01060032 (2) CITY OF CUPERTINO
'BUILDING utvtstONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
20254/20256 VISTA CT COSMOS ROOFING 01060032
OWNER'S NAME: APPLICATION SUB DATE
LEW CLEMENT G AND REBECCA Y 450 SAN ANTONIO RD 06/06/2 001
6 06 2001
PHONE: SANITARY NO, CONTROL NO.
t
415 493-6373
q-zo ARCHITEC(ENGINEER: BUILDING PERMIT INFO
kL"0 BLDG ELECT PLUMB MECH
u
jai — u
FF�i LICENSED CONTRACTOR'S DECLARATION Job Descri tl n
QZ ld G 1 hereby aRrm that[am licensed under provisions of Chapter 9leommencing p
�mF�ml-w wish Section Division 3af,he Birsinexsmtd Professions Code,and license
is in Tull force anile m. y
rere< L` n u=.a f REROOF. JUN ] 8 ZOO
KDaO Dae
m ic u.y Gantramnr II
ARCHITECT'S DECLARATIO T/O SHAKES—RESHEET 7/16 OSB
I understand lshall rtd blid
anmy pans sae useas puc records sya0 dADD 30 YRS ELK COMP sxlNcASULDING
a'S se 0 Licensed professional
R4_ OWNER-BUILDER DECLARATION
u�"
1 hereby a(Srn tnut 1 on5,B sin from tits Contrucmr'a Limnse Law for the
!' following reumn.(Section"10315,Boniness unJ I-rofc—ra,Crile:Any ci,y or caunly
Ex o which requires a permit to consumer.alter,improve,demolish,or repair any anti ore
so e, poormits issuance,also acquires the appikortf h permit to file xvgnedstaemem -- — ----- -------
is c neap rsuantto[heprovso nth Contractors;LicenseLawlchapter9 Sq. Ft. Floor'Area.-- }^ Valuation
rammer ng isth Semon 7")m Dv J (the Business and prrm"i ns CWe) ` s'•t : ;•a:'.♦. 1•. : .` sJ ,- ti n i 1.',I�1; '
loan sic
( 's exempt therefrom and the basis for the alligcd exemption.Any violation
of Section 7031.5 by any applicant for o permit subjects the applicant to a civil penalty'
of not mom than five humped dollars(S500). AM Number $12Wgfpncy Type
01,as owner of the property,or my employees with wages as their sole compensation,
still'do"the work and the structure I,not immnded or offered for sale(Sc,.7(144;' Required Inspections,
'Business and Profession,Code The Contractor s License law does not apply to an 31625029 . 00 9 p
owner of property Who builds or improves thercon,and who does such work himself
or ithrough his awn employees.provided the such improvements arc ern intended or
fffced
�dcd for stJc.Jf,however, he huilding or ni,prnvcmein is sold within ime ymr'af - -�----- - -`" -'- "--' "--'—._.. . .. .......... . ._ .. f -
iompletion,the owner-Wilder will have the burden of proving that he did not build or 305 - FRAME 1
mprove for purpose mf.ale.).
. ...._..—" — — _3.07_ '--INSULATION.—
01,as owner of the property,am exclusively contracting with licensed contractors to
instruct the project(sec.9044,Business and Professions Code:)The Contractor's 601 — ROOF TEAR OFF
License law docs not apply to an owner of a structu who honkie or seimproves thereon.
_and.whoeomraets for.such. widtacommcmrtsl licensedpursuant da the, ___. ......_..6.02 -...ROOF-.PLYWOOD. NAIL
Contractor's License Law.
_ ❑Iam=xe,nptnnnerSea! B'&eChar this mown 603 — ROOF BATTENS:: .ti;�:' r'�
bw,ar Date 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION_
1 hereby affirm under penalty of perjury Linc of the following declarations:
0 1 have and will mainuir a Certificate of Consent to self-insure for Wartrr's
` - Compensation. as,pmvlaed far by Section 3700 of the Lather Code. far 'he
perforans of the work for which this .it is issued.
