01060008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22920 CRICKET HILL RD FOUR SEASONS ROOFING 01060008
OWNER'S NAME: APPLICATION SUB DATE
LE MADGE A 645 HORNING ST 06/01/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
G ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
c m— BLDG ELECT PLUMB MUCH
L-_l fJ LJ L_I
LICENSED
Z S H- 1 hereby affim Na I am licensed underr provisionsOWS of Chapter9(commencing Job Description
Feyp J wi,hSmion 7000)of OivisionJof the Business and Professionz Code.and mylicensc
C— is mnsull force and ett
o w a Lice . Cass e-"3 9 ue.» d 17 SQUARE FEET RE-ROOF
a� s.0 Da¢ e`—Y—o r Contractor
u+3° In ARCHITECT'S DECLARA ION
�'=�g 1 undrsmnd my plans shall be used as public records
�r
w O O Licensed Professional _
OWNER-BUILDER DECLARATION
e
,31o, r hereby.Seel ma I u1,exempt from the Contractor's Professions
License Law for the _
1-z' which following reawn lece,ion t anormusiness and ve.deamili Codc:Any cant'ty xim county
Y z❑ which requires a pe,mi,to cnnx,mc,,alcor,improve,demolish,or repair any s,mcmre
cstLeI.t Amonoits issuance.ul: q .,he nppl tf rsuch perrnn fl Signed smtemem. . --._..._ . . ..--_ _
ma,he,shcenY pursmito,h pmLis fineCon"cioesLc l,w(chapter9 Sq. Ft-Floor-Area t, ., - •„ $SOd'EWua[ion
(commcmm�g wnh SttC nJ000) r Di 3 of,he Bus, u a d Proresxtons Code)
or that he is exempt therefrom and,he basis trade alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not mom than five hundred dollars(SSW). 3 4 2 Mb i%bOccupancy m" . � P y T'Pe
°1,as owner of the property,or my employees with wages as their sole compensation,
willBus ne a wmk,'nd me oda;Tmachine is not mmmtletl n, a Lawered does snot(Solapply ina n 305 - FRAME Required Inspections
Business and Professions Code:The Contractor License Law does nm apply m an
ownerof property Who builds or improves at such,and who dans such work himself
or throerect for
his own employees.provided that such improvements arc not intended or 307 - INSULATION _. -... . - _.. ... .. .... ...
offered ter ante.if,nnwitvar,cilde will b.l have t o,unpiovntrov is oldthat
he did not year or 6 0l - ROOF TEAR OFF
mnrove f e' owner-builder will M1ave me burden of proving that he did not build or improve fee for puryose of sale.). '
U Ii"ns nw ernr the Pap ny:;m exclusively Can,...it.,with tit d enn,racmrs m 602 -- ROOF. .PLYWOOD-NAIL.. _.. . .
construct,he Project(See.7044,Business and Profess..,Cnde:)The Cn,mctors 603 - ROOF BATTENS
License law does not apply to an owner of property who builds or improves thereon, - t
..and.who Co.,..for such projects with,a commetons)licensed pirmam to the . . - 604- - ROOF IN--PROGRESS
Contmttors License Law. I c +, I
°I maesenn"under Sec. ,B&,P C for this reason ' .s,`FINALEID
_ owner Data
- WORKER'S COMPENSATION DECLARATION JUN L
O 8001
I hereby affirm under penalty or perjury one time following declarations:
ulY
C mem and will maintain a Cby Sect of Conant m seLaborre for Workers BUILDING
Compensation, he work
fotl for by Sermon 37W of the Labor Cede. for Ne
performance of the work for which this perosi,is issuW.,. -
°I have and will maintain Worker's Compensation InzmaMe,as required by Section
37W of tlR Labor Come,for the Performance of,he work for which this pension is
l issued,My Worker x C mpen/.�a Compensation
n Ins anter and Policy number art _ .........
CameAMwfOtfW C4..,PIbyNo (✓C'2y7 t'7 -._ - ..-. _. .,. ,.
I CERTIFICATIONOFEXEMPTION FROM WORKERS" s.. �. I
COMPENSATION INSURANCE''
Mrs Ma inn need nm he completed if the permit is for one hundred dollars
f$body or less)
,1 cantly,Our in the performance ofmanner
a walktofor become
his permit a issued,1
shall not employ any person any manner so as,o become subjec[m,he Workers'
Applicant laws of California.Date
Applicant
NOTICETO APo the Work If,after making thisCertificateo of Labor Codyou u must
became su comply
y with
Worker's Compensation provisions of the Labor Calc,you mull
Q Forthwith comply with such provisions or penis shall be deemed revoked.
40.a CONSTRUCTION LENDING AGENCY> ae''a NI hereby aff,m that there is a consimnion lending agency for the lierFmnro nce
� 's Name for which cots permit is issued(Sec.3097,Civ.C.)O ame .....,.. ._ .. _. :. ._. .. .-_. _.
ZLender's Address -
V I ceniry that l have rcatl this application and sate tha the above inUmarmion is
Ls, E.. correct.I agree to comply with all city and county ordinances and state laws relating
0-U to building construction,and hereby anthonae represenm,ises of this city to enter upon
y:j the ahnvementioned property fnr nopec,init pmposcs C/ 3
Er-C4 IWJ agree,o cave:indemnify and keep harmless We City of Cupena dg.,a"
os
W liabilities,judgments,cts and expenses which may in troy way ncee ng'ins,said
City inconsequence of the granting of this pxmm. _ e� ,
APPLICANT ER$T S AND WILL COMPLY WITH ALL NON POI p
_ - souR R LATIc 'fs�°' 6 Y�� Issued by: 0 C_ /�w7C7h�(/('G Date G
Signature elApplicantlContractor - - Data Re-roofs
- HAZARDOUS MATERIALS DISCLOSURE
' Will thea licant nr tuture laiildin Type _
pp gra.Chaptemre2,andtleHealthandatenul T eofRoof -- -• - - -
as denned by,he Cbpernino Municipal Coda Chapter 9.12,and the Health end Safety .•. t - - -
Cade.Section 25332WIv, _
.All.roofs,shall.beinspectedprior to.any,roofing-material.being installed.. . ..-
Will meapplicant or future building occp ntuseeq ipmenn or devices which If a roof is installed without first obtainin an'ins ection,'I'a ree to remove
emithanrdous alrcontam na,ns as denned by the Bay AMA Air QualityManagement g P g
Diatom^ all new materials for inspection. Applicant understands and will cont l with ,
°Y" all non-point source regulations.
PP pt'`
1 have bad thh n d . 1. q , e Chapter 695 of the / -
Cal fo Health&Safety CM Sections 25)05 3533 d 25534.1 d rstnd,hm /�//b Aj/
ifN bu ld n8 rt tlyh amna „ht , . y eP 'b I'ryt ability me
use tpant oft prem ms which must be met prior m m...a of u Camrnne of
one nty. SignAre of Applicant Date.
own eroramhon:ed.gem ' ,. a,c All roof coverings to be Class"B"or better
. OFFICE