02050021 CITYaut�Frvc DIVISSION CONTRACTOR'INFORMATION:
- PERMIT
BUILDING ADDRESS: PERMIT NO.
10330 LOCKWOOD DR R E ROOFING & CONSTRUCTI N INC 02050021
OWNER'S NAME: APPLICATION SUB DATE
C. P. LAI & SANDY DU 108 OAKLAND PL 05/03/2002
t (HONE: SANITARY NO. CONTROL NO.
(408) 925-9995
Mac. ARCHI ECDENGINEER: BUILDING PERMIT INFO
z — BLDG ELECT PLUMB MECH
< I -I o ry I_--I
z
ss.. LICENSED CONTRACTOR'S DECLARATION
Job Description
• Ihereby affirmthat lamlicensed under provisions ofChapter 9(commencing
'y—LM° REROOF
:—t; is with ciion]0onl of Di ci"IhBn,.nnd Profusions Cade,end my licensersinfu aand cffc t.z�u eeens 2 �r'I REMOVE 1 ALYER OF SHAKE, INSTALL 1/2 " CDX
O` 30 # ASTM FELT & PRESIDENTIAL SHINGLES
Da aIOI"J ARS1 understand my planr <d
i �
o¢p O Licensed Professional
e'o OWNER-BUILDER DECLARATION
=' 1 hereby°fnnn that I am eumpi from the Con,,anor's License Law for the
?G following reason. anal to
]ompo Business and Processions Code:Any city or county
e
z which requires o permit m conmmca,alma improve,demolish,or repair arty structure
Lam miormslicenedpursuant to the Provisions o for such permit License aw(chumcm. __ -__-_._.- .._ - _- __ -
(cru he is bag wit pu
rsuant the provisions of the the Business
License Law(Chapter 9
(commhe k e ina S,beref'l000)d the basun 3 of the Business and Profusions Code) d •'t'' Sq:Fe,FloorArea-s�,.�i->, 4'xf - $13 616ib,
6. ,�• � fl...l . aa,_d ;:�.. tiY; t.. iii:
on
crown Section
is exempt tang applicant
p li and the basis for Ne subjects
be applicant
t to Any violation
of not o m than v my hundred
dollars a500). subjau Ne epplicanuo a civil penalty r Type
of not mom than five hundred dollafs 13500). 3 4 2`� 'Lr!b6t0 _. '� Occupancye
°1,as owner of the property,or my employees with wages as their sole compensation,
will do the'work:and the suumur,is not intended or offered for sale(Sec.']DM,
Business and Professions Code:The Contmcmr's License Law does not apply to an 305 — FRAME Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 307 - INSULATION
or through his own employees.provided Nat such improvements art not intended or
'comple ion,the:If,owner-builder
the bustling or improvement offorc is within not year of 601: — ROOF TEAR OFF
-
completion,the owner-builtler will have the burden of proving that he did not build or
improve ter pmpnre of sale.). 602 - ROOF PLYWOOD NAIL
°luowner i'thetutee p(Sec.7am excBusiness and Professions
licensedhe cmictonm 603 - ROOF BATTENS -
' License the prosect(SecIIoa,Busm,oandProfessionsld,toTheContractor', 604 — ROOF IN-PROGRESS t Si
License Law abet nm apply toanowner of property who builds s p vas thereon
and who comaens!m such pro)ecu.with a enmmetor(s)1 ed purauam m the
st Law.
❑I em exempt under Sec B&P C for this reason
Owner ER' Dote "
WORKS COMPENSATION DECLARATION
I hereby uffrm under penally of Perjury one of the following declarations:
f ❑ 1 have and will maintain o Ccnincam of Consent to self-immm far Worker's
.�. Compensation, as provided for by Section 3700 of the Labor Code, for the
Performance of the work for which this Permit is issued.
°1 have and will maintain Worker's Compensation Insurance,as ounred by Section
3700 of the Labor Code,for the performance of the work for which this permit is
issued M Worker, pensat Ln I
27�ca c s and Pol'cy umber ere
dF - Policy N - ,
511-oulug6 _ _
yy
CERTIFlCAT)ON FE%EM ON FROM WORKERS" r.ti. t }R'h'.rt aYt\ .. ,1 :iF .1.Y
COM ENSATION INSURANCE- a^�-
-(Thii section ricdd not be completed if the permit is for one hundred dollars '" - ( ` ` .
(51 001 or less.)
shall not employ any .• _•'
1 certify that in the performance of the work foe which this permit a issued.1
p Y Y person in any manner so as m become subject to the Workers'
ppliunseaion laws of Colifomin.•Onte"
A
NOTICE TO APPLICANT:theWo If.is Co making this previsions
so of Labor Con,you de.you
r ,
become' comply
the such fo,d Compensation or tmn Permit ohall be the Labor res.lo . must
Q Q fano lh comply with such pmv tions or this permit shell be deemed rcmked.
[[nn 'CONSTRUCTIONisaconstruction lending
AGENCY
1 coy that them
rc iso onstm em
on lending agency for Ne perfnebce
ffrr 'Leah or R k for which this pemit is hx.,.cd(gece 3097,Civ.C)
Lcrrer,x Address'' ' -
'V, 1 cagey tom 1 have read al s application and same that aha above laws mnin is
W,.Es cubed I agree m comply with all city and county or tmi,ees and stem laws ,fling
' �,V the itbo building propndhereby inspecoiiureposematives o(this cirymemerupon
--k] the ahovume gree to properly and inspection purposes.
y eHk)agree is save,indemnify and keep h may in the City y s Cupertino against
sd
Q0 liabilities,sequence, costa and expensesofthis
which may in any way accuse again xr said
V.� Cit,i onsequenee the granting of Nis permit. -
• ICA. tS f S Yf L COMPLY WITH ALL NON-POI `
sora - . nONS. p Issued by: Dale
mf ird .rue t - D.p Re-roofs
HA DOUS MATERIALS DIS SURE
Will ppl'�futme Wilding pantsmrco Ieha bus atmal Type of Roof
as defined by be Cupertino Municipal Code,Chap
m 9,12,a the Health d Safe,,
-
Cade Sen on 25532(U _, •, • u +'�I i j 1 S k� l•`t _ _ _ .__. _._.
❑Y s t ❑No i `.t All roofs shall�be inspected poor ro any roofing material being installed.
Will the applicant of future bolding occupant use eqm t or devices which If a roof is installed without first obtaining an inspection, I'agree.to remove
emn haraidous air ecomminianns its defined by be Bay Area Air Quality Management
iDiatncta all new materials for inspection. Applicant understands and will comply with
°Yea °NL nonpoint`soureeregulations.
'Ju`M.,
hphaeordo s materials iequ rc e t under Chapter 95-of the
California ryCode S ctions25505 25533and255341 u tl mu dthat (/ yr
lithedueurten0y have etenant,that t s yresponi b'I' ten 0(ybe L::` '�;; 7 �f U.`,'t¢Ils w be r poor to iss ce°f Camficaae ofan
`� ISL i re of Appli n[ Datet ..All roof coverings to be Class `B"or better "
;' ... 'i,;:.:_•...,.. .. . . .. .. -.. `:` ' _ .. OFFICE _ . ._. . .. .. - ..- ._