00100143 (2) CI'T'Y OF CUPERTINO '
[WELDING DIVISION PERMIT CONTRACTOR INFORMATION:
❑UILDINO ADDRESS! PERMIT NO.
OW;IV S NAME: APPLICATION SUB DATE
10539 JOHN WY CROWN ROOFING INC 00100143
ZONE. SANITARY NO, CONTROL NO.
TAI WAYMING AND YALI L- 214 CRISTICH LN 1.0/20/2000
M C le AIXCI If 1'f:C'1'112NOINEER: BUILDING PFRMi'I INFO
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F L W (406) 369-7444 BLDG I:LECI' PLUMB Ni
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2 O m zLIC[SNSEDCONTRAC'n)R'S DECLARATION .lob Description
C Z H O 1 larch,Erni[[mal 1 ant licensed under prnvlelnnv rf chapter 9 rcnm aowing P
pmt_w Ivan Scotion'IIXXgnfoivisinnJn(Ihe Puincss unyl�mhoions CS,Jc,and Iceme '
is in full lora ani c[ct.
Chs. I.it',
0Dacl Cont[µ+m
u 3 I_v, ARCHITECT'S DECLARATION /
O,aj 1 underhand my plans shall be used as public records
LL z
w o o
Licensed Professional SHAKES TO CAL PAC
OWNER-BUILDER CI ARAI ION
I h rc a
hereby
ct that
IaexciI I Tn Ihe nf I un Liotme,f r for the
Z Q I'hich g (Section 7031.5.It ss d l f ` xC d e Y city neemne
E F county
.cn ,it I ,t I Are,r. I lis[ p. any vnnurc
aCao Pial 'I y d vi,i II hl tt II 'g dChan,'t
loua tp It m p i If he c to d r Unease I wo.,C.t9 Sq. Ft. Floor Area Valuation
orlimI¢ gw..ama trurnmdIhe vsmt?,Ihe li,ad .,fior.A.,vi Cndc l _
orSec IDI is 131.5 b(tnetufmli and the basis for the allege)exemption.Any violation
of notion]n?L5 iv any applicant for a pm,nit.wrbjed,.the applicant m u civil penalty
III rte lumra Bntn live nandred dollars fssoBl. APN Number Occupancy Type
❑I,as owner of the property.or mycmployees with wages as their sole compensmim,.
win do the work.and the smeture is not intended or offered lin sale(See.7011, 1 SOtaO
Business and Professions Code:The Contractor',License law does nut apply to air 'Required Inspections
of pr.,.y Who builds or ime provthereon,and woe
hit ds xuch work himself
,n rrhnmgh his own employes.provided that such improvements an no intended or
offered IDI sale.If.N xever.be building or hnprovenrnt is sold within one year of 3591 9003. 00
Iurnpltion,the,wmer-builder will have the burden of proving that he did sol build or
mprove Gm purpose of sole.).
01,.,,wact at the pm,crt,am vxcl.,ivdy cimlmrrinl;..,It Licensed comment. 305 — FRAME
I!in.Untcl the pmjtl(Scc.WMd,lm, an,[pool. s C,de:)The Cammnnrs
t c1..wdoe, I,lap,lye,nnuwncrFrpro,d,whnnnJd.,r.nproa.Immo,. 307 — INSULATION
and sun,cnnrm,,, R,t such projects with a convact s)Iiccn,eA purarm,,the
601. — ROOF TEAR. OFF
O l am exempt under See ,II&P C Ga In,reason
602 '— ROOF PLYWOOD NA I I_
owns Date
WORKER'S COMPENSATION DECLARATION 603 — ROOF BATTENS
I thereby than rude,penalty of peij r,oneut tire fon,w;ng deehraiion,: 604 — ROOF IN—PROGRESS
I have and will maintain a Certificate of Consent to self-imum for Worker's t
Comptnatitin. as provided for by Section ?]IRI of the Labs Code. for the
pod more of the work for which this permit in issued.
01 have and will maintain Worker's Compensation Instm nce,m required by Section
?]Ip of the LeMn Gvle,r,r tM Ever announce of theCwork far which this permit
our
C.
d Policy
Curlier Al)- 'I H'I'IfI0Y101'IEXfilMl9'ION FROM )RKIiR
COMPENSATION INSURANCH
fl'Ids,eBio,nem nm be couiplclW it the ,or it ix on true at died dollar,
ISI dish fir los I
1 certify that in the performance of the work for which this permit is issued.1
shall not employ any Person in any manner m m to become subject to the Worker'
Compensation W x.of California Dao
Applicant
NOTICE TD APPLICANT:If,tree,making this CcniBcate of Tsemprimn,you should
heconte subject to Ic Worker Compensation provisions of the Llb,r Code,you must
timhwim comply with such mn.i ar,or this art,.hall be deemed rooked.
FCON mRUCnON LENDING AGENCY _
tri > I hereby allimt that there is a ronsmation lending agency for thepimformana
k7 or the work for which this permit is[sunt(Scc.)119].Civ.C.)
Q. Q
Name
Leader's
_
Le der's Address
U 1 ronil'y tb:d I have tend d s al,dicntion in Lsun dor Ihu nb,vc infer
G4 ley eft.I ogre 1 mply w'an I c and u r y ord .Ind were 1' c rang
Iv
mlung -
U In Mlldiagcornch
rruandnm yumoIa sent livex,fthrx Wil t vqm
the:Iamnnon4 J matter, rinspction pts rtes
F p, IWe7a• ern Eva inJ
may and keep Ennio the City(if C gain,(
(n liabilities,ju acosts a em noes whi n any way atom g n said �.r —
U Z City in t, yu n of ti g f tti mit. O -/ O /�N lY
APPI lC; - . AN .COMP W A l I -POINy'
P Issued b Date {/
iR 10'
awrtof Applir.rV ,ntmomr Date Re-roofs
HAZARDOUS MA iR1AI S ISCLOSIIRE
winleapphtlmorfutureimikim ,tcou'ar 'tore urhaanehaealloemaena) Type of Roof
a,deiand by the Cupertino Municipal she.Ch: let 9.12,and the Health and Safety a
Calc,Section 25532m)'I
[3 ye, El No All roofs shall be inspected prio to any roofing aterial ei g installed.
Will me IIvl,fit�mm Ulnare nandi ,r,un,Ise e9.' ear,,dela.wmeh Ifa roofis installed withou fee obtaining an p&tion I .grce to remove
,,it hwwdoue; c'ullwoninunt,as dtlned by the limy Arca Qudlly Mmagmn
i.tdt'r all new materials for insp on. pplicant rstands n will co fillwall
Dyes El No < all non-point source regu it ons. _
I baso read the hty sic..mat lulx rer 4.
yminmm� a ��
Culifominl &Sokay sic.See n 55115,25sJ and 53).1 undcrt td thnl
if rho bli ng d,ws not can try has t [.Ihu t' msibiT ton ''m
sis iµ-cup t of the rcyuitcme o hic a t ,a,is, a re I em care
nce
7S,gature f Appl' fit Date
F namm,d, I Dae All roof coverings to b Class`B" or better
OFFICE