0 1evrifyl .r I ve read this, plication and state that the above information is
CL neer I agree r co. ply wan all yand small ordinance,and scom laws miming
Q U robs l i b tme- n,.rdhc.b Ih ri pre m i ca inn: 'rye mrupen
he aM I rope Prry 1 1 'lin , 9
W N I S de fY d keep b rml the Cly f C pen ago st
V) lud'II J t. p wl h ) any way 6'hn.a. id
U Z Cly cre
fah s to ft es pc t
SOUP( , CN 'RST )s D\ IIICOsIPLYWITH AL NON-POINT Issued by. �7,ar ate
191 v J.
mg- plicanuc nlmmor [)ale Re-jirir*on- int
HAZARDOUS MAI ERIALS DISCLOSURE
the applicant lir I um budding orcupem store or Dandle humidor,claterlal Ty
as ddi by the Cmweino Municip/al Code,Chapter 9.12,and the Health and Safety
Cort fol^ 5321o)? 43'N
ave, _ Alle inspect d prior to any roofing material being installed.
Will the zip tea Iorfuture building occupant use ewipmentordevices which If alled wit ut first obtaining an inspection, 1 agree to remove
emir Ita'aune. nm sa,del' d by the Hay Area Air Quality Management
all ls for i potion. Applicant understands and will comply with
6 yL" all rce r gulations.
I has t etc liarud formit:ds mgriarl rimer Chapter 6,95 of the
icnokitCalifornia[.] &S. y0 ,t cla me 25 that a is my c,,e,i.1undersmnd that 2
C hernia r n . r yl :ncnu5O5. S 33.,125534,hitityto....and ht � /+euanl d Ices cr xylv4.ynmt be nml Prior m usuun,erfacendieum of
D<erpar r m /K—V/) � � // igI atur f Appl cant Date
'-'� f4—/!� All roof coverings to be Class `B" or better
eaglet maim
OFFICE