00110053 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PFRMII
5914 SUTTON PARK PL CROWN ROOFING INC 0110053
OWNER'S NAME: APPLICA'I ) S I1"r
CHOW JOHN CHI—BIJN AND WININIE W 21.4 CRISTICH LPI ivy�jOFa
. PHONE: SANITARY NO. CONTROL NO.
(408) 369-7444
?az
f 0z= NGINFER: _ I PERSHIANFOARCfILCl/I
MUCHL[cLust
Or
LI
J _
I_1 1�1
�i
y=
LICENSE flim ' COcenRA aside,S ,i'i s,DECLARATION Chan - Job Description
o,_ I nemby anion shin tun of heed under pnd poo s of ChaMer9(commencing
wpm winoSeminre d)mfDivisionooftheHn,inexsanAi'mfession,Ctdc.anAmylicenw REPLACE SHAKE W/ TYPHOON TILE
a x s Lin o, Cease ane erre,.
Y u U License madr Lic,p
Dom Class in
u LL C ARCIII II C9 S DECLARATION
\RATION
I J t I 111,final M1 II he lood n,ad,fic It J. ,
y 0 0 I.sen 11 11 /�/
i ce' y UWNI s,HUp,to i11 Cl ARAIION
u _ I h,Afoul I]as,I ,naIeG Ili,( mat -'1'' Law,f tbe
.(1o.wi h 7031'.5.If 11 I Code Any city otlocno y
s
E x p whun rittlmm., Iormit lu uh tet h e ,psi 1 nnrrnc Jowl vh,or mp,i,acd tiny wernerc
i3. Prun t - '1 La tl III all 'ht n tl 's I.Ilmcm F
did no with
as, ( 1 4 III Co tailor,i Lien,1 (co- ode) Sq. 1 L Floor Area 1j�(
to mgwA,Rulon]Ildl)of e :tool theli n and Prl.A.,nslmion 0117
or has lieiscecnlpt anyap li and the trI Ise the Cll the apsemant to Any viWildly
nr Section7031-1by anyam0donlirapermit vnnlens Inc applicant torcivil pP-^ulty
of nor lm,re malt live ntlhdmd dtu,r,(g5110), ANN Number Occupancy Type
❑1.asownerof the property,(,tiny I oyer,wish wage,as their.mle eomon
penean . .�.r7S3$0.3:- tTm
will do the work,and the structure a not immoded or elfered for sale(Sa.7(H4,
11 am,,and Proo,ion.,Code:'ate Comments',License Law docs net apply man Required Inspections .
caner of prapeny Who build,or inti Ihemon,and who due,such work himmlf 305 — FRAME
ar through his own employees.provided this such impmvemem,are mol intended or
oRamd for ole.If,however,site building m improvement is sold..thin ome year of 307 — INSULATION
iImpletion,the owner builder will have the burden of proving that he did not build or 601 — ROOF TEAR OFF
mprove ser w,,,I'Rolle.).
❑1.a,owner or the Impem.out exclusively contracting with licensed contractors it) 602 — ROOF PLYWOOD NAIL-
ou er the project(See.71X4,nosiness and Profusion,Cale:)The Contractor Lmivenwhwdtes not apply m:mewnmefpmpenywho buildsorimprove%shImen. 603 — ROOF BATTENS
and who cemmch,for tush pnjcct,with a contmmta.)licensed pumuat m the 6Q4 — ROOF IN—PROGRESS
l.i
fe cenxe Law.
E3 I am exempt under Sec. .H dt P C for this reason
Owner $):m,
WORKIiR'S COMPHNSA'1'IUN OECLARA ION
I hereby afiims,odo,penalty of Perjury one of the hdhws'ing Jeclalsonall
❑ I have aid will n aimain a Cendinte of Consent to wlGineum for Worker',
Couiacsallon, as provided la by Section 371X1 of the Lahr Crile, for the
perf..... afde w,,,1,lin which @ice per ail i,i"mrd
Cl I have that will moul'nln Walker's Cwnlmnrnlion Inrurnneq ill required by SCflion
37Q) it lha Labor Cade,tin the ill mu ue if Ibis worg ha which this permit is
sued.My Woder'e('algsnamion Inmmnce Carrier and Pul'my Instiller arc:
I'day Nn.:
CERI'IHC'AI'ION 0I7 EKFMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
(This acoder,ncerl oat he can..fried If the pnnnit is fir one hundmJ Japan,
(SIINH is,lees.) -
I certify that in the p,rfortuarce,of the work for which this permit i,issued.I
shall not employ any person in any manner,o us in became subject m the Worker'
Compensation I.aws of Culifnrniu.Dam
Applicant
NOTICE To APPLICAN'11 It,aher...Ling this Cenircme of exemption.you should
account,subject to die Worker's Compensation provi,iom of the Wb r CWe.you must
Q 0 forthwith comply with such pmvidoos or this permit shall be Jame)res used.
'L
% CONSIR is van,outionION NG AGENCY
7 1 hereby allirm shin them is s nmed(Sec. lending agency for the peRomnahec
Of she wok me which Ibis permit is issued(Sec.9197,Civ.C.)
L Q Lender\Name
7 l<nJcr's Address
V Q I verily thin 1 has,I read this applieu,am and stair Ihal the above inf nmenion is
I,. F., elirrxc,.1 sgsa to comply wish all oily and county orJimneee and nae laws ma ing
Q C.) to building enmlmeion,and hereby initiative representatives of this city no ether upon
} fit the ubeve-nen,omd Poorly lir inspection Purposes,
r y fWeL9raemowe,i;Lot ctilynId Accphurmlu.Inn Cityof Cli'true against
said
.� �_ I
N City in...judgmases,1001uinU ospcnshi which nhay In any wary accrue againa sulk 5
I N"
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOIN'I' Issued by: Date
nounsSOURCE REGULATIONS.
'f A"fllcamlCmnmmar Dare Re-roo� .
IIA%Alt DOUS MAI HRIALS DISC1.0SURE
Will she Ip,liemn or bnnm Ixdlding tavp:nn store or baane hazardous inhaled;J Type of Roof
:n dullard by the Cupe,lino Muaicipai GIli Cll;lplcr 11.12,and the Health and Safety
Code.Seem 255331nri '
El Ye, Cl No All roofs shall be iNected prior to any roofing material being installed.
Will the aliplit'amminsists,hulld..god'eapmmmseegdpmemordwior,Which It'a roof is installed out firs bt' ning an inspection, I agree to remove
o 'it foramina,air et assainam,is,deined by the slay Arca Air(slobs,Manag,owin
Disvicn all new is
f� i ect• ican understands and will comply with
❑Ye, 0 N all no poi t s 6 alio s. eee���t
1 have mad the hamrdou,annelids requirements under Chapter 695 of the I 's
California Health k Safety Coda Sections 255115.'-5533 and 25534.1 undemand this
if the building does not currently have a tenant,that it is my mspunsihildy m relay the'
Occupant of the requirements which must for net prionto izwasrce of a Certificate ofist
°ac"paacgn
y' ' ature ppli a Date
is
Care,ata ,gena D„e All roof coverings to be Class "B”or better
OFFICE