01070003 !MTV OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10430 STERLING BLVD STEVENSON' S ROOFING 01070003
OWNER'S NAME: APPLICATION SUB DATE
BI FEN TSENG P 0 BOX 1641 07/02/2001
•s PHONE: (760) 339-0090 SANITARY NO. CONTROL NO.
w O O ARCHITEC"UENGINEER: BUILDING PERMIT INFO
w5 BLDG ELECT PLUMB MECH
so<c IJ
F� LICENSED CONTRACTOR'S DECLARATION Job Description
Oo H Z 1 hereby (firm that I am licensed under
o,-o Y a provisions of Chapter 9(commencing
p„Fu, with Section]IXI01 ofDivisionJ oftheBminen and Pufeaion.Cale.and my licca¢ REROOF.
<xf i.mr°ura rteLt. Lim.a
��� Sdt T/O TAR & GRAVEL & BUILD THE SAME.
0 La Liccm
LLc.Oti Dau ARCHITECT'S DECLARATION FINALE®
yC I Understand my plans shall be used as public records
y se O O Licensed Professional .r n
w� OWNER-BUILDER DECLARATION JUL 1 6 2���
1 hereby affirm that I am esempt from the Commit License law fat the
i-3< following rensmn.(Section 7031.5,BusiMn and Professions Coma Any city or county
S❑ ht h reroute,0 pi ta coromm ains, an p l I'h on,te,nuany onadurm
as primm it, I. y n ypli U G 1 l IW ' W m ....it 111i 111ii.a. �NG y that he 51 ap tt top n InContractor1 Caw(Chapter9 Sy:Ft.,Floor Area a uatiV 1 on
(commencing w th Seuion,]f)(0)Of Division 3 of the Business and professions Coq S .r , . _
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
--of Sation 701 L3 6y any applicant for a peemit subkns the...beam m a mivil ge alty
for not more man rr<n"oared mlmn(asBtl. umber Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation, t
will Jo the work,and the structure is not inraMed or offered for sale(Sec.]BU.
'Business and Professions Code:The Cmarye m's License law docs not apply no an 3 07 - INSULATJFOAPired Inspections° t
owner of properly Who builds or improves thereon,as who does such work himself
or through dfor m:awn however. building that smut import is sol.are not intended m 601 — ROOF TEAR OFF
-offend for:ale:If.however.de hiave - tis sold within one - - 'ROOF - _-
g°"'"pm"""`" y.,.°f 602 - ROOF PLYWOOD NAIL '
completion,the ownervhuildcr will have the burden of proving tM1m he did not build or
improve rmrp6m°near=ae�. 603 - ROOF BATTENS
. 604 - ROOF IN-PROGRESS
O1,mowner ofthe property.7 am exclusivelyc°mrofeisi withada:) hcontractorsto caramel the project(See ]loan owner
and Professions Crede:)The improves
thereon, t _ s•
License taw Joos not apply m an owner of is Couto who builds or improve.,trema.
Cmaraw Laotians for.wch prelate with a Lontmnogs).liccnuil Pursuant.to the ... .. .. ._ .. ._" .__.
El I.,a exempt
piLOrderse See
- ❑I ren exanpt ander Sec: ',N k P C Gn this mason ' •
OYanter Date -
WORKER'S COMPENSATION DECLARATION
-• Ihereby alFm,underpeaLty ofperluryaae Othe ElLavingderiumtiarm
ata m
0 I have will maintain is Certificate consent ire self-mems,me Workers
compensation, a, pnrviJed for by Section 3700 nI the baba, Coe. Tor the
-, performance of the work for which this permit is issued.
O I have and will maintain Worker's Compensation hisman um,as required by Section -
37W of the Labor Code,for the performance of the work for which this permit is
issued,My Workers Cm pensatinn su
lnmnce causessfandd Policy number are:
Cartice-� ....i.,,"Policy No.:
'CERTIFICATION OF EXEMPTION FROM WORKERS - ' -
COMPENSATION INSURANCE.
''•'- "jThis eition need nm be n'mpleeJ r hcpermit,fim uchtedreddollen t. is
(51 00)or len.)
1 cenifY that in the performance mf the work for which this pronto is issued.1 -
u
shut
CmaparEsn'5 Z ANT:It, Itey tttanacr n� jtt, an - r
Com u p y any prison In an c t Econ est 7 t the worker
cran
NOTIC
awe Cap( lifapt
penin' is—.Doe
maks rsCe lof th a m u aaharim
z bacrum oily the sorkch Conyevar his pro it hall be
the Lubar oa,m ou hunt
Q Q forthwith comply with such provisions or this permit shall be dented revoked.
f" CA ' ;CONSTRUQION LENDING AGENCY
C ' 1 hereby affirm that them is a construction lending agency for the perfumtunce
of the d'� r',Name which this pcnnit is ix.uad(Sec.31W].Civ.C,1 Lenders Nac
Z Lender s Addrea -
U'0 1 cenifv ohm I have mad obuk applicam.and mase that the above information is
cotmt.I ali t°comply with all city and«mnty.ordmances mad.tae hma mi
Qv(� 1.building o:nn nandlon.and hereby eutbmine'repreuntum'es at this city to enter upon
;a, the ahnvr-mentlnned Puri fpr inspection purposes.
d Iwoague msmut,indemnify add kapharmless the City cf Cupertinoagamt
u-rn liabilities,jud exMover which may in any way accme ap em said
U�7 City in ' .'nonce }mon mf this permit.
AP'. ANTU ' .TANDS NDWILLCOMISLYWITH'ALL NON:POINT Issuedb Date
Re. IONS. - y:
Uate.
I"
A7ARDOUS NIATF.RIAM DISCLOSURE - Re-rOOfS
Will the applicant or future building acupw mom or hadle mount material Type of Roof - - - -- -- - -
CnJo,Seel m the Cupeninn Municipal Cole,i hapmr 9.12.and the Health and Safety All roofs shall be.l
vis seetOd bnhe C.Pturi / ,.". -
, �"'° q "• .. nspected.prior_to-any.roofing.material.being.installed...
Ai Wlllthe upplicantolfflum building acupam use equipmentor Javice,which If a roof is installed•viithout first obtaining an inspection, hagree to remove
emit IwearJnUs ter ca Unatinams as defined by rhe limy Arca Air Qualhy Management
pidamer.- �/ all new mate inspection. Applicant understands and will comply with
9 ” y" all ret sour. r gulations.
' 1 have read the haaa doses,aerials requireorms under,Chapter 6.95 of the
California Healt - 'mons 25505:25533 and 25530_(andersmnJ that .�
if the but nt have,a tenant, it is my responsibility to notify th —
af the r telt must he met prior t6 issuance of 0 Cmtifivau o
apo"`y' / a icant Dale
Data All roof coverings to be Class "B" or better
' OFFICE