02080006 ' ZITY OF CUPERTINO - -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
A a BUILDING ADDRESS: PERMIT NO.
7536 HOLLANDERRY PL WESTSHORE ROOFING CO 02080006
OWNER'S NAME: APPLICATION SUB DATE
AM CHIANG PAUL M AND CONNIE 5869 WINFIELD BLV 08/02/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 629-2100
O O O ARCHITECT/ENGINEER: BUa.DING PERMIT INFO
m C BLDG ELECT PLUMB MECH
Z H
= LICENSED CONTRACTOR'S DECLARATION Job Description
O Z—O I hereby afliim that 1 am licensed under provisions of Chapter 9(commencing
r,Mt with Secti s)e
7f ,CfDivisionJofTheBusixsdProfessionCmlamdmylicense REROOF
,MX] t,6 in full for &" 5/ C -2 Z
s 6 License C La.If
°•o U One Contras %?a(
�+ ARCHITECT'S DECLA TION /
�g I undersmnJ my plain shell be used as public records
w a O Licensed Professional
1am 2 OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for he
C?< following wmon.(Section 7031.5,Bull..and Professions Code:Any city or county $7848
4 S C which rcquius a permit m eonssru0.almq improve,demolish,or repair any structure
toil: normiu hsuence,also rtquirtssM appliant fa xucb pemdt mfJeasildeadstramcm.
Iliak91sliunud Wrsutat Ip N!pwyisiom of Je Canvactots Littnu law(Chapter 9 1
per.
(comtrlericioB;wiN Segsan]ODO)pf Division Jof the Businvts aid Profusions Code) {_(�,, ']-?3,9 2 0 ,sty atT Si_Vjj f.t.I : I Valuation
or Net h'e'ld eLdniprthertfmt�en the basis for she allc);dd exnmprbsi.My violation
ofcou mere NaofwAndrtE doll.($50r.�0)ttwb3ecn the.ppbemtm.ervn penalty TE NO305P� ¢ Occupancy Type
01,as owner of the property,or my employar with wages as their sole compensation,
"-will ue and Professions Code:
is-not
tinuu 's Lice aofferedLaw foe snot(gee: to
- - - - -
'owner! anBerty,Who
b code.The Continuum's m's License law Joss not apply m an 601 - ROOF TEF1�g1Ilt�$Insp'ectionS t' I"%'v `
own f property,Who builds or improves thereon,and who dues such work himself 602 - ROOF PLYWOOD NAIL
of through his own employees.provided Nat such improvements wt,not intendedayear or.
.oar or race.omeowe.d,:iwlliowthebimPmofprovingtathididan�r�;dor' 603 - ROOF BATTENS 'C"'I , l.NV
•completion the ownervbuilder will have the burden of proving rhos he did ria build or �+' � � - '
improve far purpose of salt). 604 - ROOF IN-PROGRESS
_[] 11--__,__ _.._ _..._... _..._,..__ ----_--.__. _-__,._ - ___...._. _ ____❑ anowner of the propenY xclu,inly contracting with erred contractors so s I:.:. .II :'i'. -------
I;co w t the Project(Sec,7tlaa Business and Professions Code)The Contractor s ) , LCH
License Low does not apply to an owner of property who builds or improves thereon, ',
.::i T. ..and_who Footmen lor.such.projects with a.contiacmr(s).licensed pursuam.so,Ne..___.-------_._,_.____........—_._.........
.___..-..__....-__.__
Contimaturs License.Law.
' sL01 m rise fa nl&i Sea;', fothis
,n ;Dam )lp )C°CI':i'ilUl
PIId ALED
WORKER'SCOMPENSATIONDECLARATION
IhembyafilrmurtpenalryofperjurymiIt thefollowingduoamtions:- pUt� 2 3 2002
C31 hevd'hnh twill mai0lnin a'C_s:isificise'of Consent m'self-insurc for Worker's use
fcompema)ion, as-provided-for by-Section-3701)-of-the labor Code;-for the
_ - _ p amanttafNewahfawh;e4ihi,cp mins su�ils,,' BUILDING
- 37 have and all ictal cIn Workers Comp a of t I duonce r which this
bP:,that
is
]]00 7 she lobo Code for the performanc (Ne'•i.•ork for which th s pe ,i'u
issued My W rkefe ompe sv u 1 2 ane d Pol y n beram (({�
t( -CESRTIFI
ION OP
EM
ec ��afi CO/�Yijlty No !S1 l�ry'�.S Y.Itt1.•A ,vd�. .� : iAY
'( 'i newnot,be completed Pl he FANCE QRKERS
,I t PRNSATION INSURANCE v '•
dectioa' perms for one hundred dollars ++� ilhJl i:ft "� . •�JCS.Ii)I.II` Iyer}
(f
(0)or le6s,)Iu1e•..yrr. I .Lm.r .. -trr ,Ilk v.vma-err f
Shall not employthnfin the rfumwn eof Ne work(rwhich this
.h 1candy pe pemire rteI
t 'A, 11 ( f l U 114111+ It�., bnL,.
