02050003 CITYOF
m ESSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19959 LINDENBROOK LA LINDY ROOFING CO INC 02050003
OWNER'S NAME APPLICATIONS BDATE
RUYU CHEN 5554 HARVARD DR 05/ 01/2002
{�PHONE: -(408) 269-2025 SANITARY NO. CONTROL NO.
COO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
u BLDG. ELECT PLUMB MECH
y< o u I._.1
�t-� LICENSED CONTRACTOR'S DECLARATION
Z 1 hereby affirm Ihm 1 am licensed under provisions of Chapter 9(commencing Job Description
„t with se lm ]000) fDivision3ofthewusinwapndPro@xsfonxChde.mdmyRlcmm RE-ROOF (30 YR COMPOSITION)
i s s�5 Liocnm'�'!�c5 andils
e cit Lis.a7�
0 5'`� Dm 7 Contractor(
j Q a ITECf'S DECLARATION
1 undersmed my plans shall be used es public records
3 o o Licensed Professional
OWNER-BUILDER DECLARATION
=w 1 hereby affirm that I am exempt from the Contractor's License law for Ne
t?< following reason.(Section 7031.5,Business and Pm(essions Code:Any city or county $8255
D wh h q a Permit to c nsw a alter,improve,demolish or repair any thrown,
i
3� _pnht t ': Is regi th Pplicant forsuch permitmfileosigad smtemem -.... ... _
_ did he isl' 'd purtutoolmmep onshf the Contractors License Lw Uhml,r9
(commencing with Section 7000)of Division 3 of the Business and Proft.,ims Code) 4"rt'. r .i3'O1D ft;6�'LS,.'ItS��'',�+j,{'(y'1 Valuation
or that he is exempt therefrom and the basis for the alleged exemption Any violation '
of Section 7031.5 by say applicont for a pemdt subjects the applicant m a civil penalry
of not marc than five to ndred dollars(ss0O. 3 0 g1PN I faglgKE Occupancy Type
OL,as owner of the property,or my employees with wages as their sole compensation, 307 — INSULATION
will do the work,and The ode Th is not intended tl e offered Law foes no apply to n 6 01 - ROOF TEA�uORFInSpections t
wiliness a work,
and the
Core The is Contractor's intens License Law does not apply 1 as,
owner of property Who builds or improves thereon,and who does such work himself 6 02' - ROOF__PLYWOOD NAIL
or through his own employees.provided Nat such improvements an not intended or
l ufiered for sole.If.hwcvcr,the building t is sold within one' `- 603 -ROOF BATTENS - - ._..__.. . __ _ _-.. .... ... .
gob improvement of pro year of t
completion,the owner-builder will have the burden o(proving that he did not build or -
improveforparposeofaale), 604 - ROOF IN-PROGRESS
tther hilhc tin en -
P P Yum exclusively t ting with tic nod cammemrs m
License,
the does
a.(Sec.]044,Business and Professions Cade:)The improves
m rm i,
License Lew docs not apply man owner of a cmay who).lids or improve thereon,
...and who comicns for such projects with a conwcmr(s).liccnud pursuant.m.the
Contnnors License Taw.. ..... ... '. _ ..
❑1 nm exempt under Sec. ,B&P C for this reason
ownerDate Fs9l9/�O�G®
WORKER'S WMPF.NSAfION DECLARATION
Ihereby affirm under penalty of perjury one of the following declarations: -
❑ 1 have and will maintain a Certificate of Corium m s ff insure for Worker's MAY 0 9 2002
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance'of the work for which this permit is issued.
EIBUp11 1 p1/�
1 have and will maintain Worker's Compensation Insurance,as required by Section ILDING .
3700 of the Labor Code,for the performance of the wad far which this penrnt is
issue(}'My Workers Conifficustion Insurance c 'er end Policy number are '
CYnor S /
l
_"'CER CATION OF EXEM N FROM WORKE ' < ! , �,1 -
;, COMPENSATION IN
' t I
(This uclmr ared no,be completed'(the permit is for one hundred dollars "1 r
($100)or less.)
1 certify that in the performance^f the work for which this permit is issued,)
Shill not employ any person in any manner eco as to become mbjcat
to he Workers' , ^• '
Cm-opc setlnn laws of California-Date, '
NOTICE TO APPLICANT. _ ..ous .. . .. ._ .__. -. . . ..... .. ___ ... .._.
If.Corrmnsamohisovisiosofof Lalborodc.you Das,
becomesubjecty it earker's Compensation provisionsofthelabor revoked,you muse
z uld
O
forthwith comply with such provisions or tots permit Nell be deemed revoked.
4 L,Q' ... CONSTRUCTION LENDING AGENCY
- I h by affirm but hsntn letlCagency
performanceftM1 wt , kfr ""of th which his print issued(Ire,NEE is,C.)
Lender's Name . . u, , °.; _ . , _ ..,
._... t
_ .._ .-.. ..
Lender's Address'
U I certify(het 1 nave rid this vpplicmion and nam Ihauhe above infommtion is
comct,I egream comply with all city and County ordinances end state laws miming
� U rebuilding conlormton.and hereby amore,representatives of lhii city 1. upon
W' the ebovemcmione0 property for Cyinspediogpuryoses..,t 0. (We)agree iosave,indemnify and keep harmless the City of Cupeitino'egam,
FI V1 liabilities,judgments,costs and expenses which may in any way accrue against said
U.Z City in consequence of the granting of This permit
APPLICANT UNDERSTANTJS AND WI 11PLY WITH ALL NON-POINT'
S. CE ULA s Issued by: Dale
meter o(Appl¢a U omevnnr ne'� Re-roofs
ser Y 5 the cn�p[ero�M Opal,caa Chapter 9,12,and the Health and
-
HTSARDOUSRIALS DISCLOSURC I
W 11 the uppl ant future building acupant store of handle hazardous mat I ''1)rPe of.Roof
,
Safety
Code Section 25532( 1 t .• . - .' ; {. .1.
�°� All roofs shall be respected--prior-to.any,roofing material being installed._
wnme ppi ore tf e 1- lot n Id ap t equpmemnrdeviceywnrn
e - If a roof is installed,without first obtaining an inspection, I agree to remove
unit hazy d s o by the B y A Air Quality Man ge ent '
District all new materials for'inspection. Applicant understands and will comply with
°Y all non-point source regulations: -
k✓ 1 he e read Ne hazard s m t nal mq u Dade ChM 695 of the' ���/// '
CCel a mil Health g:Safety Code Sen ons 25505 t it is and 25534 I and mend(het I -iJ z�� // /)
Ill mbuildingl not currently h taw t that t 3 m rc `J/ A/ L%a-„/�rTy///j YX/l/
occupant tM1 catch!' .. a
re ns h' hmusebe y P^^ alit ten by the _
Occ P 9 r m ism of Ccn,B V,
B Signature of an Date
Date
'4 Ownermion orracilit . . once All roof coverings to be Class"B" or'better`
_.
- 7 a . . 1 ..OFFICE - .. ._._.