00070087 (2) CI'BUILDING
UCUI N
FRTNO
IL NPERMIT CONTRACTOR INFORMATION:
RUILDINO AOf)RIiSS: I'ERMI'I NO,
21054 MARCY CT COSMOS ROOFING 00070087
OWN12R'S NAME: APPLICATION SUB DATE
HSU TSEN G AND HWALIN H 450 SAN ANTONIO RD 07/14/2000
SANITARY NCONTROL NO.
(415) 493-6373 O.
0.7 ARCHITEC IENGINEIiR: BUILDING PERNIH INFO
.0c HLDO ELECT PLUMB MF.CH
i.E IJ =l f=1 G7-1
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vow LICENSED CON'TRACTOR'S DECLARATION - .lob Description
Z z 3 I hereby inpon thin I um lice..,✓undo,provision.of Chapter 9(c-mmencing
�° wahseeann7lRxnoflavisi,maoflheEta.int...nndrmrelinn,Code.and,nylicense REROOF T/0 SHAKES, ADD 30#
x m sr ix in lull force nn,LL..{{Irµ �. /D' p
w¢ Lieen.c Qlpa/ CL-7_ Contrat,lo9 Lic.k r O_
ARCI 11:1PC DIiC1.ARn'nON
°—I O; I nndcrsbnul my plain.ha11ll M1e anal Is puhllc mn,rJ.
u6 Llcertad 11rnt'asnlo..al
ydCO
OWNIIR'Iel1Ille,t DECLARATION C1on TION
rKi,o 1 hereby alma tins I L caen,pt,rain the m,,in Cos hale,,,law es the
F Z>' t-Ilwlt ma reaaoaeollk(Section 711.a15.Il,aIle, and Prooe.c all li Calc:Any city eel can my
se t p wh rl ssu e. it I f t p r,i 1 d ilial, p" y.denent
i3= am
prior I y pr tnto,or
lianal l hrermrLic L J_Immem
mann n. epursuant I In p o.. ram Contractor's l w .to Co l9 Sy. FL Floor Area Valuation
(,am,aheeI,ewith saaaoan Tian
and Barisisa-rma It,edesand te. An, Code) S10625
01 mm he i..caer,ml memnam a„d m-n-..k.Tor tar anegm eaemmmn.any viown,&,
of Section 7/31.5 by any applicant for a Knob subjects theappllcanuo a civil penalty APN Number Occupancy Type
of in,more Ivan five nundnd dollar.(5500). .
❑1.a.ownerofthepn,perty.ormyemployeesw;d,wage.astheir.olecompereaaon, 32654031. 00
will Jo the work,and the structure is non intend,,]or offered for sale(See.7941. Required Inspections
BusinessandProfoe.ions Code:The Contractor's License Law'does not apply In an y p
crane,of property Who build,,,improves thereon.and who does such work himself 305 — FRAME
or through his own nnployeu,provided that such impmv,mre enu anm intended nr
offered far sale If.howonr•the building or improvement is sold within one year of 307' — INSULATION
cnmplelion,me owneoWilder will have the burden ofpmving that he did not build or
improve for nnposeofame'I' 601 — ROOF TEAR OFF
❑1•as owner of,heproperty.am enclusimly contracting with licensed contractors or 602 — ROOF PLYWOOD NAIL
construct the PoNel(See.7(94.Business and Professions Cwt:)The Contractor',
Lm
otr>e Law does all apply inanowns,of pnpen,who build,or improves lineman, 603 — ROOF BATTENS
and who roriont s for n,ah projects with a umuacno4q licensed purmum no the
connocnor.l.ir,o.eLaw 604 — ROOF IN
—PROGRES
0l nal escolp,ander Sec. .B&P C for this reason
Owner Dune
WORKER'S COMPHNSADON DECCARNHON
I hereby avant muter penalty of penury one of the following J,rlamfom.:
have
and
will a,unmhn a clailical- of Commcl n,.eRannam roe Wnd.cr'n
0.. ovation,
as pro ted Tor by Seeno. 3700 of ,he Lab... Code. for II„
Krfarn,nec of the wank tier whi,l,this rcl o,I,i...ed,
and will maintain W..Se,Compcmahoo doemom.as myuhed by Section
.7a1 of the labor Calc,for the performance of the work for which this permit i.
issued,My WorkersContKarabon hionno ce carrier and Policy number arc:
G.vrie,: iii �.-.rahty w.:57/—e0'/�z�
ChRIII ICA ION O'EXEMPTIOfn FROM WORKERS'
COMPENSATION INSURANCE
(thi.,Sanion need nal be completed&B,permit is for one hundred dollars
(5100)-1 le".) - -
1 eendy that in the perf,nnance of the work for which this permit is issued.I -
Shall not employ any person in any manner m as to become subject to the W'orkers'
Cornr,n.ation laws of Culifamia.Date
Applicant
NOTICE TO API'61CAN'I':IL slnr making oris Cenifcan of Esempnion.You should
Wa,me subject n, he Walk.,,Con lven.ation moviaiana of the Labor Cesiv,"u nar.n
Q O orthwinh mmphy wan Such provisions nr this pearal.hall W deemed revoked.
F5� CONS'I'RUCRONLIiNDINGAGFNCY'
a ' lochy Olhan Ihw Them i.a mnattuction Trading agency for the performance
W o,the walk for'bull thl,permit is r and(Sce,3097.Civ.C.)
Pee Q lander',Nunn .
7 Lender',Addres.
UQ llenity than nave'cadmis-ppncation and aunetnm the ass,inkann ion'u
Is& t•.r coll'ect,I agree no caruphy with all city call moony-nllnnnces and smm law.ml.do, .
Q U InbrLIingcnn,Imenian.:md hembyalli rim rcrtmnanov,of in,city ,,enter upon ,
�] he abovotnmioned prole%far inspection pnrpn.ea.
y (We)ague nave,indemnify.,it keep harn,lee.,the Cay of Cnpcnlno ngain.I
Vi liabilities,judgmenls,coals and enpense,which may in any way active agalns,said
U z City in cnnseyuence of me granting of thin panni..
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RBOULATIONS.
Sigaamnornppli...trco,arno Dan Re-roofs
I IAL\RDOUS MATERIALS DISCLOSURE
Writ the appliant or futum Wilding occupant wl
store or hae havoil mamrial Type of Roof
aS defined by the Cupertino hlhdcipil Code,Chapter 9.12,and BE,Health and Safely
Code.❑yes 355741.1'1
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant(it future building necupvntuse equipmemlar devices wmnt If a roof is installed without first obtaining an inspection. I agree to remove
emit hatras out air contaminant.m&-fined by the Bay Area Alt Quality Management
;,Tritan all new materials for inspection. Applicant understands and will comply with
G Yes ems! all non-point source regulations.
I h I the hajandoes contendsyu t. J Chad 6.)5 ot the
CalifirroaZalIIsnoruyCJ S f 5495051551] J45A31 1 a 1ybut
he ✓/ '��/���V
if1 n r It men nhyl l t than r y r 'n IC Try int
',apanlon C, r,L.wlIao,.nlW,,,prat t-','l.adatr,ra clrll Wnt ,f
0...a,a"� Signature of Applica Ia� Date
7TTL
Uw�,er o,rnnho,;ae -Noy D,r, All roof coverings to he Class"f3" or better