02010047 (2) C_IUUOF SINO
BUILDING DIVISION PERMIT INFORMATION:
�• :B3'Ll li ADURE.SS: PERMIT NO.
20584 SUNRISE DR CAL-PAC ROOFING SAN MATED 02010047
OWNER'S NAME: APPLICATION SUB DATE
CHEN DENNIS S DER AND YI P 2515 S EL CAMINO 01/11/2002
.PIIONE: SANITARY NO. CONTROL NO.
qqq' (650) 286-0450
O O ARCHITECIENGINEER: BUILDING.PERMIT INFO
w BLDG ELECT PLUMB MECH
E uJ 0 u 1__I
Z S w b LICENSED CONTRACTORS DECLARATION Job Description
O z�+G I hereby affirm tha 1 am licas¢J under previsions or CM1uptcr 9(rntnmmm,ng
p_tly i, Tia rnnrino)r,rnixi., n Bnainex.anarmresi, INSTAL DECRA TILE W/INSULATION OVER EXIST
QQ S re ran fore.dna Di,, ,(
S�o.K License Cln s v Lic.p �u
j�3 LL Dale�� A S D17Cnm
Yk1 O Iunlcrand my pLns shall he axed, tier M,
Y
c p SO Licenacd Prolecxitnnl
°' o OWNER-BUILDERDECLARATIONRATION
I hereby.(firm o n,I nm exampl from the CmJmclC d I:Any c Lew fnr Inc
followg a which re recta.(Section T03 on a t.d Ruminant ap vm,Bern li ewe:Any cityir an of county
e $20154
zpO which .. ....a__toil re uirest a al¢cnfor ouch
Janrvaitt fior e a sigamuncemre
3 m _nota ficeuance.a..a]1.he no,al..applicant The Era permit miceree ow(Ch¢mcnl p
real 'a"sciri la pursuant li the pmm.oinsnl the Cnnlrua,ire,Liccasc Low Cwh,) jI l �fpA1 QOr/�Igga_ Valuation
.,mmcnctngwithSmief7"awdteha,,, aofthc BnsinesxenJ PmfAn,esCwe) ('llrK l :3 �lV V.Yl OU•'Sd`'•°. 1'�"':
or hot he is ex6npl lneixfrom:mA the basis far the nllFsul cpdnplinn.Any vinlntian
_.of Satiin 7031.5 b any applicant fur a peoul xnbj«u the applicant to stall penalty _ __ .
,of nolmnrethan Evsbnw,wdollars O.S ). APNN,,�,,�e - � • Occupancy Type
305 - FRAM
01,ns owner of the properly.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70<d, - — - - .
Basins.and Podjrs...ix Cod,:The Comramor:c Licrn.¢Law docs not apply m ua 601 - ROOF TE 9 'Inspections
r of property Who huikk or improves themon.and who does such work himself
owns 602 - ROOF PLYWOOD NAIL
or through his own employers.scat building
,hal each in,Tent is sold are nil irdeaded
year of
cared far snlc.IC nosvevef,the building or order f,a, is sold within ore year of
uomple,ion,n,e nwnef-batmen will nave me harnen tr pn,ving loth ne did nm nada tf 603 - ROOF BATTENS '
improve for purpose of sale.). 604 - ROOF IN-PROGRESS
El,oa.awnenrftheproprnY•rmenclu.ivelycomrac,ing with licenseJconvznors,o - ' ..o 1.11 "
naBucl the pr.jcIl(Sec.7011,1,Bii,a ees and Pmfessinns Cwep The Cn.)owl.,',, ,
License Law dins not apply In an owner of property who builds or impmvu theater.
andwho contractsfor such p I
1 ' will t< tor(.)licei,ed larsurant It the
Contareter's Lictanse Law.
❑1 ccmnpl ars '- "� .nxircr nsre.a,n
°wnDale
WORK17R S COMPENSATION DECLARATION
' I hereby infirm under penahy n!perjury one of the following declarations: �a /
( [Ive I hadoll will muinmin'a Cenificnic of Consent m seelf-asnre for Worker's ` ;,
.,` Campenandon. at provided 1'or by Section 1700 of the Labor Code, for the
inufnnwncc'of the work for which this permit is kited.
