01070040 (2) C�JY OF
BUILDING DmRONNO :PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
1048 TUSCANY PL WOODS ROOFING 01070040
'099 1ELT JOSEPH AND RINA 1020 HICKORY CT A07G? 11y2001
• PHONE:
(831) 637-5576 SANITARY NO. CONTROL No.
�
G c re ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
s — BLDG ELECT PLUMB MECH
Z 8 y" LICENSED CON'TRACTOR'S DECLARATION Job Description
O w E I hereby affirm that I am licensed under provi ions of Chapter (commencing REROOF.
F w,I-j with Section 70091 of Division 3 of the Business and Profcesions Cade,and my license
or sin murnnean j ex 1 / T/0 SHAKES, RESHEET 2/1611 OSB,
w�� Deep a�a/.) DD 40YR. PRES . COMP . SHINGLE.
L a O Date --1 D Y CoCommctor
ARCHITECT'S DECLARATION F'N A L E D
x-t 1 understand my plops hollHIT be used us pLA rtcords
pO Licensed Professional
ad,TOWNER-BUILDER DECLARATION JUL 2 '7 2001
vo I hereby affirm that 1 am m exempt frothe Contractor's License Law far the I
F Z< following reason.(Section 71131.5,Business and Prnfasinns Code:Any city or county
Y x O which requires a Permit to comtmm.alter•improve,demolish,or repair any swaum
r,3= ^pior tot awe.also9 th applicant for such sernufile,o fsigned statement - — -
hit he s licensedpirstrirs 16 Ilio,mr,mor,nftheCommeter',License Law cnapter9Sq. FC Floor 'DING . i $93�ration.
(core g with Sect 7006) fDisivon 3ofdve Businessoil Profession,Code) !}_'�_L f.:'. . 1 e xl: ..
or that he is exempt therefrom and the basis for the allegod aemp rob.Any violation -
of Section 7031.5 by any applicam fora Permit subjects the applicant m x civil penalty
of not more than five hundred dollars(5500). 3 5 999'MI81III)Q10 Occupancy Type
❑1•as owner of the property,or my employees with wages as their sale compensation, l
will do thevot and the stmcmre is rod intended or offered for sale(See 7044: 305 — FRAME Required Inspections
Business orad Profession Cade:The Cnr
mmem's License Law does not apply to an q p
of property Who builds or improves thereon,and who does such work himself 3 07 - INSULATION
oryr through his own employees,provided that such improvements arc not intended or _-
.afrerea for sale.If,however,the bonding ar improvement is sold within one year of - . _- 601 — ROOF TEAR OFF- .
ompletion,the tomer-milder will have the burden of proving that he did not build or '
OFF-
completion,
for purpose of sale). 602 - ROOF PLYWOOD NAIL
_. . ._. .. 603 _ ROOF 'BATTENS _2... ._ _ _.. ._. .. _
❑Las owner of the pnPeay,am Business a contmdng with da:) he Curacmm m -
c License
the project ISec.Z1.Yt,Business and dy who b Cale)The connerora 604 — ROOF IN—PROGRESS,
License few does not apply to an owner of peppy who builds ted paustea thereon.
_ Co who contmense L such projects with a conuanonsl licensN pursuant m the .. .. . .. _.. _ __. _.. .._ 1..._. ..... ._ _
Contractor's exe ptmacLaw.
p I em exempt under See! 1 1 '.B&P C for this reason -
_ Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby ufhrm under penalty of perjuiY,one ofthe following declarations:
_ ❑ 1 have and will maintain it Certiticale of Convent It,sell insure for Wmiscr's
Compensation• as provide) for by Section 3700 of the lebor Cale, for the
performance of the work for which this Permit is issued.
11 have and will maintain Worker'x Compensation Insurance,as required by Section
00 of the Labor Code:for the performance of the work for which this permit is
farri<r:!'Y WodeV Compnsdtion Insurance canierand Policynumberare:
-..W-.0 ..y.,..._�...........,.,. _ .... - -
_.Xrly—iRawyN.. -�s�or—�4tb �.). ,,i::.,is s... y . . -_ -. _ . -
s' 'CERTIFICATION OF EXEMPTION FROM N4RKERS'L, .l i:.1 L 1i 2Z 5'.i.-'s f ; . ' v: '
. '.' COMPENSATION INSURANCE''.. ..
(This section need nm he anopleted if the permit is for one hundred dollars
x3100)or less) . .
1 c n'fy'bar in the performance of the work for which thisper n i is issued.1
shall not employ any person to any manner so as to become subject to the Workam 1
Cona,matmo leve of Califomia.Date-
AppBador
NOTICETOAPPLICANT:If.a1¢r tanking this CeniOcate of Exemption.you shaulJ st -
Q 0 become subjca to the Workers Corafenimion provisions rime L aIver Code,yon most
forthwith comply with such provisions or this permit shall be deemed mocked. t
z -CONSTRUCTION LENDING AGENCY -
E"' I hereby affirm thin there's a mh.v0uetion lending agency for the per6lmmoae -
-� of the work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Namc
Lender's Address '
U O 1 send'y that I have read this application^rad xme it,.,the above infnnnatmn is
4s tr correct.1 agree to comply with all city and county ordinances and state laws mining
.. C to building consauction.and hereby authori2n represenmtl ves of this city to enter upon
the above-memicned proprty for inspainn purposes. -
E,,,,O. '(wc)agree to save,indemnify and keep harmless the City of Cupertino against
CQ liabilities,judgments.costs and expenses which may in any way accrue againit,said Vith
City in consequence of the gmmi this permit,APPLICANT UNDERSTAND ANO ILL CO. YWITH AI.L NO -P01 T ' Issned b Date
SOU
RCEREGULATIONS " - • . 7�//� y:
Signlm,cat'Applie.mUCommctor :. - _ Date, Re-roofs
HAZARDOL. MATERIALS DISCLOSURE
Will queapplinataftarebudJng P l sa6m arrhandlehalardousmmnm ...TypeofRoof ..
asdfned by the Chairman Municipal Cade Charter 912.and th Health and Safety ,t
Code.Section 25532(a),. .jF f f i.t!h l • - 1 .,' �. t , Is . . s.
" ' ' All roofs.shall,be inspected prior_to any roofing.material being installed. ..
W'dime...heartor future haimingoccnwint ioc equipment or device.which If a roof is installed without first obtaining anlinspection;I agree to remove
emit hazardous an conmminanes as defined by the Bay Arca Air Quality Management
Dimrinfr all new materials for inspection.,Applicant understands and will comply with
ore, ❑�r�. - - - 'all non-point source regulations.. .
I have read Ne Wm rdcun materials requirements under Chapter 6,95 of the; , n
Califomia Health k Safety Cale,Sections 25505.25533 and 25534.1 understandthat - a , /11t/101
if the building does not currently have ascnan6thnt it k ol,responsibility to notify the `
occupier or the requircm ents which must he met pricer it)issuance of a Certificate of 06
Occupancy.
�� CI -Signature of Appli ant_ ,. _ - ,. Date
Owner or anmariaen gem Da All roof coverings to be Class"B" or better
„..;
. , ... - _ _ . ... . _. .. . OFFICE