02010109 OF
CITY
I BUILLDI G DIVISION CONTRACTOR INFORMATION:
_ _ PERMIT
BUILDING ADDRESS: PERMIT NO.
10466 WESTACRES DR WING' S ROOFING INC 02010109
OWNER'S NAME: APPLICik9TIONS BDATE
TSENG CHEN YANG 561 RUTGERS ST 01/28/20,02
PHONE: (510) 481-3818 SANITARY NO. CONTROL NO.
❑a Z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E w G BLDG ELECT PLUMB MECH
T f-1 I-t LJ
Z 5 H= LICENSED COM'RACI'OR'S DECLARATION Job Description
O Z-G I hereby athrm that 1 am licensed under provisions of Chapter 9(commencing
Puns-w with Section 7")of Division 3 of the Business and Professions Code,and my license
T/O WOOD SHAKE INSTAL INSTALL 30 YRS EL
�� Lie.. Y.r SHINGLES .
O a, Da Conuvcmr .[ YIv�
' 3sorn Cr'S DF.CLARATI l F1�VALGD
rcz O g sl understand my plans all ba used as public records
w a o D Licensed Promoimel FEB 0 7 2002
OWNER-BUILDER DECLARATION
X-i, 1 hereby affirm that 1 am exempt from the Contractors License Law for the
C?a following reason.(Section 703I.S.Business and Professions Code:Any city or county,
Z F O which rc,um.a pent it to emoomel.aha,improve,demolish.or repair any structure
se
Ca pnorto BissuancaaB the pplicmtfo hpermitmfileasignalS achom Rijii ni G . , $78 ... _.. .
oleinlicensedn_(h : puc,amt the p ism of the Contractors License Law(Chapter 9 .Sq.-Ft. Floor Area 1^,I iif 1 Valuation
nbg wnh Sect 1]000)of Division 3 fin Bsiness and Prprgssmi Code) �,'t.)�b rf s..<A.- { i)Lt 111;;'sr 9y.°'e'J t.J llsl.`
or that he is exemq therefrom and the basis for the allei emmtiniba.Any violation
-of Section 703L5 by any applicant for a permit subjects IM applicant toe civil p...... ,
'°four..,ban five hundred dollar.S500). APN Number 1 o:g•,;il-t Occupancy Type
OI,asownerofine'roan,.many employees with wages as their sole con froution.
will do the work;and the structure is not intendedor offered! =]a(SEC:]Oda- ---------- - ----- -- -
Business'and'Profess ons Code The Contractor's License Law docs not apply to an 307 - INSULAT M4bired Inspections • +-
owner of property Who builds or Improves thereon,and who does such work himself 601 - ROOF TEAR OFF
or through his own employees.provided that such improvements are not intended or
ffered fog sale:If.hbweveT, he nuildih4 or improvement R sold-within ons Yew of '-----"-- —"-"- - -- ---"'--- ----"" --.--"--�--'
(completion,the owner-builder will have the hurcen of proving that he did not build or 602 " ROOF -PLYWOOD'NAIL::
improve fir"mposeafsofe). 603 - ROOF BATTENS
- - .. ._ _.-_ . .__. . .. _. - .. _...--- — - IN-PROGRESS----
0 - -- - - -- ----- -
_ 1;as owner of the property,am ewlusively contracting with licensed contactors to 6.0'4---'-ROOF- - er;i:;�',�i:••I:�''- ^-
o.tabu,the project(Sec.70".Business and Professions Code'The Contannr's i' n:rt L."A-lilt
-s-'-
and-who
Law does noirapplysuch
to an owner with
property who builds or seimproves thereon, {
_ .. _and who.comactseL such pmjmts with u comrunorts)licensed pursmat m.the. _.._ -----
Contractor's
_ C nam cxrs License Law., _
,.,. .,. �.,4 . ,'�- ��'&PCfor this rtasan Ip.+ is:' � -
_ clam eaemPtamer sea ;B ,. ..r;
Ownd..•. . ,r .Date r:. , ,
_ - 'WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and ssillii6main a Cenificaie of'Cons cat to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code: for the
"`- perfommnce of the work for which this permh is issued.
