03070237 (2) CITY OF CUPEWHNO
BUILDING DIVISION PERMIT �CONiIRACTOWINFORMATIQN. f;
R Or ADDRESS: ALL SEASONS ROOFING SERVIC �RMITNDO 3 0 7 0 2 3 7
OWNER'SNAME: 2640 PACER LN PERMIT ISSUE DATE
DAI HUANG 07/31/2003
ONE: 4089724455 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
w❑ I hereby affirm that I am limmwd under provisions of Chapter 9(commencing Job De tion
,. withSecbn nofDivision3oftheBusiness Professions Code.and my license is ��ee
I
full fore nticffeo REROOF ■vA.Ix..E�
'tj? Licenu ss — Li
�I,p Dam ICumrac - Q ,g
2003
ARCHITECT'S LARATION SEP
uI undcrstanJ my plans shall W used as public records 4 s '
¢tatLicensed Potfesaimal
tiCs OWNER-BUILDER DECLARATION BUILDING'utl<E I hereby.]Frim that I am exempl fru.Inc Conlrecmr's License Law far the BV L/ NG
00 following reason.(Secdun 9031.5.Business and Prefemit ns Code:Any city or county
�m which requires a permit to container.alter.improve,demolish,or repair any swclute
,IT prior la its issuance.also requires the applicaul for such Permit in Me a signed statement 85(](]
E�o That he is licensed pursuant to the provisions of On,Contractors Lia fee Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 70(K)of Division 3 M the B usiness and Prodessinm Code)or 36907026 . 00
F$ Nat he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicant to a civil penalty of APN Number
par more thane hundred dollars(k5W). Occupancy Type -
r I.as owner of the property,or my employees with wages as their sole compensation.
will do the work and thutsuetum is not intended oroffemd rouale(See.706,1,Business 3 05 — g�.�r,�
and Professions Codc:The Cornmemr's License law does not apply to an owner of 3 0 7 - INSULATTO d Inspections
property who builds or improves thereon,and who doessuch work himself or through his
ten employees.pro.ided that such improvements are not intended or offered for sale.IL 601 — ROOF TEAR OFF
however.the building or improvement is sold within one year of completion.Inc owner.
builder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
"1e')' 603 - ROOF BATTENS
rl.as owner or the profanity,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
construct the roject(Sec.7064.Business and Professions Code:)The Conmctor's Lt
cense law docs not apply to an owner of property who Wilds or improve thamnn.and
who contracts for such projects with a contrampr(s)licensed pursuant to Ne Contractor's
License Law.
r l am exempt under Sec. ,B&PC for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby afro under Penalty or perjuty one of the following declarations: _
1 have and will maintain is Certificate of Consent to self-insum for WmkeriCompen-
Sinum.az provided for by Section 3700 of the Labor Cade,for to Performance of the
work for which this Peril is iuuad.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Cade,for the performantt of the wart for which Nis peril is issued.
MWn ku/sC mpeunt;on inaur1nn�cc icraytl Policy number..:
CarilfrJ" .,> /�Policy No.:f.�.
CE IFICATE OFEKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mi.section need not becomplen:d if the permit is(me.hundred dollars($100)
,it leu.)
1 certify thm;n the perfom ince of the work for which this Permit is issued,1 shall nut
employ any person in any manner sur as an become subject a be Workers'Compensation
Laws or California.Dam
Applicant
NOTICE TO APPLICANT:IL alter making this CcNRcate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you moa
,z forthwith comply with such Provisions tar this Permit snall W deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
I hereby affirm thnt there is a convection lending agency for tM Performance of
Ya the work for which this remit is issued(Sec.3097,Co.C.)
13 Q Lender's Name
Y
Sz Lender's Address
J Q 1 certify that 1 have read this application and salt that the above information is -
1.Fcorrect,l agree 10 comply with all city and county ordinances and start laws relating to
^JU building convection,and hereby authorin,mprcaentativu of this city to enterupnn do
.hove-mentioned Pmpe ly for inspection Purposes.
y (We)agree to save,indemnify and keep harness the City of Cupertino against
f/]
liabilities.judgments,costs and expenses which may in any way accrue against mid City
JZ in consequence or Inc granting of this Permit.
APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by. Date'
SOURCE R
7-31a Re-roofs
LU pp ica Conuaztor pat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W;II the applicant or hum"building occupant store or handle hmardeus metrial
as dell by the C.Infl n Municipal Code.Chapter 9.12,and the Health and Safety
Code.Sermon 25532(.)? x
ryes g - All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future building Occupant use a u; If a roof is installed without first obtainin an inspection,I agree to remove
nP sequipment or devices which g
tit hamAnus air conmminanu u defined ray thc Bay Arca Air Quality Managcmcnl all new materials for inspection.
innict?
❑Yes
I have read the havammusma erials regaimmems under Chapter6.95 of the Califor-
aiaHealth&Sadly Codc,Seed..25505.25533 and 25534.1 undersand did iftM Wilding
dire not currently haw a thank th.ilia my responsihilily w notily uranl of the
quimmcn wmenmual meter;orwsavanauracerdRcamarptepPycy Signature of Applicant Date
0 ac aur r;xcd cal /Date All roof coverings to be Class "B"or better
CITY OF CUPERTINO o
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # O Date:
V l
Building Address:
l� � . � R . Cup�V-z v g50IL�
Owner's Na Phone#:
oZ to `4 -E
tra tor: D(Av t Cfes License # I
ContI bcl
a t: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
XWood Shakes Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri tion: T pjr 0 t e D S
E k pitS to 1/ OS lat7e WGi ^
Residential Qodimercial ❑ N u�
Fire Zone:—Yes ❑ No
❑ Confirm d with lanni g Dept. i
there are an restricti ns: LJ
Cost of project-. Q I Type of Construction: O`cupancygroup: Z
. t
A li I Fee ID Fee Description Fee Group
BPERMFEE Ald Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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