01110066 CITY I DING DIVISIO ND CONTRACTOR INFORMATION:
PERMIT
BU`LI)ING4DDYESS: PERMIT NO,
2994 STANDING OAK CT WESTSHORE ROOFING CO 01110066
NER'S NAME: APPLIC71ON S B DATE
jrfHOMAS JOHNSON 5869 WINFIELD BLV 11/ 14 2001
DNI". (408) 629-2100 SANITARY NO. CONTROL NO.
2,-,.
OO ARCHITECUENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB M5CH
u LL 1 1 1 _1 L _J I__J
LICENSED CONTRACTOR'S DECLARATION lob DBSCClppLIO
_ nnemnyarfinnthatlambaensedumaecprowHonsorenapmr9mommenC1as TEAR OFF/OSB GRAND (GAF CANYON
iy
u wish I2IB" l(IOOhwf Di ofthe BusinessondY e>i �W ,ZTlicense
is in full Inme anlfi'tb<f.
za Liccnsc CL a °
O n U Dec "In'"oaur
TECrS DECI_ARA N
1
0, ms her hired as p.hlie records
i i 8 O Licensed I' ,fes
z ° OWNER-Bl ECLA
w F-'u. I hemby affirm that 1 am exempt from the Contractor's License Law for the
z< bsuowing reawm,.(se<nnm 1031.5.Business and rrefcelnns code:Any dry or county $11369
dt,awhich requires.permit ,,emshom site,impoe dem lsh or repairan,n mrc
en Priors t .req tire applicant fitirsuch permit to file a.,gel statement 4(2.
that be 1 Jp amt m pro sofm Contractor's LcenmLa (Cha%erg t .`3 Y� 'OL l"'�r.`P/�,, .'V i Valuation
(comm aawd 5eotiu othse fD" oil tr snee mtlP (aw(Ch Calc) i :P ' e. `., ' t•Is
m Inco he is exempt thercfnnn"°nd tM1c naafis for the alleged exemption.Any violation
-,d Senion 7031.5 by any applicant for a permit subjects the.,he.,m a civil penalty
of as mom than five hundred Collars($500). 3 0,CPN NqdME Occupancy Type
°I,as owner of the property,or my employees with wages as their sole componnfion. 307 INSULATION
will do the work.-and-the stmaum is not intended or offered for sale(Sec:nue.
'Business acid Professions Gde:The Cohnnah is Liccnw 601 — ROOF TE Law does not apply to an AFquQtl tRnspections'
owner of property who bunds or Bnpmwes thereon,and who does such work himself 602 — ROOF PLYWOOD NAIL
or through his own employees.provided that such improvements am not intended or
hffemd I,;,ma.If.hsweset.she building ,,improvement is sold within one year of .._ _._._ 603 ROOF BATTENS
'completion,the owner-Wilder will have the burden of proving that he did not build or
improve for puryoseofsale.). 604 - ROOF IN-PROGRESS
°L se,t the of the prSeeny.am a usnsiss)and Professions
Wcnaed constructors to
License
el the present(Sec.1W4.Business and Pny whops ills or Tho dishown. 1,•; 1 ,
(.d who
Law tta.s not apply to an owner of a co ny woo) lids se improve thio she-
Contractors
he
.. -and who rs License
!Law. pmjecu with a<omructorts)licensed pursuant m me. " ... ........ ..... ._ .._ _
" Canbannr's Li<enae L cc. •.
0lamexemptunderSc .B&P C for this reason ��• Y
E® l
_ Date
WORKER'S COMPENSATION DECLARATION N I/ 2 Q p
{{ 1 Ihemhy affirm under penahy of perjury one hfthe following declarations: -O• p 2001
01 have and will minimum u Certificate of Consent m self-imure for Worker's
Compcnsnfion, as provided for by Section 3100 of the Labor Cade, for the BI IL��/y Vl
performance of the work for which this permit is issued. LU
°1 have and will maintain Worker's Comµnsaims Insumnce,as requird by Section
3100 of the Labor Code f theto arse,of Ne week for which th s peon t is
issued or ors Co y'1�tpP,'ge� t 1 rumce'd 'e �n y moor
car"It� s`� olicyN �� r V O 'y ', 1 T.Ir.r v., .-- _ --. `. Ir.
CERI IFICATION OF EXEMPTION FROM WORKER - "
... ' ..
..._ .._..... _.COMPENSATION INSURANCE,(__.:.
r (This" aced not he comptcicd if the permit is for one hundred dollars '' ! 1, •s is
(SIW)or less.)
s
1 cenifor rte performance of ¢ k f)'Ir/w h� nn, is sued.IIAN'
shall not cmplhY do p eon anY mann t gv m b' o orkcrs'
f
,
C rid hot etion Lew bf alit bio:D
NOTICETOAPPL :I.a foraiNingrThsCcnificm hl mn,you should
become subject the Worker's Compensation provisions ofthe Labor Co ,you most
Q 0 ude
forthwith comply with.such provisions or this permit shall be deemed revoked.
"z' CONSTRUCTION LENDING AGENCY '
-� 1 hereby blfirm that there is o cnnnmelion lending agency bertha pinformane, s"
of the weak for-which this permit isissued(Sec.309],Civ.C.)
Qlender',Name_ . •..,_:_t -. .- : ...._.,-"-"_. ... _ ...
:D Lender's Address•, 1
0 1 comfy that I have road this application and state that the above information is
W L.. comers.1 agree to comply with al)city and county ordinances and stale laws relating
0fJ mWilding<onsmarlion.and bere8y authorize representatives ofthis city to enter upon
r"W the abovcmcntmhed property for inspeeon purpcm,e .
�.,96 (W grte to save tl nfy and kc ph Issfne Cit !Capco againn
h
liabilities gramns.co v and ex as which may in any way, against said
C7
City in Inns 8 g_, this p t Q
AP 1C Y UND'. . A A )WILL COMELY WITH AL f T
SOURC GU AI �� Issued by: Date
'gnamr ,.flspplicardcontr ,• .. Dam Re-roofs /
HAlEARDOUSMAI'LRIALS DISCLOSURE -'
Will the apel'Icam or future Wilding overheat none a handle hazard as tnscrial .. Type of Roof, _._ ^..... — -". -
_. as defined by the Cupertino Mu ci Code.Chapter 9.12 and the Health and Safety
Code,Section 255321x)!. ., _, :rat .. .. r , .! - • ' , ' ..
❑vet' '''' '� °°-',^'•"�' ;. ,t,'f.,t"1'a, .. - All roofs shall be inspected-prior to any roofing-material being.installed.
Will tire
ppl an future building p f use equipment or devices which If a roof is installed'without first obtaining an inspection', I agree to remove
anhazardous coo df db)fh Bay Aio Quality NI gamont
isemt al ew materials for inspection. Applicant understands and will comply with
( °Y al n-po [so regulations.
I read the h ard .'m moat rey mans under Chapter 6.95 of the
Calif a $I,h& afeny C eci ens 25505 25533 and 25534 1 "demand shall
h
tithe W I in sixes xc fly eamw t that t my expo s@I ymnoti! the Il'
obcupam fie«q eau ich man et poor m issuapc f a nim I o
Decupan I
Signatur�64 Applicant Date
owner nr autnn' ed agent .. of All roof coverings to be Class"B"or better
OFFICEis.
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