00110077 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
nmLDING117PSN44 RAMPART AV CORNERSTONE ROOFING PERMIT FROO 1 10077
OWNEWSTh!"SHLER 1605 MONTELLANO C'1' APFLICArafIfUh J1g12000
PHONE; 4089979788 SANITARY NO. CONTROL NO.
C se 0 ARCHII'LCTIENGINHHR: BUILDING PERMIT INFO
U_ I- , BLEC'IPLUMB MHCH
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IF-��y- LICENSLDCf IN'IRAQIY)RIS DECLARATION JOb DEScr tion
O m G 1 LcmM1y action that i all,lwenscd under no'ki iu uI Chupmr 9(cmmn""ing
F°__M .in Section rllwlaDekion3q.1the Bu.ins,.andprofession,Code.and in,Bccilw REMOVE EXISTING NSTALL 1/2" PLY
m i ism full and effect.-3 ! / 9 2�/-.
a0 c� Li cbwx __!— Fact,b O
d m1_ff_YNv�> Cnnuucmr_Cep QNmGE-�QIC—
FARCIIITECriS ECLARAHON ^„.
I understand my Plans shall M1e used ax public mcnN '. ..? V
nep O Liconacd Prul'e,,ionll
.f OWNER-BUILDER DECLARA'HON
u] m I hereby affirm,hal 1 am exanpl from the Connac,orz Lieenm Law for the
F Y fallowing auxon.(Section 7011.5.Business and P,ofe,siam CWc Any city or county
E xC❑ which ry lmres a Permit to consumer.ulcer,improve.demolish.Or repair any structure
i3� pnm
orits'dsmnncc nh..rcyuier,the applici ilir,uchpaffil, ,l if,usigmalsanenem
that he is licen,ed parsaaal la the pm.l,un,oldie comm.tart Licen,e law tchapler 9 Sq. Ft. Floor Area V.S,Itu �j/j
(commencing with section 700 )of Division 3 of the Business and Professions Code)
or that he is exempt mamfmm and the basis for the alleged exemption.Any violation
Of Satio.17031 5 by,my applic:n i Fall Wrinut suhjc.k the appl'amu to a civil I*nulty �f I,D,�,
moat ream hall five hundred dolln,a($541d. A `d"SYgfbF 00 Occupancy Type
01,av..net of the cr xmy,o,my employee,with rages as Nair hole compensation,
will do the work,unit the slmcluru is not intended Or oferest Ibr sole see.90,14. I�
Rna ,loan`oa,,.i.Il,Cade:'rheCoalrao...*,Li..m,eLaw dOcaall apply
toa. 305 — FRA&quiredInspec:tions
r of proitut Who build,nr impe vcs therein.and who docs such work on,sal(
Owner
tnmugh his own employees.provided that such improvemctns am not intended or 307 — INSULATION
offered for sale.If,however,the building or in.provemem is sold within one year of
<o..NeNn.,tnaownei„hies,will hmtdicondenOfpravir,full hedmmnbuild 601 — ROOF TEAR OFF
m,prore purp.,co
111.avower of he properly.cit,eWlumwely eantraeti..g with Vermeil mmearm m 602 — ROOF PLYWOOD NAIL
Lrv,tm<t the prefect(See.71N4.Beane„tend Prrce sionx CeIeD rhe Continetor, 603 — ROOF BATTENS
icence law Anes nn,apply to an 111.11 of Pt Openy who builds,,,unp...c,the..
and who contmctv tin such pmjev with a carlmeng,)Lcensc,l pursue 604 — ROOF TN—PROGRESS
Carpl
maem's Liaise Lux'.
0Illa"Wa. amler See. .BkI'C for thNALED
w°" ENS T 0 8 2001
WURKIiR'$CO111'LNSAI'ION DECLARATION
1 humhy aftur,end"Punchy of perfury orc of the following declumton,'.
0 1 have and will mdntain a Certificate of Conserv to self-Insure for Work ILDING
Compensation. as provided for by Sation 3700 of the Labor code. for
peror aocc of the work for which this pmant is Issued.
Cp have and will mainmin Wodcr x Compenmtion Ir%umncu,as required by Section
.hip of flue Latae Cale,for the perfam.:nne Of the work for which this permit is
hued.My N�b�rk�er',Coounfen,-at-i1na la-mar a cumerland/Pula,nbmnts,are:
Cartier:=+w4--e—I _✓�{—Policy No.: (��160`�T�a
C1291'IFICATION OF EXEMPT[ON FROM WORKERS'
COMPENSATION INSURANCL
1'I'hi,wction used sol be.00tplumd If Ne Ix,,ail is for ons hundred dollar
($10(bor less,) -
I certify that in the performance of the work for which this permit is mavel.I
shall not employ nny lemon in any n.mner,a tax ,,be...mc able,,to the Wurkcrr:
Compcnauion Law,o1'Caluouniu.Dave
Applicant
NOTICE DO APPLICANT:If. he,making this Cenifiate of exemption,you should
Inc vanmeuhjc.lm the Worker's C'om,1011l ..provision,Of the Lubar Cods,you ma,, -
Q0 foodoin,eanfly thi.pemil,h,m he deumedsvolwd
FZI CONSTRUCTION LENDING AGENCY
a I hereby af.rid that them is a construction lending agency for the fxdonnance
III the walk hes wind Ihi1 pcaOR is i,su1J(Sm.3097,Ci,C.)
L Q lender's Name
5 7 Lender',Address
U C I eerily that 1 neve mad eta nnrrcutino ores Mme her me ahold information Is
fa. `: a,Etta.I agree Io.....ply with ,If city ami county nrdnnmcus and acme Ill.,relating .
O V nibailding construction.and hereby andante uprewmativex of this city to ener.,an
fine biloc-incenonedpmpe.,fill inspectionlarfalov.
1014,
(We)agree Ion J Hy dA pct Issthecr fColeman,aginst
liabllies ad"nens. I 1 sop 1 h roily in nny way... g'In,1 aid _
V zCit ,. y 'e Id br ni g Of(his Permit
NT UNOERSTANUS AN 'ILL COMI YWITH AhL NON POINT issued by: Date
O( . AnO L A���/^fib
-,rgnamre..fnpphea�i Commctnt Dale Re-roofs
-IIALARDDDS IATIiRIA1S DISCLOSURIi
W.Rbe applicant,.fm,e lvildingos'cupch. mm or handle haz,N,ws material Type ofof
f ,Ix ddined by the Culeninn Municipal GNc.Chapter 9.12,and the Heaph and Safety
Cndc. en 2553200^
❑YnCl NO
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant or lmml building Occupant use etfuipinent or devices w high If a roof is installed without first obtaining an inspection. I agree to remove
nr.hamnlo,,ter.n.at the x a,dclinnl by the Buy Are,Air Quality Mun.gcmcnl
Uisaie7 all new materials for inspection. Applicant understands and will comply with
�Y1. .o"° all non-point source regulations.
hove ralA the hunaduus mmeiul.m 5,2553nn under 4 1 mr 495 d the
I Cu'tmdu Health MSufcty CnJe,Sccti11ns 455115,25533 nnJ 2553J.1 unJcrxumJ thnt
e building J,x,nm curtently nide a¢nunt.that it ix my reapmsibilhy ren^tilt the
ac I of the feynimmem,whichQmt M re�n prior m issuance of a Clnifcam of
igna[ure of Applicant Date
Owner or auhhomN agent Dmf All roof coverings to be Class"B" or better
OFFICE