02010004 CI tic of c DIVISION RTINO CONTRACTOR INFORMATION:
PERMIT
-BUILDING ADDRESS: PERMIT NO.
19863 LINDENBROOK LA WESTSHORE ROOFING CO 02010004
OWNERS NAME, APPLICATION SUB DATE
• WANG A TENG 5869 WINFIELD BLV 01/02/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 629-2100
BUILDING PERMIT INFO
q Q ZO ARCHITECf/ENGINEF.R: BL ELECT PLUMB MECH
a i
AFH
Z S z LICENSED CONTRACTOR'S DECLARATION lob Descrip on
O z_vi O I hereby affirm that 1 am licensed unJcr provisions of Chapter 9(commencing
P-'_+(•. with Section]000)ofDivision3ofNCRuvinessandpropaatorsCW and my license TEAR OFF EXISTING 2- YERS, INSTALL 15/32
<yytj iainfullfo¢eanJe ¢t. & 30 YR. GAF COMP
s z z< Licen a lass Lic.a
3 C' Dme/i Contractor
aARCIi1TECT'S DECLARATION Aca) f�j
1 understand my plans shall be,used as public records `
S�r
6 p O
Licensed Professional -
e• OWNER exempt R m the Contractor's
1 hereby affirm that 1 tun exempt from the Contrwl Co License Law for the
fallowing reason.Sectioerrant 703 1.5. t,after improve,
Pe,clarom Code:Any city odours,
IgSG
which bailout, permit construct,aper improve demo)t t rtpap any awaure
prior ons issuance.pursuant
N applicant for eConaremuu is gwfstatemrnt.
that pa's licensed p�rs - n th p s: n 3(if the
l Law(Chapterode) y,.,, S Ft Floor Area nation
s .. .g, n,set 0000) heDivisionbook
a eisin tx, aia f Any code) , 9•i .� yri ivl:`?�!�1t�1'x�:
or that he is exempt tA<afiam anJ the bass for the alleged exemption.Any violation
-of Section 7031.5 by any applicant for a permit subjttb the applicant to a civil penalty
,ofnot mre
amanfive hundred d.lms(6500). umber o Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
wit lidothe work:and the structure is not intended or offered for gale(Sec:7(}t4,' - -- _
Busineis and Professions Cale:The Contractor's License Law does not apply to an 3 07 - INSULATI]A9uired Inspections
owner of properly Who Wilds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements arc not intended or 60.1 _-... ROOF TEAR
offered for sale:If,however,the building or improvement is sold within one year 6f -" N- ;-
comPlethimthe owner-builder will hovethe harden of ro,in,that he did not build an
602 - ROOF PLYWOOD NAIL -
improve for portal ofsaIt)' 603 - ROOF BATTENS _
-- -- .... . _. - - . ._. .. .- - ... . - - — -
^ : cnuowneroftheproperty,oraBusinessadPrvctingwithlicensedeContractsm 604 - ROOF IN-PROGRESS
-•- c License
the ods n (Ser.]BJa,Business and Professions Code:)The wes Contractor's
Liceam Lnw docs not apply m on owner of property who builds or improves thereon,
C. ommmseLasach-0mjcds with xcomrac[or(s).licensed.puruam.m.N< . ._.. ___..-_.. .. .. ...._..F _ —.. ._ ...._._.. .__._.___. .__... . .._._.... ....__..
..01 rn i.c 'w' /�
Contractors LICCwt Law. ,V/r"y E"®•
_ - ❑1 am exempt unJ<r Sec: ;Bt,4'P C for this reawn
Owner''„ ...: Date '. - • JAN 0 8 2002
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury�one of the following declaratimi
O I hued'and will maintain a'Cenifiwte of Consent to self-insure I'or Wakcr's' BUILDING
- Compensation, its provided for by-Seainn-377 of the Labor Code,for the
_ perNrmance of thaw.,k for which Nis permit is issued,
01 have and will maintain\Yorker's Compensation Intimate.as r<quia i by Section
37M of the Cvbdr Cade,for the enfromme of the work fd(whieh Nit permit is
issued MyWorkersCim,ermalman Lamont,came,and Po1'cy ratable,are:
AII/�poldy No.
i "t CERTIFICATION OF EXEMPTION'FROM WORKERS
COMPENSATION INSURANCC`x'Iv^"t`
+i(This sabtion n,cd n n he'complete d if the perms is for one hundred dollars '',tl tT'"' t -I' -1
f5100)or Icsa.l ,
I de rofy ih t n the perlormancc f the ork for wN h Ns perrtdt is i;sued:I t i). ; l n-^ rifts .u o i
shall n i employ any pe any manner .a_sgp btto�yf object to the Worker +
nr
'C t tPcnsat qT/aws 1 Cal 4
you should --_ - - ` •�• r --
Nor ecor. �P ANT 1 Corn,crigaidafter making hr Cisions fExemption,Cadi -
b<com suhj ntoteWO erwkinds or
provisions of the Labor Cmeool. must
0 tbnh N comply with tach r J
p nor tN perm t shall M deemed oke
..
thereby afti. that .. __ -. .. .... .. .. ._... _._.. . __. _.. .___ .
y -H '• CONSere is a ION LENDING AGENCY - ' 'a i'
_ Y rat th t Ne wcu n lending agent)for the perfortnance s
.a r sofnthe work for which Nupermsyissu<d(Sec.709);Civ.CA
-•Lender's Name -"
`�—
L- 'Londe Address r. -
'nTZ � � .. .. lit ( It1C1'•"I
V I certify that l have read this application and state that he above information is'
fsr.E. 'too c, I agree m comply with all city and county ordinances and state laws relating
5 mWild. conumatom and hereby social tepmsentattvdof this city to enter upon
Ir7 the riw em,arsd p perty f -nspc i p rpo, ,,,
;a.
d (W,) greem , J unify and keep larmless theCity ofC penin against
Z liabilities 1 dg rents c st. and e.,a,c,which may in any way aclona,against said
U Z Cayincomcquence of the 8mminp if thispc t _ �s O,•S
LICA.\T UVDER$TA`10$ :hD WILL \IPLY\xrJ�Z NOV.°SVT Issued by: D v
OLRC TICE\ \ /i` ILL (/ �fJ
S s tt of Apl ant/c total r Date Re-roofs •r
HA'ARDOUS MATERIALS DISCLOSURE ;
Wili me tipacont or f-man"Llaildins,decapa, lon,i name hazatdmix mm nal -TYpe of Roof
as defined by the Cupermano Municipal Cale Chapter 9.12.and the Health and Safety .
Code S - .
ratan5
2. '2 1 v { - i. -' •"/'. i `
❑Y - yoNo 'i All roofs shall be inspected prior to any roofing material.being Installed
W urn pppbc torfuture bald goccupant use equipment or devices which If a roof is installed without first obtaining an inspection,,-agree to.i-emove�
em t hada d s urexanaml as defined by the Bay Are A Quality Management
D sat t all new materials for inspection,Applicant_ understands and will comply with
"4; Ely"':io r 1aN° - all non-pont[source regulation f, -
- 1 have read th hecudous materials regio rearmnc4 nder Chapter 6.95 Of.the
California Health A,Safety Code,Sections 25505,25333 and 8534,1 understand Nes
-ifs hltlmg duesntc.ma.tlyhaveai t th antan,rcspo bltyto noofy -
part of the rcGu m tits which an t her met prior to issuance of a Certificate of
p�. Signature ofAp titan[ ._ Date__
owner or aa0a;e agrnrnt :, Date, All roof coverings to be Class B' or better '