01110067 cJTv OF cuPENo
!BUILDING DIVISION CONTRACTOR INFORMATION:
SIOPERMIT
GILDING ADDRESS
110'491
PERMIT NO.
DAVISON AV WESTSHORE ROOFING CO 01110067
INI E NAME: APPLIC TION 5 B DATE
3IE-CHIA LEE AND LIN CHEN—YI1 5869 WINFIELD BLV 11,14y2001
PHONE:
t(�'"+ (408) 629-2100 SANITARY NO. CONTROL NO.
E O O ARCIi1TECT/Cp'GINEER: I
BUILDING PERMIT INFO
u
a E BLDG ELECT PLUMB MECH
IJ LI L__J ___I
.8 y z v e LICENSED CONTRACTOR'S DECLARATION r
Z=C thereby ).f that I am licensedunder pmeisionzMChapmr9(co encingr Job Description
,XZ! wimSOclion7fa Blair,
'o of the BusinessandP `f�a c elt°rcense OVERLAY 25 YEAR GAF COMP.
�ce f: L cense fossa fQet. C7/( ° °�
z w:U License L-op
3 n y Dom Go ECa
,u -o-
0< ( CHITECT" ECLARAT
fff-
nd .r my pP use a,public records
zaS
C,C Lircnse P
I _ .siona OWNER BUILDER LCL "
1 hereby limiter 1 ran exempt floor a Contractor's License Law for the -
following reamer(St 703 1,5.Business and Professions Code:Any city m county $4800
E F C whim residues a Permit m consumer.alter.improve.demolish,or"rarely structure
p in'r" ..em leo requires iheapphaam forsuch mormin,file.slied stammer, _. .
ththe IsBlamed prionarriod the previsions of the Cormallin,License Law(Chpte'Y, -- ---- -
(rm gstiths a ]000) fDivnronIollmBua a adPoreasionsCode) v'_-tstij,v369 3,( �9r.Eb'6a'r'. t q . Valuation
or Nm he rs exempt rhercf and Nc baso for Ne alleged exemphoh.Any notation ,•'°-' . - i�lE_1
-of Section 7031.5 by any applicant for a pnmit subjects Ne applicant to a civil penalty,
:grnet m°re man foe hundred dollars(asoo). 3 0 gIPN *qU*E r . . : Occupancy Type
,. ❑Los wnernfthepropedY.urmyempleyeeswirhwagcsnsWeirsulecompensaio"I 307 - INSULATION
will do the work:and the structure Won intended or o@red for sale'(Sec:7044"
'Business and Professions Code:The Connector'sso License w Law docs not apply m an 601 - ROOF TEA�BquQF1'kjnspections^"
or thmu ry his ow rosity Who Wilds ur improves thereon,aM who does such work himself ROOF PLYWOOD NAIL
owner of m.awn ecuria mss.pfov:din that such improvements are not intended or 602
^• "off cif al,hfall*if,h rl b 'Itling6r mpmvemcin's W thin one "' -- '-"'"-
ldin 603 - ROOF BATTENS F:1 t'r •-- '
pl t p own b 'Itl 11 have the burden of Prov g Ill.,h did not build or
'ran°`f°SP°p° °r''I`'). 604 — ROOF IN—PROGRESS
--
❑1 her rthep a ny m p oloics%adPitelY raningxdh I' d Contract to -..—__._ _. .. .... . .. ...._._- ._ _, _
Liceconsnse
the project(s ]1144,ess-1 o and Profess ons C°dc)The improve,
b,,.. I t
Llv l Law duos notapply Iran ownerofpmontr who Wildase pooms .on do. r: i°'Ut
l= _ Co actors ions for such pmjau.wirh.a contractors)licensed punuant.m th,.
