00090051 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
I UILO1NG ADDRESS: PERMIT NO.
ROOFING 0009100511
OWNER'SNAMr10206 SANTA CLARA AV PL CATION SUB DATE
wri111
ONE: YU SHIH Y AND LU CHIN C b8bli WINFIELD - SANfrnaYNO a IN).NO,
w J CARCHITECT/ENGINEER: — 1tUIl,UIN(l I'IiRMG'INFO
a BLDG ELECT PLUMB MECH
GFaN
ON
LICENSED CONTRACTOR'S DECLARATION ' Job Description
I hereby nlfinn thw].,a IiecnnW'unJcr pnrvisianx at Ch 9lu+mmcncing
2_F°W with Sacrm7000)ot luskian Sol'the Imonassmil'ndanians Code.aNmy license 's
-I in full Tome an If c
mz�a liacme ala„ :t,3�-- Lia.N� � REMOVE TAR AND GRAVEL ROOF AND INSTALI
e' e a U I ableWar, D Cunvucen.
1.1c f.ARAfIO
1 underxend my pmnx,hml x cissa ax panne man DOWN ROOFING
a a°° Liccn>cJ I'n+ILazinnal
OWNER.BUILDER DECLARATION
w m 1 hereby.offna that[;all exempt from the Convnmor'n Licrnve Law for the
C ¢ follmwing ne son.Notion 7131.5,Busies,and Prole,ona,CoJr.Any city m aonmy
M which Ary pc n c t cl It p J Lh p Y.w[mre
a 5� prior r. : -
4 theapplicant t l h pa 11 file signed statement
that he butansidp 0a,mvisions altl c t tor'�License Law(Chapter9 Sq. Ft. FloorArea Valuation
(,mannearecing,wtn Section 7000)of Ussion Jot he Business and Prfe: n-Gde)
or that he is exempt harefnsm and the oasis for the alleged exemption.Any violation
of section 71131.5 by any appnenmt tarn parmh xobject,theappheant n,a civil pooahy
of inn more than five handmd dollars ls50B. - All Number OccupancyBTy�eO
❑I,as owner of the property,(it my cl luycc with wages as their sole compen.ation. _ SS //1YD1
will do the k d the structure of warded er uncred for sale(Sec.70a14.
Business and Professionals Code The c inn Law does not applytoan Re uired Inspections
o�w fprpcny Whoboldimprovesthereon,aJ M1 d h workh self - s �^
agh h-ova ply l ov and hill h i p ave o il t t mad of 326i_c005. 0
offelnd f rWile.If.fawner.the building or impmvcnal is sold within ane year of
h+mple ion'me"xnerinaidder will base the burden of proving that he did not build or -
,tprove pamo,cit 305 — FRAME
C)1.as owner of property,am exclusively contracting with licenced aontmemrsto 307 — INSULATION '
on the project(Sec.70,14.Business and Profexsionx Ctxlc:)The Contractor's
1-i saw l.aw tax,ant apply to an owner of plopery who builds or improve,mereou. 601. ROOF TEAR OFF
and who c i1noots for such W project,with a csurna licensed pursuant to the
Cmocaums Lfccroc Law, 602 _ ROOF PLYWOOD NAIL
❑I an exempt trader See. ,11 xr P C lot mi,national 603 — ROOF BATTENS
own`r WORKER'SCOMPrNSAHON DITCLARATION 604 — ROOF IN—PROGRESS
I hcrtby off tin under penalty of perjury tine of Ilia(ol lowing Jedatationa:
❑ 1 lime and will maianin a Carliliene nlCou-in to mlGinsac I'or Walker*, f
Contpcehe provided for by Sermon 3700of the labor Cods. for the
pe [
rlormemaneco of the work for which this pemtit is issued.
C1 have and will maintain Worker's Compensation Inwrmtce,as requirtJ by lection
700 of the Labor Coca.for the performance of the work for which this permit is
wed,Myy,(Warrkai ss Compon sauna Insurunec currier aull P mhcr In'
comer!1_L1.G 'UD policy No.: ;>O S i• VO
CERB'IFICATION OF EXEMPnON FROM WORKERS' ,
COMPENSATION INSURANCE
(This section need not be complcta l it the part is for nae hundmd dollar
Shot or It".) '
I sanity that in the performance of the work for which this fill is issued.1 _
shrill not employ any person in any naraler so as In hecnme xunjcet to the Workers
Cno,sen,aion Law,of Calibrator Date
Applicant
NOTICE1fl APPLICANT:IL after making this Cenilicae of lacmptinu,yet,should
become subject u+Ihe Worker,Compusatim,pmvi.inn,of me LaburCde.you moa
t�Q O fnnnwith comply with such pmvi,ion.lir his permit>hall lie deemed mvoka.
CON ti I'kUCI'[ON LIINUI NO AGENCY
„F1 I hereby aRnn ma he.is a corsamnion leading agency for the performance
of the work lin which this pemtil is issued(Sce.3l Ci,C.)
S Q I.cndcr',No e
z Lsmdcr's AJdre,
V Q 1 eerily that 1 h:rvc laud this appllcmiou and sena that the abuse information is
W P cornet.I agree u,comply with all city Ind county nrdlnunees and ,are laws relating
0 m building construction.and hereby authodrc repmxntatises of this city to enter upon
(rry] theaK xa-mentioned property for inspection purlxoes.
t d (We)agree to save,in ftormiy and keep hondass the Cay of Cupeninu agaimt
lA lianilitle.s,judgments,costs ami expenses which may in any any accrue against said
V - City in cam s,manee of the gaming of this permit.
^ APPLICANT UNDERSTAN SAND WILL MPLY WITH ALL NONPOINT IssUedb Date
t/CC EGUION'. i LA /`/K ipd y'
Sii rmcn Ctm"namr Dam Re-roofs
4ZARI)OUS MATERIALS DISCLOSURE
Willme ti ficaa 1t,future budding occupied core m handle na.,wnex material Type of Roof
s deinol by the Ce,mono Municipal Coca,Chapter 9.12,and the Health and Safety
Calc,Section 25532(10:'
Ell It's F7 - All roofs shall be inspected prior to any roofing material being installed.
Will mcappreaot ar Emae brrldill,occupant now eaainmem ordit which If'a roof is installed without first obtaining an inspection, 1 agree to remove
,,it Incomem s air contamhdmts as defined by the Bay Area At,Quality Muwbcmcnt
Altace lcNt� . all new materials for inspection. Applicant understands and will comply with
°Ya° all non-point source regulations.
1 have mad Inc Safely
room notions 2 mqui25533 a under Chapter 6.95 0(Ills T
it
iling lthdu Ns Safct Gds Sections it 1Jand2553i.lundenmul that �!_/// � ] V
if the building dam nil cw'rcndy ham n lcnunl,IhaPon'toy,aponsiblliry w t fiem me l-
mecup nt of the requirement,which all he lid nonce of a Cenilicme or
O""p'"`)'' /,,z'_Jd Signature ofA lic• Date
Ow eror,athori,.ed—�e t —
Data All roof coverings to be Class,"B'• or better
OFFICE