01060133 (2) - CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: LJ PERMIT NO.
10347 TULA EA EXTERIOR SOLUTIONS 01060133
OWNER'S NAME: APPLICATION SUB DATE
JOE WING G AND KIT F 1771 SMITH AVE 06/22/2001
PHONE: SANITARY NO, CONTROL NO.
(408) 358-1233
G i7 a ARCHITECT/ENGINEER: BUILDING PERMIT INFO
,y- LDG ELECT PLUMB MECH
a i u L_.I 1=1
Ga
Z t w E- LICENSED CONTRACTOR'S DECLARATION Job Description
O Z- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
rr ml_w with Section 7000)of Division 3of l he Business and PmPossinnx Code,and my license SHAKE TO TILE .
a s in ran Tones and street. ,6357
Licese Class .3 motor
INSTALLAOSB 7/WOOD
16, SHAKE.0 LB. FELT,
O p. me S G CLAr ✓r�.
u3.p. ARCHITECT'S DECLARA ON �(_U�jam'
t
or 1 undersand my plain shall he used as public records =„se
u'i R p ee Licensed Professional
c o OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Conavctor's License Law for the
t z r following reason.(Section 7031,5.Business and Professions Code:Any city or county
E cc 0 which tritium,v permit to construe,altar,improve,demolish,or repair any sauearc
cecat- that he i¢tUuance,also the Iiemn for suds t to Glc a signed statement - --- - --
3 priors re9atrrs pp Perini
j fiim'ed PorsnaW 3a the Provisions of7be contractors license Law(Chapter 9 S .Ft. Floor-Alta: ,, f' 148)J`f�uation
(commcncing with Sectiunjol)Ol of Nvision 3 of the Business aid Professions Code r '3-)4 sq, - . . .
I - ! { . .-. li .. _ fa. _i�� l� '
or that he 7 exempt therefrom and the basis for the subjects
the ckempt to Any violation -
-of Section7031.5vanyapplicantfor a permit the applicantroacivil Penalty
.of not marc man eve Wnarca aanams(ssooY 3 5 ggFA��m�b t�� •• Occupancy Type
❑Lasa,mawar the propmy,or my employees with wages as Ila,, ole compensation. I
will do the work!and the saucture'is not intended or offered for sale(Sec.]BU,
Business and Professions Cade:The Conuaemr's License Law docs not apply to an 305 - FRAME Required Inspections
owner of property Who Wilds or improves thereon,and who does such work himself 307 - INSULATION _
or through his own employees provided 1M1at such improvements sol are not sanded or
.Broad for rte owner
builethe ll haven-"improvementis sold within no - f -- - - - - -- - -� -
'�ompmron.thcowncrbuildcrwillhavethebureofDrovingthathedidnotbuild°r 601 - ROOF TEAR OFF � •.' 1e%� ' ^"
improvefarpurpaaofrale.)- 602 - ROOF PLYWOOD NAIL
-CF - .. ... . -— - -- - --- —-- --- -- -
❑I,nxownerorib--prainyamextlusiveycommucting with licensed contraeors to - 603 — ROOF BATTENS -' - - '.Ice:ri yr �' ,.-,--- -
eon:wan the full(Sec.7344,Business and Pink,.Sa...Col The Cmu a mm's6 0 4 — ROOF IN—PROGRESS '
p'i 1,
License Uw dsxs not apply loan awnerof property who Wilds or improves thereon.
- _.wd who.contmcu.forsach.projttu wim.a contructoms)licensed Parsuant.m.me
Contractor's License law.
❑Iam,exemptunder Sea t..'. - t .B'&P C for this reason I t 7 /� —_----
OwsatI flat,
WORKERS COMPENSATION DECLARATION
�" Ih by man ond< p Ity fp jry tthe Toll gd cl..,an,:
❑ 1 have'.ad-will mammin a'Cenifit of Cnnsehi io self-insure for Worker's
�.1a,--J Compensation, as provided far by Scation 3700 of the Labor Code. for the
performance of the work for which this permit is island.,
❑1 have and will maintain Workers Ccoiturradom Insurdial as required by.Section
3700 of the tabor Cade.for the performance of the work for which this permit is
issued.M1fy WsyarQk,d�s Compewtion Insurance sorrier alb Policy number art:
Cariiccr NaQOTfGT/Aa):, Policy No.: •- _ - ..,. - ;-
.CBRTIPICATION Op EKEMPTION FROM 0 KERS,;— _ r J x'a . J. ',3(
COMPENSATONINSURANCE -; -
,. ,
n' a t't(T to action riecd Tia hcnmpleud if the permit is for one hundred dollars '
IS 100 a:1eu,1 t
.A 1 certify maim the n in bynce of the ,u fo h,eh th u i' Sued'
shall not anion L ws;f all n any ma as io beiv+me subject to the lVorkcn
norm s
Compensation un Laws nfC if ':Dgrc
'Applicant ' 9 .: ,.,. . . . .. ... _. .. ..._.
NOTICE TO APPLICANT If.after making this Certificate of Exemption,you should
become subject to the Worker i Compensation provisions of the Labor Cade.you must
O 0 foulwith comply with such provisions or this permit shall be deemed revoked.
"h Ip' V"CONSTRUCTION LENDINGAGENCY ' I
C-> 1 hereby affirin that them is a cnswe on lending agency for the performance 'I^
�. of the work(or whmh th s permu w nzsued,ISec'309] Crv.C 3 -
-Leader's Name—. __• '-t:u.-+ .-+ ..r._. .. _ ...- _ . . _ . . .. ..
. a,Z Tinder's Ad dress
U 0 I certify that 1 have read this application and sure that the above information is
correct.I agree to comply with all city and county,ordinances and state Ian%mining
'] V to building construction,and larnal inubmize representatives of this city to enter upon
'-W the above.motioned propany for,inspection purposes.
'(N'garcctu save!�indemnify ATN cep hat less the City of Cupertino against
-N lials h, s. add u,costs and ex m any way accmc againnaid
V-z City in ass q ace dftheg' tin of
A�u.I NT NOERSTA� f < 11, '1'HALLNO'MIN' Is$Dedby: Dale
/ as
: ..
Sh,110741A,licamUCamumurr .`. . ' pate Re-roofs
IS. , `„ .-. HAZARDOUS'h1ATERIAI.,S DISCLOSURE54
t
/ Wu m Pplie, t r t bowing pat,a ar h d1 howl s nntenal Type of Roof _ _...._ . - ..._. ......
.
X
fined hyth CupertinoMncp ode Chapter9.12.and th Berlin and Safety
- ,-
Code 'eco n 2555( 911+ - - - + a• ' 1 ' ;
, - ' , r '- All roofs shall,be inspected prior-to.any-roofing material being installed..,-, _
it W'll ih applicant future bt bribing o coupon, '
t necq p t d a. in
, ch if a root'is instidl'ed without first obtaining an inspection', I aoree?to`remove
our has d contammarta do tied by the Bay Area A Quality Management
Di t.. - J,. all new I `eriae�gact!
for
licant understands,and_will_comply with
Ed Yet - j„ ,. '.. , all no o fit so1 hove rcaJ•mc'hazartlnus materials reyuiremcros uder Chapter fi.9io(theCaliforniaHe &Safety Code.S'climax 25505.35533 and 25534.1 undernmd thini(Ne build'gJ es not currently h' <a a .t iti my mponsibility to notify the. p[CN
occepan i tl re bourn.
I to t ows.of a Csin .to d
( Occup c
ranlWdrca age _S nature of Applicant . ._ _ Dale -
_ �,. . All roof coverings to be Class "B" or better
a; OFFICE