12030072 CITY OF CUPERTINO BUILDING PERMIT
BIIILDUYGADDRI?SS: 7414TIPTOELN CONI'RACI'OR:WESTSNORE ROOFING PERMITNO: 12030072
INC
OWNER'S NAME: ROY LORD 2245-A FOR'I'l1NI,DR DATE, ISSUED:03/152012
ONVNER'S NIONIi: 4082552860 SAN JOSE,CA 95131 PRONE NO:(408)694-0060
❑ LICE.NSP:D CONI'RACI'OR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG r r r
ELECT PLUMB
License Class Lie.b
M ECH r RESIDENTIAL - COMMERCIAL "
Contractor Date
hereby affirm(hal I am licensed under the provisions of Chapter 9 J013 DESCRIPTION: REMOVE EXISTING WOOD SI3AKE d INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business S Professions ROOP
Code and that no-license is in full force and effect. OVER NEW 7/16
1 hereby affirm under penalty of perjury one of the follmving two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided Int by Section 3700 of the Labor Cade,for the
performance of the work for which this pemtil is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,Inr the perfomma ce of die work for which this Sq.Ft Floor Ares.0 Valuntion:$19479
permit is issued.
\I'1'LIC.\N'1'CIiI2'1'I PIG\'PION A PN Number:35932060.00 Occupancy Type:
1 certify Thin I have read this appliauion and slate that the above information is
correct.I agree to comply with all city and county ordinances and sate laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property fir inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify xpenseswhich ayaciryogcupeninoagyinst inconsiques.njudgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against Said City in consequence ollhe
graving ofthis permit. Additionally,the applicant understntds and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature Due
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby utfirm that I am exempt from the Contractor's License Law for one of All tools shall be inspected prior to any rooting material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection,
will do the work,and the simcture is not intended or offered for sale(Sec.7044,
Business&Prolessions Code) Signature of Applicnl: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044-Business&Professions Code). 1 I ROOF COVERINGSTO BE CLASS"A"OR BE FI'F.R
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cenificate of Consent to self insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,Ibr the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work Port which this permit is issued. California Ileallh S Safety Code.Sections 25505.2.5533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth S
Section 3700 of the labor Code,for the perk rmanee of the Work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,
should I use equipment or devices which emit hazardous air
permit is issued. contain i nnnts as defined by the Bay Arca Air Quality Management District I will
I certifythat in the performance of One work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I leallh S Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Calilontia. If alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I most 0o are lie authorized agent:
forthwith comply With such provisions or this permit shall be deenmed revoked. Dale:
A 1111LICANT CERTIFICA'T'ION CONSTRIICI'ION LIiNDINC AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of oork's
correct, I agree to comply with all city and county ordinances and state laws relating for which this pennil is issued(Sec.3097,Civ Q
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this pennil.Additionally,the applican understands and will comply ,\RCIIII'F:CI"S DECLARATION
9.18.
all non-point source regulations per the Cupertino Municipal Code,Sectial
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BIIILDUYGADDRI?SS: 7414TIPTOELN CONI'RACI'OR:WESTSNORE ROOFING PERMITNO: 12030072
INC
OWNER'S NAME: ROY LORD 2245-A FOR'I'l1NI,DR DATE, ISSUED:03/152012
ONVNER'S NIONIi: 4082552860 SAN JOSE,CA 95131 PRONE NO:(408)694-0060
❑ LICE.NSP:D CONI'RACI'OR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG r r r
ELECT PLUMB
License Class Lie.b
M ECH r RESIDENTIAL - COMMERCIAL "
Contractor Date
hereby affirm(hal I am licensed under the provisions of Chapter 9 J013 DESCRIPTION: REMOVE EXISTING WOOD SI3AKE d INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business S Professions ROOP
Code and that no-license is in full force and effect. OVER NEW 7/16
1 hereby affirm under penalty of perjury one of the follmving two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided Int by Section 3700 of the Labor Cade,for the
performance of the work for which this pemtil is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,Inr the perfomma ce of die work for which this Sq.Ft Floor Ares.0 Valuntion:$19479
permit is issued.