❑I have and will mainc,Iin Worker's Compaea,ion Iasumnee,as required by Sat
37fM'of the Labir Cattle,far the pitfonnnnecor the wotk'far which Ibis pertfm is
., aatw My :racy' Ca pe x I um ct ¢ nnn�JPoli Y mbe 're:
C. .f.. ..O[��{��C� licy N �'//
1 R' I AI If1N til .%F.MPIION I WORKERS �'�l „'(/ a i;k'e r. !I IL '(.�!. f h ••
('Thi' COM PENSAI'[ON I '
I I s scmiodeced-not hc'cum lana if the Mar INSURANCE,
one h — _ - •— -
'npr p •pc 4 ••nnJrcd dollars
(SIM)or Ices.! '
1'teilify'Ihat in doe-pa,ratnounc—1 the w,4 far which Ihi,pr,iail is inan aL I
Oaf not emplty'any person in any manner so as to became.suatel It the Worker.'
Canpcnsmian luwsol'C.nlili,rtiin:Dnlc ""'
arpfinam,
NOfICEabov to
a Work eI alici liami tion provisions
ovisio s of h Lab rlion;you a must ..
If
bcchwithtotal mobs Wuchpn Cirtip....linpmv Ionall the LoMd Calik you must !
tZQ O forthwith comply with such prtvininne nr Ihis pennil slulll be 0ecnuA revnkcA,
J) n;1: It, "'!' ,CONSTRUCTION'LENDING AGENCY
I hereby i,lconstruction I wbg ager y fordic pe femtance
of the k far which this per l i,
toow lS 3097 Cit.C.) 1
a`Q Under,Name -
Z Lewy agree
U Q 1' tfyt iib Ad PQIb d pl lica II 'b f limit
uric I lug I c ply with II city nJ ty dada cc. d ,I laws Iming
Q U
an
lJ g l 'i Ihercby:I c i mel vI f,h: ,y 1,cn ar upon
[Ta
he ebo l dplapendr Cie.nphan .
(NW)air.l e y akeep l uCcly fCp 1 a,nge ill
f/] Imb 11 1 Igoe t. I pc h ch nY Y 6 Inst.mA iz
ZCity d o equenie nr y my cif it,%p
APPLICANT NU rANDS AND WILI MIIttsl III AL1 NONIMBNT Issued b r Date
M)URCT.IRI: y'
S.. . a t dem r ...,unl. Re-roofs
HAZARDOUS TLRIALS DISCLOSURE
Wilt-a ppl II future boldat,loceusina it leadic1 . I6: .rre, ,l Type of Roof
wit f J by th C Mn M1i p I Calc Ch plc 9 1 i a A th I I hh J Safety `/ ,
Cw ❑Yes I551Lu1 t�,a t , .. 4 •r .r, of }'+,y \1 .•
`'�J�\' 3 All roofs shall be`respected IOT to an offing material being installed.
Wall Ih I t fuI c to adi I sc n c I J x whicL ai '
pp e r arvr If a roof is installed wit .Ins[ obtm g an inspectioti;'I agree tai remove
emit) nN - cmi 1''.Acrncl b)II di yArc:A Q 'IIYM igcna.n,
•mm , ' all new materials foyt ecUon A icon[understands and will comply with
j oY all non-point sours egulatio ,
1� t I h J d e 11 I' ills n CI p, O5 f the /
Califr H Ilh&Suf w Sci .15 2 JJ d255J41 J lad,hn r _
hhl Id' gJ'v C Oyl m II t' Illy cpn allyl notify the �! �— / U �
cccup,nt of,he mens wh ch mus Ipfnrto ssuance of a Cerifcae of
n :• H`ctpancy' re, .' t'; /0 n ture of Applicant Date
% nra ager, ares All roof coverings to be Class "B" or better
OFFICE