02040095 (2) CITY OF CUPERTINO
BUILDING DMSION PERMIT CONTRACTOR,INFORMATION-
+ BUILDING ADDRESS: PERMIT NO,
WOODS ROOFING 02040095
OWNER'S NAME: APPLICATION SUB DATE
KAVENY JOHN J AND DIANE W 1020 HICKORY CT 04/18/2002
PHONE: SAI:ITARY N0. CONTROL N0.
(831) 637-5576
1u0
O ARCHITEC'VIN
ENGINEER: BUILDING PERMIT WFO
& FFBLDG ELECT PLUMB MECH
sSki -6 1 L-i C.J L J U
LICENSED mOnRACndDofIhcmbYoffiwhnlicensed rpisionsChapter 9(commencing
Job Description
yt4 with Section 7000)ofDirision3 of the Business end Pvfessionx Cade.and myliccnu REROOF
Lianull f'rec andt2? Lic.X
o�u D„e a'q Liic. tar T/O SHAKES, RESHEET 7/16"OSB,
us'o ARCHITECT'S DECLARAT N ADD 50 YR. ELK COMP SHINGLES .
f's5 1 understand my plans shall be used as public rtrodtlx
rc p O Li<enud Professiovl
6�rOWNER-BUILDER DECLARATION
to 1 hereby ORw that 1 vin eaempt from the Contractor's License Law f«the
ti
following reason.(Schon)0313.Busi er and P,adcodov Code:Any city or county
F F O which requires a permit to conswct,alter,improve.demolish.or repair any structure
3$ prier to lu issuana.niso"ttinastha.,plicont rorsuch permit to film sigt�naement �- � ___.. ___._ ___ __ _ — ._— —
dfai he iglic,2%i ptimaam toUu provisions of the Contractor's License less ons,(Chapter 9 , ._t ,.a IS rFt>Floor ea' - ,.
(commmcin8with,Stttion 9000)of Division 3 O the Ruminants and Professions Code) l,( ,�' f h .5�q asst rt. ) '�.t-+ ' $95tICTallon
of Sm o ii ekemps tl@y appli bid the basis for the alle.pl o m to Any i pemon ^
'of Searmore 31'3 ve lumaxedi ontfaapermit sublaxa the vpplicam toaeril penal pppp��yy tj,,��
�ar«bdre than fivi nanerea emlah(uoo). ry' 3621130'L�U� :.'.;::T <u Occupancy Type
❑1,asowneroftheprogeny,amy employerswithxbees etheirsole F(SaFsalon. '
"will"doThgd'Pati:and the adunum rs n«in-tContractor,
i be cense Law doe sild(Sec:7044;"
'Burmeir Ind property
Wlions Cane:The Conutnor i License Lew does na apply to.. 305 - FRAME Required Inspections
ow nu of progeny Who builds or improves Herron,randopy who dues such work himself
i
such
.ordistantcond6h sispwn emplaycese Wilded ing
0utmpac i_ets mis sol are in imeMeQ«_
iottaed i.61e.H,however,du building e impmament is sola within ore year of "�-
completion,the owner-builderwill have tMburdcnofprovin8thethedid notbuild« 601 - ROOF TEAR OFF ' -
—r
improve for purposeofrale.). - 6.02 _- .. ROOF PLYWOOD NAIL
s _
7.
DLasowaft IM.o(We property.am exclusively conlraun 1M11ce Th«mtian Ct m
war gw' 603 - ROOF BATTENS
eoamsc Law does project(Sm.7toa moBusioe anderywhonseoe )The,attract«: 604 - ROOF ZN PROGRESS TL"� ``'
Have law dm not apply s an owner of property who bu Itls a impvva Ncrton. '
_.and-who cwracts.frc.such.projects with
a.conautars).liccved-pusvuw..to she.__. r
'. oncto/s Lc
vc Lew:
❑teep ander Si:` B$PC fa Nu_ , rea...
_..__. ___....__.. .....__._—__..___..