�xrp 1 have and will ma main Warkcr',Ciar,....ioo Insurance,as required by Section
of rhe Labor Cole,for the performance or.
f the work for which this permit is '
is J.My Work is Coinpemanon Imsr a er and Polay sooner am:
artier
w ' PmTyN57/—O� '�%Z� f-•��\.;.rl _. ; .. . .
CERTIFI. TION OF E%EMPf10N { •• 5 t l
COMPENSATION INSURANCE ___ _ __.__-._._._..__—_—__...—. _ ...
't`flTie senior need not be ampleted if the permit is for one hundred dollars "' - ""'-` •`
($100)or less.) _
amp) that in the performancenn the work for which this,petit c orker I -_ ., _ s I,,
shall not employ any person a any manner so m to become subject m the Workers
Comicant- maws of Culi(orn'us Date'
NOTICE TO APPLICANT:If.a making .: - .... ._ ..-.. .. .. . .. .... . . .. ... -. __.. .-
foci making this C visions at of Exemption,you should -
becomcsubjectto yohe such
Compensation provisions at the Labor Cade.you must
0 0 forthwith comply witM1 men prm'iaimts or permit shall the dnmeJ revoked. `
F7 ' CONSTRUCTION LENDING AGENCY
E:
> 1 he rcby-affirm thath construction,' lending agency f the performance
� .., of the ark larviorin tM1 pe t issued IS 709] Civ.C 1
(sneers Naar . . _. ..
o'z
I,ari Address A.
V . 1 certify thus 1 have mad this application and some that the above information is
ri.F correct.1 agree to comply with all city and county ordinances and state law's relating
C V w hrildingconstmalion,and hereby authorize mpresenmtiv6 of this city menmrupan
�•s 64 the aMrvomenunned property for inspection pnrpnsos. _
�+.46 IWclegme,nvve.'mdenmify and keep lmborrvi he City of Cupertino..Trost
Vi liabilities,pid,nome.costs and expanses which may or any way acme.,am,,said _
. U"L
City mcmnsegmen«arthegmmingm�m emtit. s�
A PPIACANT UNDEBSTAND \�' It .COMPL' VITHALL NONP1187 Issued by: _JO� / /ll�J� L Date
SOURCE REGULATIONS. `/e /u Y'
'signature of ApphcaMCoaracm, ;, Dae Re-roofs '
tL\ZARDOUS tATERIALS DISCLOSURE
wII he applicant or(rand halrfng accupaot sore or handle hazardous material Type of-Roof
as definedby the Chpertmo Municipal CWe,Chapter 9.12and the Health and Safety
Code.Section 25532(a,^ ,,, s s',,,r
, _...AlLroofsshall be inspected prior.to_any.roofing.material.being-installed.
.._.
'Wil the pi,plictim or more mildngmccupant use equpm t ordwmca,wnich' If a roof is installed without first obtaining an inspection, I'agree to remove
emit hazardous air canm airans as defined by the Bay Arca Air Quality Management
District': all new materials for inspection..Appjicantunderstands.and.will comply with
1 . .oyes " yrr - • -' all non-poo[ source regulations.,
1 have read he M1 m s trabrials hCqts1tmdrrCh pt -6.95 of the
CI( naH 'Itb&SIly CW 5 i .re5503 5533' d25534 J .and,but
� //�/
if she'buildingdax note tiM1 t ttittr y .pan tittyr asify,he / /�t..
aer Paul of rhe ems which must b,met prior m issuance f C n fn¢of l—A ( ,
0scop'"` _ _ pp_ _ - _ Signa pp cant Date
., ._. L O�K ._-. .. .. -__ . .. .._ r ., . .. . e . s ._ .. _
JJJJJJJJ cure of li
owns ora„thori a �Date � All roof coverings to be Class"B"or better
OFFICE