00070128 (2) CITY OF CUPERTINO*
1011-" TocKLNI� NIIT CONTRACTOR INFORMATION: 00070128
BUILDING ADDRESS: PIiItMI'INO.
GAR PEACH 07/21/2000
OWNIIR'S hfiME: - APPLICATION SUB DATE
PHONE: SANH'ARY No CONI ROI.NII.
O ARCHITECfsEN'GINEIiR: BUILDING PI;RMIT INFO
HI.DG ELECT i'LUMB MECH
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Ste= LICENSED CONTRACTOR'S DECLARATION RE—ROOF Job Description
ncrcnv n.Bnn Ih.e 1 um licensed under pnrvisinnx of Chlnpmr 9(cnmmmncing .
F=^J with Section700(bol'Divixinn)offe,ltu.incss ono PmleksionxCWc.and nsy fleet. _
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Poll riJ effect
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g I tndersmnd stir scents coot E>c cant wbhe memrdn
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e,—O G Licensed Pm1e,,innd
OWNER-FUILDGR DECLARATION
='m I heo:by NOnn that I anon const from the Connanm'n License Law for the
r%< following meson.(Section 7031.5.Business and Profession.Code:Any city fir county
O which remains a permit to.....ural,,alter..impmmature
denmlisM1,fir rtpar,any smat e 1307
z o prim,,it,issuance,aAn mature,the appliuout l'orstth peoniuo fill asignedsmretncnt
that he is licensed pursuant to the provisions Of the Contauctor'%Lialow,l_isev chapter 9 Sy. Ft. Floor Area Valuation
cnnttnmaingvi,th See,on 70001 of Division 3or the Husinass and Prof cions Code)
or that he is exempt Ihemfmm and the bads for the alleged exemption.Any vitiation
ofSection 7031.5 by any applicant for a Fiction Wbjects the applicant it)a civil penalty
of ral .,rc than live hundred dollars(950(1). APN Number, Occupancy Type
I]1.mownerol the IF pa,dy,n,my anq,lmyeas with wages as their sole compe...fion, C
will do the work,and the domain,is not intended or offered for sale(Sec.7(94,
Business and Proresshms Code:tine Contractor,License Law does not apply to of 307 — I NSESlgim"CiRpacclions
owner,,f Pmpeny Who builds o,improve,thereon,and who does such work Munsell
or through his own employees,provided that such improvements arc not intended or 601 — ROOF TEAR OFF
oncred for sale.It.however,the builalm,or Improventcnt is sold within ane yea,of
completion,the owner-miller will have the lwrdcn of pricing that he did not build or 602 — ROOF PLYWOOD NAIL
onnmvc to,purpose of sale).
❑I,as owner of m
y.amexclusivelycon;ructingisihmeervedcontractor. 603 — ROOF BATTENS
ft
,nsouct me project(see.7044.Hnemess Iced Prmfic—ons Code)*The Contractor s 604 — ROOF IN—PROGRESS
Licenw,Inw does not apply to an owner of"progeny who bunds or improve,thereon.
and who contracts fm such projects with a enntraatorls)licensed puouant u,the
Commctnr's Licca¢4,w.
❑1 ma exempt order Sec. .B&P C for this masa
Owner Dam Y
W'ORKER'S COMYENSAHON DECLARA'I ION /
I hereby affirm under penalty nflecury one of the following declaratian.e O '
❑ 1 have and will maintain a Cedifca c of Consent to sdr-insure I,,r Worker's V
nnavenation, as pmvfiled for by Section 3710 of the Labnr Code, for the
peft'onmanse'01'the work for which this plaoit is isweJ. -
❑I hove and will nminmin Worker,.Cnmponsation In.umnce,us mca red by Section
37X1 of the Labor Code.lin the performance of the work for which this permit i.
issued,My Work, CtI)pr:C4 p_Iryyi _c1ame�Tn P,011iSy�nummber
Cocom, N/Policy 7No.:_.SO/-a-6J_iJlO
CI'RI'IFICA9'ION OrIiXEMIMON FROM WO I: S'
COMPENSATION INSURANCE
I,his semen need nm be completed it Hat,perudt is Ice otic bandied dollars
(S 00)orless.)
I eemiry Ill.,in the Performance of the work for which this permit Is I...ed.I
sh:dl not ennploY any person in any manner m as to become subject to the Worker, '
Compensation Isw,tit Cmim,nln.Dot,
Applicant
N(yl'ICE'IO A1111LIGWT:If,after making this Cenif icnte of Exemption,you should
become subject m the Worker's Cmnpc isation prav,,am,of the Luton Code,you mast
Q O f..Ihwith comply with such pnww I,m This permit shall W deemed revoked.
Hy CONNFRUCI'ION LENDING AGENCY
a1 hewhy n01nn thm there is it constmcbnn tending agency Wythe rerfonnunce
W of the work for which this permit is i.sued(sea 34197,Co.C)
0. Q Lender's Name
= Z Ixodcr's Address
U O 1 certify that I base rent dui.application Iced ,all that the°holl infmmiatimn is
[.. comet.l agree to comply with all city and county ordinances and state laws relating
O (� mIt Win,consume and bemby aahnrim mpmscmmme,o(this airy to enter upon
IM1e ahovo-tnentioned pmparty for inspection putsuses.
p,t (",aI agree to syn,indemnify and keep harmless the City of Cupertino against
tZ) hannam""Ol mama,costs and uPerocs which nay in any way neem,ugainu said
C.I Z City in a 4r race til the statin,
APPLE.ANT D fPL THALLNON- A 1 Issued by: Date
SOI' •r LATIO S. Y
signat,, Of AppmaGlfco,toanm Dat Re-roofs
HAZARDOUS MATERIAE S DISCLOS URI:
Will the applicant or future Wilding occupant scare or handle hamrdou.comenal Type of Roof
e defined by(he Cupcninu MuniclFol Code,Chapter 9.12,and the Health and Salm,
Crile.Section 25532(u)7 No
All roots shall be inspected prior to any roofing material being installed.
Wi 11 the nppraam or future building oeeapant use examines'o,devices.hill, If a roof is installed without first obtaining an inspection. I agree to remove
mit hamrsoua at,co n tainant.:a defined by the Ito,Arca Air Qaal'ny Management
District? E3 No all new erials for inspection. Applicant understands and will comply with
0 yes all no -po' it source t reg a '.
I have read the hvardeas amerials mouiremmca under Chapter 6.95 of the
Culihnnia Hcohh&tit@Iy Code.Sccdnos 255115.25533 and 25534.1 eaderstnud that
iftha building does not currently have a tenant,that it is my responsibility to untidy the
rupmn til the re,niretnaox which nntvt be told prior,,msua ice of a Cenilicam til'
nm.p°"er- ' nature of Applicant Date
Cacti tunhodeed.gan, Date All roof coverings to be Class "B" or better
OFFICE