01060152 CITY OF CUPERTINO
BUILDING DIVISION (PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10329 MC KLINTOCK LA WESTSHORE ROOFING COMPAN 01060152
OWNER'S NAME: APPLICATION SUB DATE
,#--HEN GAI-BING AND TAI-YUN 5869 WINFIELD BLV 06/26/2001
% PHONE: SANITARY NO. CONTROL NO.
(408) 629-2100
0e5 Z ARCHITECOENGINEER: BUILDING PERMIT INTO
b ou- BLDG ELECT PLUMB MECH
Nab tJ L� 1--ii 1 1
0 S v= LICENSED CONTRACTOR'S DECLARATION Job Description
`=G 1 hemby affirm mat I on licensed under provisions of Chapter 9(commencing P
FwF d with SectionY000)ofDivision Softhe Business and PmfessiomCac.and mylicense REROOF 30 SQS .
<x - isWrwlrarcemwe£r, 7fr7 2Z
K m m Licence0w,
13 Lie.a
w 3 a yDoleUG 3l O/ Contctor
u.O ARCHITECTS DECLAR,.. P
C- ra
1 understand my plans saill be used-public com,
ad�g 9 Licensed Professional
c is OWNER-BUILDER DECLARATION
t�i = 1 hereby affirm that I am exempt from the Contractors License Law for the
C z s r lim mg reason O,,cdon nn 1.s,Business and Fired..mnx Code:Any eqo,xmmy $8000
x o which rcrrybes n r mml m con'"".alter,improves nemali.al nr repair any arucutm
rmu�•" prior mita iswantt,aHo myui¢s I.,soli lofl...
d%y flmhciklicrnted punuunttothemisisiumuf the C.nm,dws License lrwl Chapter') 9,0
1 O - Valuation
mommwki y-ah Section2anlm'Di.isiun 3arme Basic.,and limbessiom Cwe) 3 4 h St0 .I'V6ea
or that he is exemps dmreffnm and the basis forme alleged esen,saw,Any violation
of Section 7031,5 by any applicant for a psnnil subjects the applicant to a civil Penalty
of not mote than five hnndned dollars SSW). 305 APNPWTJft "0 Occupancy Type
❑1,as owner of the proPeny,or my employees with wags m their role compensation.
will dame work,and the structure is not intended or offered for sale(Sec.7044.
Inspections
Ins
Business and Professions Code:The Contractor License law does not apply to an 601 — ROOF TEA�gGi" p, r
owner of propery Who Wilds or improves Merton,and who does such work himself
or through his own employttc,provided that such improvements art nrn intended or 602 — ROOF PLYWOOD- NAIL
offered for sale.If,howevcq the building Lir improvement is sold within one year of 603 — ROOF BATTENS I
completion.the owner builder will have the hoiden of proving that he did not build or
mprovef..purpoa or.me.). 604 - ROOF IN-PROGRESS
O Las owner of the property,a xclit ively commis ng with licensed mnwctws m
_ construct the proJedt(Sec.7M4,Business and Professions Code:)The Contractor's r
License Law does not apply road owner of property who builds or improves thereon.
aaJ wow continue for such projdm wild a comm dash)hedirmed rummum 1.he
Gnntmaar'a License lrw. ;>_ FINALE®--
- ' O 1 am exempt under Sce. ,B Rr P C for this reason Owner
JUL 0 9 2001
WORKER'S COMPENSATION DECLARATION
1 heathy affirm order penalty of perjury one of the following declareticirs
1 have and will maintain a Cenificam of Consent iv self-insum for Worker= BUILDING
C..otpemstion. a;.provided for by Section 37W of the Labor Cade, for the
Performance of the work for which this permit is issued
O 1 hm'e and will ovair:taid Weaker's Cantpenintion Insurance,as required by Section
37W of do Labor'Cnrla'for'Ihe pmfirm rnm of the work for which this permit is
issued,M Worker's Compensation Insurance carrier and Policy number we: .,. _...... .. ... .... .. .
Carrier: 'Policy No.:
. CERTIFICATION OFEXEMPTION FROM WORKERS't I
., COMPENSATION INSURANCE" _...._...__._.. _.... -. _
(This acdnn nceJ not W amsPlomA if the Pennil is fin ane hundred dvlln.s ' t
Is Iq)1 ar kss.l
I verify that to the Ise'anmpa of the work for which this Permit is issued.1 ,. t. r..C r. r -
shall not employ any person in any manner so as to became subject to the Workers
Compcmation Wass of Calilemia.Date
t
NOTICNOTICE!TO APPLICAN'C lf.afro.making this Cenifinnc of Exempt ort,yon.should
C Obecome subject to the Workers Compensation provisions of the Labor Cafe,you must
fonhwith comply with such provisions or this permit shall be devoted revoked.
,^r ^ 'CONSTRUCTION LENDING AGENCY '
1 hereby affimr that there is a construction lending agency on the performance
fy nit is issued(Sec,309],Civ.C.)
^ Lender's Name _ Vcn. .. .. ... ...... ._. . . ._._ _. _ .._
n me lour lorw Ic this .
U z Lenders Addre,c
U Q 1 verify that 1 have mast this application and store that the above information is
res [^ carred.1 agree to comply with all city and county ordinances aM state laws miadng
�.0 us Wilding construction and hereby nuthorim reprtsentwives ofthls city mentor upon
W the uhnvcmentiured property fnrinspection.....uses. _
E„s ps (Wel agree rat save,indemnify and keep fiamtless the City of Cupenim against
'14 liabilities.judgment,coax and expenses which may many way accrue against said
U Z City in consequence of the graving of this Permit. /fist
^ APPLICANT UNDERSTANDS AND WILLCOMPLYWITH ALLNON.POINT Issued V� /l /L���r
S RCE N ❑ 10 Y' - ---- -
. � ,.
IS W, ppI -VComnmmr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Wtu iM apVlmam of future Wilding acapa d store m handle haruJsws mamdal Type of Roof ... _ .
as defined by the Col.,.Munkip¢I Code.Chapter 9.12.and the Health cal Safety _
Calk.Section 25532fad't
❑Yes -All roofs.shall.be inspected prior to.any roofing material being installed.
\pill the applicem or lwure twilPubg swcupam use cquimtwnt or Jevims wM1ich If a roof is installed Without first obtaining an inspection; I agree to remove
emir hutardnw air contaminants as defined by the Bay Area Air Quality Management
District all new materials for inspection. Applicant understands and will comply with
°Yea XNna all non-point source regulations:_
I have read the huaardous mammils requimmems under Chapter 6.95 of the
California lienhh,&Safety Code,Sections 25505,25533 and 25534.1 understand that
fthe Winding Joe,not cum..,ly haveu¢mm,mat it xmYm,,m,m`tm notify tify the n /
pmts of the mqu omens which trust be met primr to i..mmce of a Certificate of tJ/// l
tr
ature of Applicant Date
v -6,tmhodaed agent Date All roof coverings to be Class"B"or better
.. .. . l OFFICE