- O 1 base and will maintain Wdrkm',Comfonsaimi Iniumnce,as requited by Section
3700 of Ib labor C de for the f rtna c of ih- brIs for h ch rh s'pe di
ism, My N•or rs C pe t I ur - d Pol crY-f tube tie: _ _
Cart 1.1 (•�GCTIPI A_TIONO tEXEMI'TIO PROM WORKERS '� s,1 X11 +�.?'14, ✓,.yl 6�'�1't{�r4.�'a/a^y. M1 ('ANT, -' _�", J---•c "it P -�'-`-_---_-
b' COM1IPENSATION INSURANCE-�� a t'
`I':' :'(This,s'cet 1r'n,E I not rte c°mPlcled if the permit is for one hundred dollars r'_1.�, �:fl ll.-I `�Alt '' - rtes. '
(5100)or less.) -
-a.. %
th erm t cn ._ ----.
Lcen fy that n th Rif nce'of it k wA'h his',pi I - - - - _r__ l s t•• I
shall rm emplr y any pm crsi any manners 'a. I r 6edmn sub3en uitfie Wmkeus
Compensation laws of Calif rrob])are" " ''
.'Applkant.' t .. .. .... ___... ___.. .._.
NOTICETO
ANTIfrov�io g this Cer.M1all rbc Exempmvokcdumu
TO APPLICANT:If:uftcr makin thisCm..ns.1 h Exemption ou should +A'' + ' <�• • +
ecrood
beolovi 1 penin pct must
Q Q forthwith cum I with such ns.,,his
eA I CONSTRUCTION LENDING AGENCY '- ''l,' ` •s'
Ih �by_If maul ns i ledinga8 ,Yfrtheperfo ormuce
> of the work for which thspe.it is issued(Scc 3097•Cie.C.). - ..r.. ,___,:
lawI cent!,Nat I have read this application and state Jur the above information is --
ri.'E., cbriect.1 agree m comply with all airy and county ordinances and state laws mining
Q;.VIPbuiming crosiupion:xnd hereby aumi represpnmpves pfffisc!ty memertip,n
.; W, the above-rumloned property fnrropention purposes.. -
E.. a. Mel gree io ve ndemddy and keep Lobb s the Oty of Cupcn 'o agriou
W liabilities 3udgm mi costs J peso, Inch, y any y c g in t said '
U'Z City 14 c f theg I g of pe t _t,' D
APPLICANT UYDERStdNDS AND WILEMPLY W I HALLN NP01 Issued by: r to
SOURCE&UL 11OfS�a d
Sight`` IIalApfil cfi1?�tL .' 'Dam
-'' HAZARDOUS'MATERIALS DISCLOSURE �; t A Re-roofs
w'nm pprc t rt building« pmt stileornrdl haaalloumammal . Type of Roof. ._ _ . . .. -.._ __. ...--
as J f d bytth C pen n M p I Code Ch pr 9 I nd to H lth d Safe,,
A e R s
.. 1. Asa-A I..jA ' iii rsrA{ Y\j' 0. ` II`i`1 I
CMl' jOclon Y. i5�610� I ON 1. t s I:ls i„t�s -' JY
All roof's shall be inspected-poor to_any to material being installed.___ -
I,, Wi If he pplicam or rotfouire building p I use equipment or device(which If a roof is installed without first obtaining an inspection, ('agree to remove _
emith .d � contaminants definedbythBay Area A Quality Management
I et all new materials for inspection Applicant understands and will comply.with
13 Yea ❑No , -- all non- o t so�rce regulations -
I h mad! he hazardou. I r Is q' unu under Chapter'6.95 of the
California
al fo a Health&Safer,Code Sections 25505.25533 and 25531.1 understand m t - --_--. t _
'I theb Id gJ ate rlyh at flhm tis my apobltyt ify the - '- -- -
- cu anp r '0 usrb Apr°r m' n feCenif-ate of -
'I\ 'tQ�{1 D� �i ijv Signature of Appltc t Dat
o na r ',, 03,E.r- II roof coverings to be Class "B"or better
ace m of he I titch m
um Cizcd a8 t
. .__OFFICE--..