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00110053 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PFRMII 5914 SUTTON PARK PL CROWN ROOFING INC 0110053 OWNER'S NAME: APPLICA'I ) S I1"r CHOW JOHN CHI—BIJN AND WININIE W 21.4 CRISTICH LPI ivy�jOFa . PHONE: SANITARY NO. CONTROL NO. (408) 369-7444 ?az f 0z= NGINFER: _ I PERSHIANFOARCfILCl/I MUCHL[cLust Or LI J _ I_1 1�1 �i y= LICENSE flim ' COcenRA aside,S ,i'i s,DECLARATION Chan - Job Description o,_ I nemby anion shin tun of heed under pnd poo s of ChaMer9(commencing wpm winoSeminre d)mfDivisionooftheHn,inexsanAi'mfession,Ctdc.anAmylicenw REPLACE SHAKE W/ TYPHOON TILE a x s Lin o, Cease ane erre,. Y u U License madr Lic,p Dom Class in u LL C ARCIII II C9 S DECLARATION \RATION I J t I 111,final M1 II he lood n,ad,fic It J. , y 0 0 I.sen 11 11 /�/ i ce' y UWNI s,HUp,to i11 Cl ARAIION u _ I h,Afoul I]as,I ,naIeG Ili,( mat -'1'' Law,f tbe .(1o.wi h 7031'.5.If 11 I Code Any city otlocno y s E x p whun rittlmm., Iormit lu uh tet h e ,psi 1 nnrrnc Jowl vh,or mp,i,acd tiny wernerc i3. Prun t - '1 La tl III all 'ht n tl 's I.Ilmcm F did no with as, ( 1 4 III Co tailor,i Lien,1 (co- ode) Sq. 1 L Floor Area 1j�( to mgwA,Rulon]Ildl)of e :tool theli n and Prl.A.,nslmion 0117 or has lieiscecnlpt anyap li and the trI Ise the Cll the apsemant to Any viWildly nr Section7031-1by anyam0donlirapermit vnnlens Inc applicant torcivil pP-^ulty of nor lm,re malt live ntlhdmd dtu,r,(g5110), ANN Number Occupancy Type ❑1.asownerof the property,(,tiny I oyer,wish wage,as their.mle eomon penean . .�.r7S3$0.3:- tTm will do the work,and the structure a not immoded or elfered for sale(Sa.7(H4, 11 am,,and Proo,ion.,Code:'ate Comments',License Law docs net apply man Required Inspections . caner of prapeny Who build,or inti Ihemon,and who due,such work himmlf 305 — FRAME ar through his own employees.provided this such impmvemem,are mol intended or oRamd for ole.If,however,site building m improvement is sold..thin ome year of 307 — INSULATION iImpletion,the owner builder will have the burden of proving that he did not build or 601 — ROOF TEAR OFF mprove ser w,,,I'Rolle.). ❑1.a,owner or the Impem.out exclusively contracting with licensed contractors it) 602 — ROOF PLYWOOD NAIL- ou er the project(See.71X4,nosiness and Profusion,Cale:)The Contractor Lmivenwhwdtes not apply m:mewnmefpmpenywho buildsorimprove%shImen. 603 — ROOF BATTENS and who cemmch,for tush pnjcct,with a contmmta.)licensed pumuat m the 6Q4 — ROOF IN—PROGRESS l.i fe cenxe Law. E3 I am exempt under Sec. .H dt P C for this reason Owner $):m, WORKIiR'S COMPHNSA'1'IUN OECLARA ION I hereby afiims,odo,penalty of Perjury one of the hdhws'ing Jeclalsonall ❑ I have aid will n aimain a Cendinte of Consent to wlGineum for Worker', Couiacsallon, as provided la by Section 371X1 of the Lahr Crile, for the perf..... afde w,,,1,lin which @ice per ail i,i"mrd Cl I have that will moul'nln Walker's Cwnlmnrnlion Inrurnneq ill required by SCflion 37Q) it lha Labor Cade,tin the ill mu ue if Ibis worg ha which this permit is sued.My Woder'e('algsnamion Inmmnce Carrier and Pul'my Instiller arc: I'day Nn.: CERI'IHC'AI'ION 0I7 EKFMPI'ION FROM WORKERS' COMPENSATION INSURANCE (This acoder,ncerl oat he can..fried If the pnnnit is fir one hundmJ Japan, (SIINH is,lees.) - I certify that in the p,rfortuarce,of the work for which this permit i,issued.I shall not employ any person in any manner,o us in became subject m the Worker' Compensation I.aws of Culifnrniu.Dam Applicant NOTICE To APPLICAN'11 It,aher...Ling this Cenircme of exemption.you should account,subject to die Worker's Compensation provi,iom of the Wb r CWe.you must Q 0 forthwith comply with such pmvidoos or this permit shall be Jame)res used. 'L % CONSIR is van,outionION NG AGENCY 7 1 hereby allirm shin them is s nmed(Sec. lending agency for the peRomnahec Of she wok me which Ibis permit is issued(Sec.9197,Civ.C.) L Q Lender\Name 7 l<nJcr's Address V Q I verily thin 1 has,I read this applieu,am and stair Ihal the above inf nmenion is I,. F., elirrxc,.1 sgsa to comply wish all oily and county orJimneee and nae laws ma ing Q C.) to building enmlmeion,and hereby initiative representatives of this city no ether upon } fit the ubeve-nen,omd Poorly lir inspection Purposes, r y fWeL9raemowe,i;Lot ctilynId Accphurmlu.Inn Cityof Cli'true against said .� �_ I N City in...judgmases,1001uinU ospcnshi which nhay In any wary accrue againa sulk 5 I N" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOIN'I' Issued by: Date nounsSOURCE REGULATIONS. 'f A"fllcamlCmnmmar Dare Re-roo� . IIA%Alt DOUS MAI HRIALS DISC1.0SURE Will she Ip,liemn or bnnm Ixdlding tavp:nn store or baane hazardous inhaled;J Type of Roof :n dullard by the Cupe,lino Muaicipai GIli Cll;lplcr 11.12,and the Health and Safety Code.Seem 255331nri ' El Ye, Cl No All roofs shall be iNected prior to any roofing material being installed. Will the aliplit'amminsists,hulld..god'eapmmmseegdpmemordwior,Which It'a roof is installed out firs bt' ning an inspection, I agree to remove o 'it foramina,air et assainam,is,deined by the slay Arca Air(slobs,Manag,owin Disvicn all new is f� i ect• ican understands and will comply with ❑Ye, 0 N all no poi t s 6 alio s. eee���t 1 have mad the hamrdou,annelids requirements under Chapter 695 of the I 's California Health k Safety Coda Sections 255115.'-5533 and 25534.1 undemand this if the building does not currently have a tenant,that it is my mspunsihildy m relay the' Occupant of the requirements which must for net prionto izwasrce of a Certificate ofist °ac"paacgn y' ' ature ppli a Date is Care,ata ,gena D„e All roof coverings to be Class "B”or better OFFICE