'
Contractors License Low,
❑I m< pt undo S " " ,B&PCfonhis reason
,r WORKERS'S COMPENSATION DECLARATION
�f t I hereby uffvm under penalty of perjury one of the following declarations: FINALE D
M1 r1 ❑ 1 hese and will maintain a"Cenifcale of Conseil to self-Insure for Worker's
C°mpensmion. as provided for by section 3700 of the Labor Code. for the NOV 2 7 2001
performance of of the work for which this permit is issued.
s
111 baseand'w 11 'a nwnW kers p.nst mo nee, sired by sects
on
v z 37W of the W Cnde f e pc one f N work f which'his perm r
blard * G rap ton n rarerre. BUILDING_____.. ..-
l �o -
sem ' -'Po ICYN }. ' '..;t, i, tr ' flu', c liP:fb�I" � I
{ CCRTIFICATION OF EXEMPT], 'ROM WORKERw q ,
"COMPENSATION,INSURANCC''
P"I s ----------
(This xnl n-necdnotMcampletca tilts pcnnit isfor onehundred dollen '' : .. , t)�t lr'd:" i
(SI W)or less) � r
Inify0 i' prfr soca sftl kf . I _ _... ... .-. ...., .. ., ,
p al. -. .....
sh 11 n t pl Y ol, P n m 'mon u�qo bis kers' -
CompesaoonLexs (C Dat `
.NOTICE TO APPLI T If.aftermakingilt Cenf I IE ou should - - ----- - -
Z rice subiat rpe Wok C' pe st nl e ' ns ortM1e Lub CJe you must "
folubw1m comply with 1twh lowilits.,in this Permit shall be d mo d m,lkl. -. •` ..
Fv ' -° a CONSTRUCriON LENDING AGENCY .` -� - - --
ai' t hereby elf rm ih t th st et n d g ugc y(nhe,pe f rmance 1
r� � �Ihc kfo h iti ih spr.` tr xsueJ lS' 309]'C'v.Cl -' -
-
r`7-Z Lender's Addrers• .•.. :. ., •. _._ .. .-. .. - ..
U 0
u,••,1 certify that 1 have rtaJ this epplicerion and sure that rhe abme information is '
ks'F+ correct.Lagrt<to comply with.oll cpy and cuunq'orrlinnnces andsnm lows relining
D V to builJing constraciion,and bereby'nuthbrizd rcpresemorives of lhis'city to emer.,em
�„t W due �e i nod pony for rnspecl p rpose
tr d s I ) 8ree t demo fy and k p harml ss ibe`C ty of Nperi no age est
VJ liebd I dg r, r d e h eh y any y cru gamstd
V � City y c I g bf r pe t _
AVPLC TUN ,R$TANUS A' WILL OMFLY WITH 3 p
sou cP u u ,nous a Issued by: Date
Siginture FAppf SnVC wao - e Ile-COOfS
7. y penin n c l in IALS DISCLOSURE( t 't')
HAZARDOUSM
Will the ppl error fuhre building wrupant core h ale hmsrdou"man
r al ,-Type.of ROOF
defined h the C M� nee Ch pt 9.12 end the H ahh d t f tY
e am n 255321st \ '-. f •• {' �- Y �..
°Y °. 's sr __All roofs shall be inspected pnor.to any roofing,material being Installed. _
Octal' W 11 air
as r mm b lined a e t eye p r r gern rn If a r f is installed without first obtaining an inspection, l agree.tolreinove
smolt dbusu coram- as defined by the B yAreaA Quality hfen
District?Y all rte mat sats f spechon_ Applicant understands and will comply_with
- - - all no - oin so c regulaii
i h - d t' ,l douI r ul y t m r and Ch pl r 695:of the L '' V
Calf ni h'&serf ry Cyy Stons25505ritis ad 255341 d tan that / J
dNe bur g ammu . otlyl q mrhtus mY re porubl hlo no ythe (/ 1
occupant f m regbi fi t ch ust p r p r.lo ixs :e f
0„U Par c
r "� de Signature of Applicant Date
owe ° named r - D le. All roof coverings to be Class"B”or better "
.. - r .,.:...r.. L
.OFFICE-- - ._._. . .. .. .. _. _ ..