02040059 (2) CITY OF CUPERTINO
. : RIORM
BUILDING DMSION PERMIT CONTRACTONFITON
� t
BUILDING ADDRESS: PERMIT NO.
ROOFCO OF SILICON VALLEY 02040059
OWNER'S NAME: APPLICATION SUB DATE
SON JINSHU AND KEIBUN 844B EARLE AVE 04/15/2002 .
PHONE:
SANITARY NO. CONTROL NO.
(408) 795-3335
O ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
L—i
ID 1 heLICENSED CONTRACTOR'S DECLARATION lob Description
ID_ reby.M.that I am licensed under provisions of Cha mr9 knmmencing
„t-y wild Section 7000)of Division3ofthe Business yh professional REROOF
m y u in full form gnd2Rgc{. &
m 6 License CIasJ` .0 h / Lic.M51
csioum
3 ARCHITECT'S DECLARATI011
8 5 1 undcumnm my pWN shall W used u public RATIO ✓ ` /�
�p O Licensed Professional /
;Z fY OWNER-BUILDER DECLARATION
RATION
I thereby.(Seat the I am a=mps rmm the Conuanm's :Any c Law for the
C?< following reason. emioI 7030.comm Business and Pro@uiam Code:Any city m county 5 0 0
sF o which requires s Permit to ronswa,olur,improve.demolish,m repair any ervaurt
i 3 -which
" snce.alsarcguim the ap�licam far wch permiuo fleasignem smmmem.
d(y hthsJistnspi puRuantlo thp'phviuonsorthe Conuumts License Lew lChnp¢r9 --
1<omtxneingynth;$tttion�oaoy oroi.naian3anne safmaraw Prpksriom eoae> _ .k36�`(7 h�' r:�5ai:'t'.1"2Vf'I'til ; Y Valuation
or tWt he is`<admpt thaierrom end the basis for the alleged caemPion.Any violation '
-rof Sl no10313 by eny oppllcontfain ;nitaubjcolhcapplice,tact civil pamlry'� s �pN .,_r.... Occupancy Type
,of mat mare then Il-heMred toil.},(ssoll. 3 0 7_- ''� E
❑1..,owner of the property,tar my cmplaycas with wagas as their mle compenmtion,
-:win Eo ince sJm and the rix LTi not mcirsdo or llered for'ur(See-TOli.-
tBusirieis and Professions Code The Commctor'a License Law dors not apply to 6 O 1 - ROOF TE�A9�D�FInspeCtlOn$_an t`.<`t=T::r
owner of property W .Wilds or improves thereon,and who docs such wort himself
_orthro ehhso nemployaespm,-dae,Nta<n _,pm.<nKu w iendaeor ,--.. 60.2_.._- •ROOF PLYWOOD NAIL
m this fo 1 If Howe er do re Idmg o mpro tis mid- th o a yea of —.-. -.--. _.___" —
'completmn,theowner-Wilder will have the Wmen ofpmving that he did not Wild or 603 - ROOF BATTENS
improve for purpose of via.)' 604 - ROOF IN-PROGRESS
,1:: O t:asawner oLdu property,am Business
and
Profeini withodemed i Contractor's
onte oto so JIC�L•:'<i JI:'a'4IT IJ?('
consumer the does
n (Sec. to a owner
erM Profusions Cade:)The Conten tor, t P:.I,•ds >2f.r;
License law macs not apply m an oxmr of prapcny who Wilds or improve thcraon,
Csumum ewiceal.for..1. d u.widr•cmuaat
'. Clb+.'. .L,,:.i.::, nsed.purvuorm.Ne.
(:+- Conuamola Liceue Law.rD�ra or(q.0cc
❑lam aaemt under See:' ' BRPCfarthis Ramn t_O .):::�i:`:P:1❑
:dam ......p.. t. .... _ _
- _ Ovivn I
M: .. Dates
s ':, WORKER'S COMPENSATION DECLARATION
1 ha eby efimm under permierjury one of the following declarations:--
❑ 1 here'ondwill`m m�n m fCmiflumc bf C.. d io elf-insum for Worker'.
