00070092 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
NUU.DING ADDRIISS PERMIl No.
OW NI dR's NAMI: APPLICAI[ON SUB DATE
22639 OAKCREST CT WESTSHORE ROOFING C 00070092
111,117: SANITARY NO. CONTROL.Noto .
COHEN 5869 WINFIELD BLV 07/17/2000
QKY. ARCIIHEC'I'IIiNGINIiIiH: - IIUILOINGPEHMITINFII
00 BLDG ELECT PLUMB MGCII
6 (408)629-2100 1 _t I= =1 I=
¢y
�Nz
LICENSED CUNTRACnOR'SUBCLARATIUN Job
u
DescriptioAla
hereby that I.n licensed nick,provi,nic of Chapter 9(commencing
withltooof .o..9 offc lAlnincs,aPrnfesionsCale.and ay lcatse
is in Fall
alllmoamad effect.
s s
'Oa¢ Licn,eclass
Date Contractor
ANCIIiCI"$UECLARAION
//°g RE-ROOF andelaam .ypku narl be, ed , I O
is.a p o I.invxnl I'rnfcssionul
OWNER-exempt r DECLARATION
= I greasy.(Sera Ism 1 am.Buviv from the Contractor Co License law for me
t Z S which mi line,a(ermaai 7031.5.Hu,iu,.and lindoe.d.io l Cala Any city n,county
m x o which ts P roti.t t t Icer:- P d lies Pi Y menu
n 3
that
h m e t c pursuant
req thef gra Biu I Law
mala license([with
as n ther nn Contractor sL W on,Ce9 Sq. FL Floor Arca Valuation
(cul Ing Wills Seuvun ant and
Div' n 1 rfmc l gedc,s and 1'rol'Any vi Cn10
ion
or that he is 31.5 b IhercBom and the aro lin The bj alleged exemption.Any l Penalty
of Section c than
n v may arddoll for apermit subjects[be applicant to acivil Penalty
of out m..rc dealt tixa htmdret dunma($slk)). ANN Number Occupancy Type
❑L as ow mer rflne pmpary.or my employees with wages as their sok catnpr cation, $7647
will do the wnd,and thc.wataire i,not intended o,otfesd lir sale(Sec.7144,
Im,nlexx,tml Pour,.......,Colic:'Ihe C...uneur.License Law does nul apply ,,III, Required Inspections
owner of pmpeny Who Wilds or improves meson,and who does such work.hlntugl 3424801. 1. 00
or through his awn employees,provided that such imprmemend am not intended or
,flea lee Luk.If,however.Tho mildlog ori "Onemnnt is.old within rat,year no
omplerion.the owmerlwiWcr will have the nmden of pawing that he did nut build lir
imp... rtern,l»•sunr..atr.l. 305 — FRAME
01.nenwnnofm,pmpcmXtrue..cladvclynmwcrngwmtfmc..sed-.1111ulb-m 307 — INSULATION
consumer the project(Sec.7( .Busmc,s and 1'mfee,kns Ctdc:)'1'he Contractor's
License Law does not.pplyman ownerofpro,sry whnnailds set improves thereon. 601 — ROOF TEAR OFF
Ind who commr sut.
it.lir nc,crwith n commnmlq licensed pudumt to the
Contractor,License law. 602 — ROOF PLYWOOD NAIL
❑1 am csempl utak,See .B k 1'C for this rerun
603 — ROOF BATTENS
owner Uwe
WORKER'S COMPENSATION DECLARATION 604 — ROOF IN—PROGRESS
I hereby efdno under Peind y of perjury one of the lollowing deehnmion,:
1 have and will maintain a Certificate of Consent to mlbinmre for Worker's
Compensation, a, provided for by Section 1710 of the LuMr Call:,Tat the
,douirance of the work ler which this permit Is i,xued,
❑1 have and will maintain Worker's Compensation Insurance,as squired by Section
971111 of the Labor Code,fnr the Pell'nnnanee of the work❑r which Ihix penult Is
..sued.My Workers Compennatin,Insurance enmenand Pule,Bander we
Currin I'llhol N...:
CLIO IFICAFION OF EXEMP'I'LON FROM WORKERS'
COMPCNSArION INSURANCE
(Thi,section need not be Tor cmd if Dim pernit I.len nw hundred dollar,
(SEgE ar less.)
1 certify Ism is the p,,I i,rtee of the work for whibi Ihk permit is Tread,I
shall nal employ any perom in any mmmce so a,In become sonic,to the Worker,
Compensation Law,of C.Idomin.Date
Applicant
No rICE TU APPLICANT.If.ahce lnnk'mg lois Ceo ileum of E3 culpmhnn.arms sI...old
become subject to the Worker Compem dura pmvi,i.n,of the W15tr Code,you cost
Q Q f nhwith comply with such pmvi,inns or this permit shall be deaned revoked.
F4 CONSTRUCTION LEND]NO AGENCY '
aiI hereby alBnm that them is a conswetion lending agency for the performance
of Ise,walk for which this punuit is I...od(Sec.31197,Civ.C I
0. Q Lcmlef's Nance
T Lender's Address
1 certify tate I have read old'up11111a nn and x(at,lbw the ubovc inti,mtation is _
a. F. entree..I agree m amtply with all city and county aNlnmtces and state law.temtmg
Q U Icnab ld ,construction.and liscreby authorize asperscourtiveqfthis city t nmupon
eu1swrou,noonco po,own,for cole'dontoo m. 1
F S
(we)agree in one,andermily and 6 l lamolics,'hefty'If C Pnno against
lin Imh .c' Judgment.,costs and expenses mcM1 may in any way Ncrae gain..said /
V 7.
Cry in mm tmen,c if the Framing ofthls pmnnn. TzJ
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Slgnn on,at Aprlie:otCou ractnr Das Re-roofs
IfAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding tecup.ot such,or handle hazardous material Type of Roof
an delined by the Capertino Municipal Cure,Chapter 9.12.and the Health and Safety
CtMe.Scelion
25332x):' No
All roofs shall be inspected prior to any roofing material being installed.
W.11 inin,plieurn Itne"holdi rouwcgwpomotuede,wr,ish1d, If a roof is installed without first Obtaining an inspection, I agree to remove
milhmat a le n
cammmans as detinet by.he 1tn,Ate.Air Qualily Management
;crier all new materials for inspection. Applicant understands and will comply with
❑Ycx El all non-point source reg lations.
1 hove sad the hvmdnus mammal,mquiremems.rake Chapter 695 of the
Ciddornim Health k Safely Cole.Section.25505,25533 and 25534.I understand that
it the suildlng does not amrcntly have a mount,Ihut it is toy m......sibifhym aunty the
ttccurm,or the requircmma¢which mea he me,prior m issuance of a Ccniticutc in
Occupancy ' main pl cant Date
Own,,a.limaimd.,cut Dale All roof coverings to be Class`B" or better
OFFICE