01060031 (2) TY OF
CI
BUILDING DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10621 N PORTAL AV ANTHONY ROOF SERVICE 01060031
OWNER'S NAME: APPLICATION SUR DATE
HAMPTON GORDON P AND MARGARET' 1655 FORMAN AVE 06/06/2001
•PHONE: SANITARY NO. CONTROL NO
408) 265-5147
G m Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.00 L ELECT PLUMB MECH
i_—I II
N a'a
5 r i LICENSED CONTRACTOR'S DECLARATION3Job Descript ❑
I hereby a0ithat I pr
ax under pvisions of Chapter 9 IcorTen erne
Iy_° wiTh Section 10001 of of Divisiun of the Business aW Profrosi°ns Cale, my license
ucl fora and If / //
o W u Iwco a"til,6 sec.n ((/ REROOF.
DECLARATION REMOVE EXISTING SHAKES
3 LL Ao. hall be u e DECLARATION z 6 Y'
E: 1 undecaund m Tans shall be used blic records
� yp "'p" INSTALL 1/2 " CDX PLYWOOD
-21,
�o Licensed Pmfewiooal J
%o i OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contmnor's License Low for me
t?a following reason.(Section 7031.5.Business and Professions Code:Any city or county
Y v Q which rrquitea a Permit to construct.alar,improve,demolish,or repair any structure
of
63g .Per«toimismarce.alx°requirtnthe opplicum for xtseh gatrnitmfile.xigrcOruemem_ _ .. _ ___ __ _ ___.__._ __ __ ______
thane is licensed pdnuanlm the provisions of the Contractors License low tChapmt ....> Sq-Ft. Floor Area;�� .�• 1, -, . Valuation
(comrmneingwim SeniQn7000)cf Division 3 ofthe Businessand Professions Cede) e- k - .�•ka- 2t •r•. . .. .,�,a . . .
or that he is exempt thert.fnim bnd the basis for the allegel csemption.Any violation
f Section 7031:5 by any applicant for a permit objects the TPlicano to a civil penalty
:-.ofnrmocomedian For bectleddollars ash). APN Number it"" '.t$kgvvcyType
❑I,as owner of the progeny.IT my employee with wages ns their sole compcnsmion,j
will do'the'work:and the structure is not intended or offered for safe(see:7044: Required Inspections'.
B mue:test and ProfProfc..tons CoThe Contractor's License Law does n«apply n)an 31632056 . 00 9 '
owner of progeny Who builds or improves thereon,and who ams such work himself' .
or mml for his y ver em evil.the br idcd that sucmpr vementemcna art not intendedyear of
o(feied for ale.If,however,me buildih em is sold within one of � '- —...__...—. .I i 1
completion,the owner Wilder w0lhave heburde of that he did notWiilddor. 305 - FRAME '•r,.n c
improve Im"T f sale.l. proving ••
°°s°° 307 INSULATION. .. _.
Otras°wnef dine p(Sm.7 arae usineselycomraningw Cadie)sedeomranotsm' 601 — ROOF TEAR OFF
terror me project(Sat.7(Y1J,owner o and Professions CadoO The Commeto n, . ,'T it r. -
r. c License Law docs not apply man owner nrpmpcny who builds e improves mvex thereon,
and who eommeev.rnr safer projen,.wnna ennean°naTRan.ea Pamnarrt.m.me' . ....._ .._ _ 602.-.- .ROOF PLYWOOD._.NAIL
_.
.. t '8 . I
Comtrmc
01....e:.LieendeLSec 603 — ROOF BATTENS'-•d':.
- ❑lam exempt under Sec, t � B.4tYC for the reason' � { �'��'I•
f. covom Dater • '- 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pemly°f perjury,not,of the following declarations:
(•
01 hale and will maintain o Ccnificate of Conwnt•ur self-insum,for Worker's
F� Compensation. as provided for by Section 3700 of the labor Code, for the-
- performance of,hc work for which his permit is issued.
01 have and will maintain Worker's Coork cation hm umnee,as required by Section
37N)of the Labcr Code.for the peffornomm of the work for which this punt is
EE
Is ca MY Workce C T t psumncd cam d Pol ey number rc _ _
Cm Pinny Nu: 7.�
d CERTIFICATIONOP EXEMPTION FROM WORKERS,
This section had not be completed if the rmit is for on
COMPENSATION INSURANCE";,,: ... . ,._ -----......
P Re hundred dollars
` lcmifylhaiin the performance ofthe:orkfrrvshirh mi,,c;nitii issucA.l- _ _..— _, -• ,� ._.. __ . . )I•U. ,v �•sr'?i+yr1^
shall not employ any petioli in any manner so is to become subject tD the Workers
Compcnsauon lows of Calirnmia.Dam
.._Applicant .."'.: ....-. .. _... .._. ..__. _. . . . _ . . .....__ f .. _.
NOTICETOAPPLICANI'.117 after making this"mu, me of ExcmpTion,you Rhould', "''
hec ..... k" C penatt 'p sof th L b iced.you man'
C) Tomb tl ply nth h p, ns or th p 't.M1all
F t ' CONSTRUCTION LENDING AGENCY t .
:a > 1 hereby aRrm that There is o comstmetion lending agency for the pckommoce T "
ti of the work for which this permit is ism ed(Sec:Jo97.Civ.C.) - _ .__ -
L Lender's Namess"
=:Z Lender's Address
.U0
'coned.1,I ccnify that I have teed this application and stem Nm me above information is
agme to campy'with all city and county ordinances and state laws relating
:O.0 t°building construction,and hereby outhorizerepreienmtives ofthis city minter upon
the above-mentioned property for edion purposes.
W (We)dean msa:e.i A y and keep barmle.the City of Cupertino against
VO .hili'mv,adgmmts,c pcnses which may in any way accrue ngainst said
V.z Clly in cense � � ming of thL permit.,"1 -
AP ICA " S'ANITWILLCOMPLYWITHALL 0 PC) IssD ed b Date
.. sf 12 Y'
i t o Contractor. +' '/' J' Dam Re-roofs
m, 511.Thea licanter fummbuild) occupantstag«hmallahazvdoustmterial _. yp
HAZARDOUS MATERIALS DISCLOSURE
pp tg ' -.Type of.Roof_. _ _ ... ..
C E'Sedny the 32faf Mumapal Cod Chepte 912,a d to Hcahh and Seky .n: 'k e: ., x L. �J_ _ ','• ,�,: ,:.
CME'Section
Yei 255721 1 r. T ON..
_ 1 t 5 -:•' .. --All roofs shall-be inspected prior to any roofing material being installed.
Will the app)c t future building' occupant eq p t desire. hich If a roof is installed-Without first obtaining an inspection;I agree to.remove
raft ba rd cont t..,defiredby the Buy Area A Quality Managet
�•
District? all new materials for ' s icon. Applicant understands and will comply with
t oY El" all non-poi e iflons.
k-� 1 ban read the h W materials g t s under Chapter ti 95 of the
California Health'E Safcty CSda.Sections 25505 25533 and 255341 understand that
.dtheb tldi gdms-no t oaf t th titi,psYmppmombilityinnodifyflic
me soft ah ch must be t poor to issuarTm.f.5inifirsk.or
irg-n of plicant . Dad
. .
All roof coverings to be Class "B" or better
_
;. ,�,. .,_� '. ,. '. ._. �..:.-. - - OFFICE -- ... ..