I'I Compensate.,as-provided-forbY'Section"'37W of the LeW, Code:"for'Ne
podemook.of Ne work forwhich dtu pcmdt u issueA.f•:
❑I Imve andilltmalnu Worker':Compenaeimn lmissi me.as ha 'phi by SKtion
3700'6f the Labor Code,far Ne performvtc of the work for which this"mrit is
issued My Worke7s Compensation Into
e tune a B Pol cy wmbcr are —
�5 ... .. _-
ksLnm da .-a.. Vt ity No `�Ii�'��6 JO yG �. r.
tiry - a t ' _ ` .(st {� t i t'ri's ClCdt it ^
. • " ERTIFlCATION OF PIONFR M'�WORKEM$1- �• 1 '• a,Y. t • • - r. ,
..t a .. ..
-_.L..,.__..,COMPFNS,AnON.WSU
-
:hT:• (IDsu<t on need rwsWslo pinI if the permit is fm one hundred donna
Is 100)o Ica) _
` ..,II at ntheminany ee of Ne 'workaY xMch NB rote sided"'I J -
shall t mploY,onY.f Calif any marine .mato bacome'mD)cu to the 1Worken'
Goppm peon V s o,,Cal Tome Dam"
.NOTICE TO lZWW.If 06ntruNp mTcee[he a ',� 'a 'd; ro ''„p-•.,
.making puomayou zhould
Z become subject y wit Worker's Comyansadon prov it she of the labor Cod,you muss
0 fdNiwiN tom w mi sbch'provisions or this permit shell W dammed revoked. i
Ph
rq °111 t''tCONSfRUCTION LENOMG AGENCY' - ` ' 7Lr'X7
E” _ :�I hrrebY aRmi Chet Otani consuacuon IervJ y ajeney for tW ij:perfomuim c. L s
w'a' o(ihe work farwhich this peanuts L'eissued(Sec.3097 Cis. -C)
.ye..�..t.�. .w. ._ ....
GQ ..... _ _..,_._..... ., ..._. ._.. . ....._ _ .. ._-.._.._ ., .......__- .._ __.
;D-Z Lend aAddrcss - -
U O .,11 1 1 , _. p .
y I cert fy that 1 he,a read this'application and rmm the the oW c information is
Ll,:[. correct 1 greet comply with 11 ty and county ordinances and state laws mleting
fJ totheWilding out ei un and h for
tct.. posenmt Ks of ilhicrymc tar upon
>a La the aW a mem d pmpeny f ify an keep
p harshh,. _ - ___._
FCC.! (We)ejree iii leve lndcmnifyand kcephanneyi.Ne`Ciiyof Cupertinorut
h liabil t ryd ta,costa d expe s s xh qh m y ny way crve egain,rseid
U Z Gty anis rt e gmntin8 of th pc t '
A Oq't' DSANpN ]yfOMPLYN'ITHALL�ONPOL�Tk' r Date ° L
ce R 'Lir y l�h -2� Issued by:
g rvrt ofA Pl can nuema - r) 1 m Re-roofs
HAURb0U5 MATERIALS QISCLfpSURE
;�xsnthe.ppl¢vramtmaWud.ni pmteneo<nuMlen.ataaa.no a . Type of Roof .. _ ---. . ..--- -•.-.. .. . _..-_..
u deli ed by lh Cupen n M clpal Cod Chapwr 9 1?u:d Ne H<Wh d Safety 1-r. --
Code
_All roofs shall be inspected pnor,to,any roofing material being.installed.__
rl''.1 WJI the pplinnto.f we Wilding oc<upaf u 9uipmentod res which
emit havrdo s conuMnmrs e d fated by dR Bey Art Au Qual ry hlavIf.roof Is installed without fust obtaining anins Bon Ta
ieetoI�r^e-m-
Dtabte t ove
element_ ._ all new materials for inspection. Applicant understands and.wil] comply with
v
.�'.r, all•non-point source regulations;
C.E ant of the gthrhu Haus mat els re u prima and 2e Chapter ti 95 of Ne
t 2pomi I vndo iii d the
poico
]the Wld dee of cunen0 havc`selc that mifmmccstbtllt;_hm Ytha
Cehfom a Health&Safety'Cade Secuons 25505 355]7 and \,
f Y Y !!a
ti mmcnu loch usi W m tuarm of s tfcam of
t .�t-Gv_. -SignatureofApplicant_ ... pate,-_. �
e v nam q age t . ;y .,.,,, _ m.:. All roof coverings to be Class'rB"or better
...... ._OFFICE.-'"'
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