._Ama ant t n Law y p + .,. e,Workers'
o rw 'manneru a to be bin b s t the
p x of Calf a y0e'se` "'
1 It _..,_._
ouldr,
lb T TOAPPLICANan's Compensation
o makingion Cnins�CYLabo Code you must " " fh' <'
ate of Exesdpdo7 Y
bbcome sub3e t io the Wo Yet Com at n routs on
O Q fouthwth m l wth 'h mans or the I
P Y p pe s shall be deemed revoked. s
2 _. -_ _._._-..____.._ _-__ ._. _..._____._.. ._-.__..-._._...
G h� tItf'f COt he Its
f10N LENDING AG
•v
_ �' t_'1 hereby R'rm thin th - c no m iu Ind g ge ey f dm pe fnrmance, i .-En' 1
ohhe work'for which this petmn 'ued(Sec3(XRCt C) - ...:N s;n)f
y:C -Li der s Name c w a a _ _. n- ---- -------.-____._ _ ._-.__.__—_ —_ __.__ ........ .___ —_ . ------
Le
__._.
�.z Lendcfv Addl1 t: it, ,1 `.f - iii: (�P•Ctlbl'JJ
V � y 1 ttn fy Nos I
have with this application n end sins that aha information w
tT+"[moi cortecs I grte ro c .ply tN ells ty pend m ry rd nenc s and term le s relating
V to bu lNngconstrJcimnandhereby-.hone p unmuvex of th sit sys emrupon
ray the above t -neJ-property f m'Nion purpose
As (We)agrce totave-Zdmnify,anJ keep harmtusihe Ctiy of Cupenin;against,
rn V]
liabililmi.judgrossitts,costs and expe uwhich spay m y y game utd
C.1 z' Cis n c s Ucnce of N loam ng of Ispeon Q�
AP ICANT U ,D�kTT $AN WILL CONPLr WITH AL POINT V1V/
$ I Cr ,TIo'Js k ted Issued by: Date
Sign.0 a of Ap pdnt/C I - 1 l yl, D ti�. Re-roofs '
l', r,HA RDOUS MATERIALS DISCLOSURE
SII the Ppllcmu or hurt buoding occupant sow or hanNd hazallous umber.1 Type
avdef ed by lhbC prunoM ncPa) _ Chaps r912' dNeH hh nJ Safety ',` alt dPs il_yP Yroofing,
. ._g
O 00 -,
Cade Sect on 25$32(al 1 R t i ''•
r ❑r f Itviil ,r Na �1 ' PY V�h Et, oil l�;,rc LE .-r / v 1.') t,
ll roofs shall 6e ins ected nor.to.anroofin .material being installed.
. I.
ouWII Ne vel s rf wrc bu 1E ng ott p t q p s d t ` hen a roof is liistalled'Without first Obtainin an ills eCtlOn)`I 8 Cee[olremove
Ic t h bd s c m I t er he - by th B y A - A Q lity Man gement g p g
shoat all new materials for inspection. Applicant understands and will comply with
orsT4 'x.11 f, "Iz' , .''r all'nonpoint source regi aeons
n
1 ha a reed the M1arardoun m`msiah req ns under Chapes,695'of.the
Cal f m a He hh'&SiI y Cade stuitiods 25505 25533 ad 25534 1 omitirstand that /•Z
rf Ne bu ldmgd reqs ria rmomely have a meant Not y respembltym notify the
re m U uireme m ht h mus,be met p s nose vee of C.III or
/ Oce
arc Y I , };�u - b
' 8 Signature of_ ppl ant _ _ _ _Date
All roof coverings to be Class"B" or better ,',(,I
_—OFFICE--- __.._ ..._ —. -- —....._-_........
•
1 .( .)1;•TV_ f ^.t. .. .....__ �� �.�-'+ r. I _ .(!�'i is L'b' .tt)uon