00070121 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUB.DINr,A1410452 SCENIC CL R E ROOFING PERMIT NO. 00070121
OWNER'SNA(DHIAPPINO LOUIS F AND ROSE L 108 OAKLAND PL APPLIovTO.V7/),20/2000
PHONE:
(408) 925-9995 SANITARY NO. CONTROL N(l.
O aIZ ARCHIE ECI1ENGINEFIL BUILDING I'IiRMn'INFO
u0o
.(lG IiLECT I'LUh1H MI[C11
_ I'_I IJ I_I
�yZ LICENSED CONTRACTOR'S DECLARA'I'ON Job Description
O%_C 1 herby a(Em,that 1 am licensed under provision,of Chapter 9(mmamencing
p yf_J
is 'i
7000)ol'Division 3 more Business and Pmfcsslom Caste.and my license RE—ROOF
n full force and effect.
Y pw U Liccme Class Li"at
F Daae Contnmetr
LL LL O V, ARCIII'1'ECT'S DECLARAHON
a,.i
5 I undersand n,y In,Quill be.,it as public record. -
E o C Licensed Professional
a. OWNER-BUILDER DECLARATION
vl M I haehy affirm that 1 i I exempt Irvin the Comrnetnr'.c Licence Law list the
following I<usnn.(Sarno..70.11.5.Pusincw I I Pmfussin I,Cod,Any city or comity
F O which rnlwre,n permit Int......fall alter,improve,dre kh,nr repair any snowl-c
ac prions its i.sauence.abo equircahc applicant hor.weh pernoiuo rile a signed satatncnt
tent he is licensed pursaantb,the farm.l,inmmme Contractors License Ease(chapter 9 Sy. Ft. Floor Area Valpgigti0
(commencing with Section 70(0)of Division 3 of the Business and Pnfumimn,Code)
of that he is exempt the cloon and the basis for the alleged exemption.Any vinlmion
of Section 7031.5 by any applicant for it permit subjects Iba applicant to if civil penalty
"I tam note than Bue hal,drd dollars a500I. APP §?&1 j 10. 00 Occupancy Type
03.a.owner ofine pro,ity.Lir my mnployms wird wages as mcb,ole compen,tnion.
will do the work,and the uncture is not intended or ordered for sale(Sec.7w4.
Business and Professions Code:The Contractor's license Law diva nor apply to an 305 — FRAVIeuired Inspections
mr nI property Who builds Lir improves thl and ahs does such wmrk himself
through his own mnph,yncs.provided than such impnvmaems are not imeaded or 307 — INSULATION
,,fiend or sI II.it:Bowe,.,,ten building or hnpr...cmetn i,s,Id within one year A _
condi Bre owns-bhldcr will base the harden of proving mat he dill rte build o 601 — ROOF TEAR OFF-
mproveforpmrmsese e.` 602 — ROOF PLYWOOD NAIL
❑1,as owner of the propertycontractors,am exclusively contracting with licensed coctors to
construct 7011.Business and ProMTh
Professions Ce:I e Cobrractors 603 — ROOF BATTENS
:Lm<t the inject(See
Law doses ten apply II,an owner ofpmpcny who hands art improves meson.
and who maacts for such protect,with aI codmcmr(s) licca..ed pars,,",to me 604 — ROOF IN—PROGR SS
Contractor's License I.uw.
❑1 am exempt under Sce. .B A 1'C for dons reason
Dimer Date 7
WORKIiR'SC ])arSAI'ION DECLARAt'IUN /
I fil afnmr,tele,peachy"IsaLry..u,0thefnnowi,gdedanalmaa 3i
I have and.,It maintain a Cedificme of Conant m self-insure for Worker's /7
Compensmiom, as pnvided for by Section 37M of the I.abm CMe, for the
performance of the work tis which this permit is issued.
O I houc and will tnaimaiu Workers COlomensa0on Immunes,tm mtlaired by Smdsn
3700 nr the Labor Code,ter the peroinama of the work on which his Friend is
issued,My Worker,Compensation I"mmnec carrier and Policy number are:
Carrier. Policy No,
CERTIFICATION OF E%CMPI WN FROM WOR KERS'
COMPENSATION INSURANCE
(I his section need Bol he crmplainl if the lemon ii for ane hundred dollmn
IS I(ill or Ins.)
1 cannily that in the performance of rhe .,it for which this permit is moat.I
,hall not employ,any person in any member so as to become.subject to the Workers
Compensation Laws of Calitistar.Dore
Apphaatn
bill CH JOAPPLICANT':II',fuermaking,his Cerookaeof Exmnptmn,you should
become sabjeel 10 the Workers Compem:niou,nwid ms or lie Labor Cade,you nm.a
QO fnnhwith comply..Ill such provisions or this permit,hall he deaned rooked
FCONSTRUCT[ON LENDING AGENCY
a ' l herchy affirm that them neo constmetion lending agency for the petl'snnanm
fsl of Ibe work forwhich this Permit is ls„ncd Nice.3097,Co.C.)
QL,dc,'u Name _
7 z Lenders Address
U Q l senify thm l base rend this application and sae rha d,above informaion is
Gso [r tercet.I agree to comply xi,h all city and county ordirmnaes nM,are laws telling
O U ..,halt.......nam.dnn,trod herebyamhoo,.a representatives of mi,city to enter upon
me ahuuc.ntaanioacd popsy r r inspcctiot p,rpoyes.
[ra 0. (WO agree m save.Indemnify and keep huraless the City of Coleman against „
V] liahiliries.judgments,em...and npenxs which may in any way uccme agmina said
V L City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued lJ Date
SOURCE REGULATIONS. y'
Matron'it Appllcm✓Cmemcros Daa Re-roofs
HAZARDOUS MAI FR A19 DISCLOSURE '
Will rhe applicant or future lvilmag occupant store of handle harsnlnu.nutermi Type of Roof
as defined by the Cupertino Municipal Corfu.Chapter 9.12,and the Health and Safety
CMe, cY,o 25532(.)!
OON.
All roofs shall be inspected prior to any rooting material being installed.
Wnlfine appli,nalorlimurelanild'ngnecfpanlawls,t au,nlordevicawldd, If a roof is installed without first obtaining an inspection, I agree to remove
Ii a hzmrd,.,air snot n:nun as ddimed by the Bay Arco A it Quality Manages,
P,cdert =natu
inspection. Applicant understands and will comply with
❑Yca ❑No r
1 have read the heaardous materials requirements Imder Cb,prer hI of the
Cnllfi,rnia HuaIIM1 de Se@ay Crxlc,Seellons 255115.25511"nd 2.5530.l Lindero.al that es O (�
inhf nllimnrg ales m,I.orrcmly l,auaatcmua.dant i.Iny lc p"naUtility,'I Batt dv 11 1 -L
Ocopem of die rc,.irc,acnt,which moa he Ian prior to 6wfna,r a CenBbtme is
scupon, nt Date
Owner or..ill tied agent Dam All roof coverings to be Class `Bs' or better