\I'1'LIC.\N'1'CIiI2'1'I PIG\'PION A PN Number:35932060.00 Occupancy Type:
1 certify Thin I have read this appliauion and slate that the above information is
correct.I agree to comply with all city and county ordinances and sate laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property fir inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify xpenseswhich ayaciryogcupeninoagyinst inconsiques.njudgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against Said City in consequence ollhe
graving ofthis permit. Additionally,the applicant understntds and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature Due
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby utfirm that I am exempt from the Contractor's License Law for one of All tools shall be inspected prior to any rooting material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection,
will do the work,and the simcture is not intended or offered for sale(Sec.7044,
Business&Prolessions Code) Signature of Applicnl: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044-Business&Professions Code). 1 I ROOF COVERINGSTO BE CLASS"A"OR BE FI'F.R
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cenificate of Consent to self insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,Ibr the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work Port which this permit is issued. California Ileallh S Safety Code.Sections 25505.2.5533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth S
Section 3700 of the labor Code,for the perk rmanee of the Work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,
should I use equipment or devices which emit hazardous air
permit is issued. contain i nnnts as defined by the Bay Arca Air Quality Management District I will
I certifythat in the performance of One work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I leallh S Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Calilontia. If alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I most 0o are lie authorized agent:
forthwith comply With such provisions or this permit shall be deenmed revoked. Dale:
A 1111LICANT CERTIFICA'T'ION CONSTRIICI'ION LIiNDINC AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of oork's
correct, I agree to comply with all city and county ordinances and state laws relating for which this pennil is issued(Sec.3097,Civ Q
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this pennil.Additionally,the applican understands and will comply ,\RCIIII'F:CI"S DECLARATION
9.18.
all non-point source regulations per the Cupertino Municipal Code,Sectial
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BIIILDUYGADDRI?SS: 7414TIPTOELN CONI'RACI'OR:WESTSNORE ROOFING PERMITNO: 12030072
INC
OWNER'S NAME: ROY LORD 2245-A FOR'I'l1NI,DR DATE, ISSUED:03/152012
ONVNER'S NIONIi: 4082552860 SAN JOSE,CA 95131 PRONE NO:(408)694-0060
❑ LICE.NSP:D CONI'RACI'OR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG r r r
ELECT PLUMB
License Class Lie.b
M ECH r RESIDENTIAL - COMMERCIAL "
Contractor Date
hereby affirm(hal I am licensed under the provisions of Chapter 9 J013 DESCRIPTION: REMOVE EXISTING WOOD SI3AKE d INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business S Professions ROOP
Code and that no-license is in full force and effect. OVER NEW 7/16
1 hereby affirm under penalty of perjury one of the follmving two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided Int by Section 3700 of the Labor Cade,for the
performance of the work for which this pemtil is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,Inr the perfomma ce of die work for which this Sq.Ft Floor Ares.0 Valuntion:$19479
permit is issued.
\I'1'LIC.\N'1'CIiI2'1'I PIG\'PION A PN Number:35932060.00 Occupancy Type:
1 certify Thin I have read this appliauion and slate that the above information is
correct.I agree to comply with all city and county ordinances and sate laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property fir inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify xpenseswhich ayaciryogcupeninoagyinst inconsiques.njudgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against Said City in consequence ollhe
graving ofthis permit. Additionally,the applicant understntds and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature Due
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby utfirm that I am exempt from the Contractor's License Law for one of All tools shall be inspected prior to any rooting material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection,
will do the work,and the simcture is not intended or offered for sale(Sec.7044,
Business&Prolessions Code) Signature of Applicnl: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044-Business&Professions Code). 1 I ROOF COVERINGSTO BE CLASS"A"OR BE FI'F.R
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cenificate of Consent to self insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,Ibr the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work Port which this permit is issued. California Ileallh S Safety Code.Sections 25505.2.5533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth S
Section 3700 of the labor Code,for the perk rmanee of the Work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,
should I use equipment or devices which emit hazardous air
permit is issued. contain i nnnts as defined by the Bay Arca Air Quality Management District I will
I certifythat in the performance of One work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I leallh S Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Calilontia. If alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I most 0o are lie authorized agent:
forthwith comply With such provisions or this permit shall be deenmed revoked. Dale:
A 1111LICANT CERTIFICA'T'ION CONSTRIICI'ION LIiNDINC AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of oork's
correct, I agree to comply with all city and county ordinances and state laws relating for which this pennil is issued(Sec.3097,Civ Q
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this pennil.Additionally,the applican understands and will comply ,\RCIIII'F:CI"S DECLARATION
9.18.
all non-point source regulations per the Cupertino Municipal Code,Sectial
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional