01060047 'CITY OF CUPERTINO -
BUILDING DIVISION PERMIT - CONTRACTOR INFORMATION:..
BUILDING ADDRESS: - PERMIT NO.
10186 CAMBERLEY LA FOUR SEASONS ROOFING 01060047
OWNER'S NAME: APPLICATION SUB DATE
E ANZA OAKS H.O.A. 06/08/2001
PHONE: SANITARY NO. CONTROL NO.
G ZQ ARCHITECITENGINEER: BUILDING PERMIT INFO
�r BLDG ELECT PLUMB MECH
C7 C
Z 17 Z LICENSED CONTRACTOR'S DECLARATION Job Description
O
Z'4
o I hemby affrtn Sha I am licensed under provisions of CM1apmr 9(commencing
F4FiJi with Section 7000)of Division 3 of the Business and Profession Code,�upmy license
he f t is in full force mri t eg z O 'S
"m a ueense las LIe.N REROOF.
3 a U ,Dam �, `5�- �— Gnmwcmr
FLLOm ARCHITECT'SDECLARATION T/OFF CEMWOOD &
<j 1 understand my plans shall he used as public records
ce�> INSTALL 1/211 ' CDX &
de-O.O Licensed Pmtop,roul
of OWNER-BUILDER DECLARATION
I hereby affirm that I din exempt from the Contractor's License Law for the "
F Z a following reason.(Section 7031.5,Business and Professions Code:Any city or county .. .
ec o which q p rmv to construct aIle,,improve,demolish, p y structure
en cc p t ls'ssi onec,9sn reg,....the ,pi,rnfors:ch per -uo fleosft,d,nor
nt _ - ... _.._..... ...o.._,......_._..
�3 min 1.. Ip II "m' 1' Ist rn Coo 1 r - L (Chit1 .9 S ht Flow Alfa Valuation
l mncingwthSo n7,")of Division 3 ofthe Busln�s ndPofessionCode) 7 ,r 9' S 1s
or that he is exempt therefrom and the basis for the alleged ekemption.Any violation
of Section 7031.5 by any applicant fora pemrit,ob io is the applicam to a civil penalty
of a.,more than five hundred dollars($500). APN Number ': $gffdyancy Type
ID Los owner of the property,or my employees with wages as their sole compensation;
will do the work;and the stme um is not intended or offered for sale(Sec:7144; Required Ins ectlODS"
Business and Professions Code:The Contram Contractor's License Law does not apply an 34242 019 . 0 0 e q P�
owner of properly Who builds or improves thereon,and who does such work himself
or gh h employees.provided Oat such improvementst i d d
eri
.off df Ie If,however,the building orimprovempret is sold th. oae year of
completion,'Neon b Id ll havethebude he dad a.,bmild an 305 - FRAME
i mp o c for p ry f I ) A
3.07. - INSULATION-
"DIa Der ofth p pay n
continuer th project(S 7044 Business
_ ly d Professions
f t g Cask:)
ad )Tdh Contractor's
on
tr on vrr''
. - - - . - TEAR OFF
ROOF
Liceme Law does not apply to an f property h builds � nA emarai
suchP Jet. th r t 4s)t .ed p am _
Convince,License L -602 . -ROOF_ PLYWOOD "
NAI{ L
Glm s B&Perm603 - ROOF BATTENS(,,-
Dome,
604 - ROOF IN-PROGRESS
- WORKER'S COMPENSATION DECLARATION ,
I hereby affirm under penalty of p 1 Y o e 0fabe.f(lowing dedare inm:-
D 1 have and will'mainiain a'Certificxn,or Censer(to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
_. _. porfan none of the work for which this permit is Issued..
D 1 have mid will maintain Worker's Compensation insura s regaimd by Section
:37W of the Labor Crode,for the performance of the work for which his penont is - -
i ❑ My W,,kers l p ion Ira' a and Policy b ._.._.. .......,
14wer,c..N �4,' CZy7 7.y3 .
C tt P Ivy IONF f
CERTIFICATION OF EXLCH IN FROM WORKERS - i'\ • h' u+• - S.�1_... ..1„a s1. f
'COMPENSATION INSURANCE ...._.... _
_ (This saetlan need not Iw co iiplemd f the perms is Por one hundred dollars " ' `" ''' - . :
181 W 1 or Icss.)
1
pertthat competition,of the ink for hPermit r s
shall not employ any parson in anmater so as m became sub3ec[m the Workers
Compensation Laws
of California Dine '
Applicant
NOTICETbOthis Certificate of Exemption,youshould
becomesujme". he Work,,,Cmm,vm.loupiriolthe Latour Code you most
forthwith manly
witl h p my thispermit hall
Ee deemed mocked. I
CONSTRUCTION LENDING AGENCY
� ; 1 hereby Ginn th t 1h tot ! n lend'ng'age y fo the perfu r 1. „
n.i .of the wo k forwhich th permius isw d(S 3(197 Civ C 1,
d-
❑ -Led Name
... ._.._. .. .:.p, -_. ::.. ._.... ... ._. ... . ........... _ � ,.. -.._ ._._.._. __..__..- .....___._ ....
Inl I ,
V'C) I certify that l have it rh. ppl t d. es b - f a Iran' "
c t I g tog, ply iall city tl mratan
y d' ons d I 1 s ting
: 0 (, t b Id g construction, dhe by cimhereprcsenwty soFth send toes upon
�y 700 th b(We'amm�ed propend prifype t n p hainflp.
�.Qy (Welg m rilend'fyar,,keph may
is way
fCupertino against
aid
Iz I of, 3 dg sins t and pens which m ty in any y - ago t said
UZ city
y •ne .. ('
. :APPLI NTU STAB N�fWILLCOAIPLY VJrr�ALI,�IGN-PIxf Issued by: Date
SOU ATIONS !y }f'-CJ
�Signpmmof plicantlComracwr Date Re-roofs -
HAZARDOUS MATERIALS DIS
PP P m st CLOSURE -
adelledb the Ci nrno,Municr a1C d Cha ter�o h nJic ialth a "af:d _'�rpe Of ROOF -• - . . - .. ...
Wall then Iain aft reh ld
dSfry
Y P P p 9I dth H hh ,5� .. ,
code,se fn 25532t ) All roofs shat
D yes n + I If a roof is installed without first o
Il be.lnspected.pnor_to any.roofing matenaLbemg installed------
Will
--_- _
W d.. t,sm t f t,A Id p t eeyupmem in
which btalnln9 an ihspectlOn}I agree.t0 remove
emit h d s a'r c tam pants as defin<J h the B Are A Il40 Man em
D n t all'new materials fo spection._Applicant,understands_and will comply with,.
Y Y Y gm
all non-point sou regula[lons .
I bal read he lno.m5 mate], ret,milem,under Chalice;693 or the
Califorpar,Headift&Safe C d 5cium,25505 25533 and 25534 1'understand that
-ifb Idrng dce:'n
c ntlyh it i thorn sin) p rb'btym r
Ocoupon
cup t f t musm t M po
t or to ace of_a Certificate of
p Signature of Applicant Date
owner nr Dain ,neat gent oto All roof coverings to be Class `B" or better
. . . ..... ... .._.OFFICE.. _ ....___.. . . . .-. ..