Omber.: i., r. „Dam
. . ,,. wn•
e_
WORKER'S COMPENSATION DECLARATION
-1 hereby aRw«Wc pevlry of perjury oti Of du following deslwdov:—
❑ 1 hiJe'aid will'mointam�'CcriiBceic of&i;a,'to self-insum for Workers
Compevasts :prodcd f by-Secuon 3780 of-she lab« Coele,'for-me
perrormmnce of the w«k for hch this pemul is ss d,,,.q
'!I have and 11"nu Woh C pe Inwreii«as req rM 6 arson e`p7
y ^ ormantt cation of the xxrk for Which this!at Ss
s T� OO2
a'CER, issurur<e conn d Pohcy storage
00 of the lab«Code fo the pert
ssoc M Woke( Co erector1
cnrler• �- fpalgn :�:A'S'-ov ryr6 .,;�y11Li*. + yl,•, f I r.� - .'_ .__.- � ,.:L1tr. "
I... EXEMPtION FRQM.WR1RIONIS _ ; , - T \ a•_eg ., r
v COMPENSATION _ _
rlThn sentou rad n«be completed d the pemut is f«one hundred dollars P r ••I-
cit:: I..ai N' if ••,•--^•�•~••y-
rS100)
1 emf than rfornbntt of th< 'rk'forxM<b tha r I __�----�—�-��--�—
'sh l .. R pewtsrxid,l :^f"�::f,� r d 1'%tlt\
Com I tion L any ppcc son,ni any mapnerldo s to become{ bJ n to l;I Workers,
Compcnsstion lives of C I f m Due'
..A"te.,t ..:. .,..e.t.a -. .. .__..
NOTICE TOAPPLICANT:ojsjr aftrrhpa Jng NisCenjficme ofEum,ty.ousbwld ....
becora'subjeet to are Woitets Cmpeitwtiod pvviiiav of the Libor Cale;you mum
QZ nM1 cA m siov or th s
Q fonh Ut eo ply p pew s shell bed N rtvok d. -
'r~q •? ° U (:CONSTRUCTION LENDMG AGe'CY r, .r' .a *,.v`.1'I ! u . .
W E! r� «" I hereby alfml th t there 'e con wet testa,g reg cY Tor the perf rata f .f �.
-_i of the ork'for hch dla permit is ssue0(Sec JQ9T Ci C)�c c^_�, -�
hJ" («nay to tlh ertad du ppl caro dram tha the abo f tion is
Qi"VU the ebo xFgnu t—e�prolpe (rtr my,sapmc(eouhon purppreouse>nthcsrtha aty toe mles_n
terup_0
�,y I IWq iprce io a e.l�emhdy khd kelp hawlca4l'h Cny of Cupemw eyunxt
h liabtl t a rydgsana:cow arW pc see hlch mey n my ey ucrpe egaivt wd
Utz, Chy m awuqucnce of the gmmmgpf NIs wu r.
A@M.1C,4�7l�Dc'RSTIaa'�$A\D f0\IPLYW 1ALL�O�P Lv rc �/
SGCRCE REcI�LATrO.st Ls� � Issued by: Date
ssgnaNrt of Appl caoUConleacm .t5 to Re-IOOfS
t t ii HAZARDOUS, RIMS DISC
s+i W11 she appbant«future WddCoampapt naeo nwle Health
Type of Roof
uQefined by the CupesumM runpal Code Chapter 913 raid the Hahh and Safety
Code Secavn45532(e r { •r. 1 ' r + : •�:1• 4 t 1 \'� ria t ...^ - "s!•
❑ver , 'lain, f'tr` R ___. All.roofs.shall.be ins ected nor,to.art roofing material.bein installed.
cwt h wdous rev conaminanu as defined b Ne BayActe ' ^ _
I rt J IV JI' :^.
.:. a WIIW a licuttorfumrcbulain ac muuequpine to a ices which If a roof is installed without fust obtalnmg an'inspectioti;3•agree to''reitiove
A Quality M [c m .
Diana _ __all new.matenals.for�nspecnon_ApplScant understands ani will comply
.thr OYti� all non-point source regulations:
v 1 Navel ad�Nm haesrels iruiic eIs niquinciilents'oiW Chpier 695 of Ne
Calf W Health&Safety Code Sections 25505 35537 and 25534.1 understa d th t ... ,. .. _
if th budding dory ncccuwntlY ha eemnanl doth smY.resPonsibtbty to nou(y she �' �- . _' qj”"'""�� __.........
r Occu .{ naaae o(a Cmrfi m of
acupant of the requ' emu x h ch m ss be ma poor to t
> .._ -- - --_ _. _. _.
Signature of App cant._ Date ..
owner All roof coverings to be Class;'B"or tietter '
,
__ _y_... . . ..... -..._ _ -......_._. _..._.. .. _..___._. _....__. _ .._. . . . .. -
OFFICE . . . ._.....
-.n r e'Y-- ' .. '.�6. _ .I-..�.. .. S :'Ta.:• I I'erD ?lL .00