01060046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
22928 CRICKET HILL RD FOUR SEASONS ROOFING 01060046
OWNER'S NAME: APPLICATION SUB DATE
dIDE ANZA OAKS H.O.A. 45 HORNING 06/08/2001
PHONE: SANITARY NO. CONTROL NO.,
\. (408) 278-0330
-Z ARCHITECT/ENCINEER: BUILDING PERMIT INFO
m- BLDG ELECT PLUMB MECH
aUG CJ '—ICJ CI
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Z h i LICENSED CONTRACT'OR'S DECLARATION Job Description
0 Z_C 1 hereby affirm Ihet[am licensed under previsions of Chapter 9(commencing
pins_; with Section 7")of Division Xfthe Business and Professions Cad license
Case i=ia�«layy6 ant�egexr3 Lic.x yZzLdn REROOF.
s O n O Date 6 p -_J,_r Commcom
LLO�
ARCHITECT DECLARATION T/OFF CEMWOOD
r g Iunderstand myplans shallbemad!aspublic records INSTALL 40 YR GAF COMP
�
tmn t o O Licensed Professional
a X OWNER-BUILDER DECLARATION
tn g 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F-Z_ following reason.(Section 7031.5.Business and Professions Code:Any city or county
D
which re1 s permit to construct,ct alterimprove,demolish,or repair any sincere
w a prior to its9 thePdw,to to,such purrivo,il
4c,h! 1. .cil non ,owk filContractor,1 La (Ou'ur9 „f. Sc Ft Flooi-Atea, Valuation
( mmenang with Set 7000Iof Division 3 of the Busi e.amid Proms ons Code) '' ' '
or mm he Is ekempi therefrom and the naris for the alleged eaemptiah.Any violation
—of Section]03 LSiv anyapplicantforapermit subjects the applIcammacivilpenalty
:or not mare man five hundred dollars(1500). APN Number $Rnbancy Type
❑I,asownerofthc property,n my mr,fl.yaox with wages as Meir sole compensmion.
'-will'do The work.and The-structure is rut intended or'offered'for-sale'(Sec.'7044, Re tired Inspections
ly
Busineis and Professions Code:The Contractor's License Law does not apply to an 34235009 . 00 9 p,
owner of proper Who builds or improves Merton,and who does such work himself
o Nro gh h'. .ply provided thatuch improvements art n t intended r
._:off df .-le If, he b'ld 'g mPm emeni " ld wthmnne year.(
comPlaton the owner bu lder will have the burden of Prov ng that he did net bu Id or 305 — FRAME
improve for purpose of sale.).
-- .. 307_---'—INSULATION
— - --- —.--.
O 1,as owner of the propcny aim exdu ely carer n g ith littnsed cottmcmrs to ay -
construct the project(Sec 7044,Business and Professions CWc)The Contractor's 601 - ROOF TEAR OFF I ,
License Low does not apply roan owner of proper who builds or improves thereon. -
ane who.contraws for sueh.proiats with a eamoseon.)licensed pursuant to the --' --.__602__.- .-ROOF -PLYWOOD—NAIL--
Contractor.,License Law.
Ell am exempt under Sebr ,'.�"'': ..Be�Pe,r«gni,reason 603 - ROOF BATTENS:'r` :n,7t,i'i,
Owner " Dite604 - ROOF IN-PROGRESS
-' WORKER'S COMPENSATION DECLARATION -
"' Ihereby a?roe under pcnuhy,ofrLrjury one of me following deduroliuns:
_ ❑ 1 how;and will nommin o'6mficme of Constant 1. self-iromm for Workers
Compensation, as provided for by Scciim-3700 of the Labor Cole, for the
pumotian,u of die work for whim this permit is issued.,
-
Olhv d will
e, t nee the efompelto 1 ro req reJbyminitin FINALED
3700 (the Lab r Cade fee the performance f th work for which this permit is ,
issued My isi ker's Cmmp
^^�.t n Incur
m,contnontJ Pol YmOmiter ryrc, ... - ,. .• ..., _.. s as s_
Cam d'Nw�1 W✓ L�ls it'Policy No G✓cZV/Ds/ y�� . .. . .. _ -
CERTIFIC'ATIONOFEXEMPTION FROMWORKERS f , -' �• • iTZ is•a^� laYJUN 2 0 2001
COMPENSATION INSURANCE; ..
_,
(Thsscctinn ne.d not be completed if the pemut is for mm hundred dollars - 'li 'IL':' t. �,.I'4 IY. !
5I00)orlaa)
net
Corti that the Ifo none f tl e work for which tl s pernti s sued I ! A .,I -I .19,,•tai r s, r, i _S
s 'm •.. - .
shall not employ any person.in n numiter so us mbecame subject to the Workeri
m
CopcdsApplicant Laws fCal'fomi DDaa.'
_'
-
NOTICE
NOTICE TO APPLICANT II ft r inlf n f Exemption.you shatIJ
Z become subject the Worket'i Compensation provisions of the LaborCode, must
O fnM1 th Comply with such provisions orthis Kona shall be J cr d revoked.
-
t
f CONSTRUCTION LENDING AGENCY
a-� 1 h reby alYrm IM1 t th a co wet on lending agency far the perfmonsince
Lenders Name__ - ,.__-i.�__...._... -. ,,.._- ..._•_•. .. _. ___ _ _.__.. _.._ .._
Lender's Address. ;,t,,., r;ri! •'l i
UO I certify that I base mad ibis application and sum that bove information is
f;_IJ c t I g t comm)with 11 city and c ty N d tate 1 ws refining
O v to building ct t and h by authorize r4provertative,of this city toenter upon
d agree top pend for nspe t n P aisle, .,.. .
'0.a (Wed agree t,cost and xxfy and keep hamay in
w4,ity of com again
i ain I,laid
F_W liabilities,judgments,costs and expenses which moy,in any way accrue ogaina said
U i Cty eq ftM1 gr i °ohhspc t - '
APPLINDESTIANI$$$$AND: WILLCOWPLYWFALS_�YIssued by: DateSOUU�� , / J
�—
Sgnamrcof pliwnUCom em, .,DamRe-roofs
- HAZARDOUS MATERIALS DISCLOSURE
-. wll[h pplx nl wt It m g v I t 4,'n leh rd 's matedill
s , Type of Roof
.......
as JWbyre CpmmaM c CW Chapter912 doff Health and Safety + ` xf ICod 2553_(al r . rya . )
OYe: s � 1 1. -All shall be
inspected. rior.to any roofing.material being installed
's -Will'he applicant r future bId g p t use equipment d ice.which '
c th J arCo.,.m t def eJbyth BayAicQ allyUanag mem If a rDOf I$ IDSlalled'WIt110DI fIISI OI)Iammg all mSpeCllOns 14,&e6 to'remove
Datall new materials for ins ,Applicant understands and_ will comply,with
El Y" :,t rva all non-poin uncce_regullhons ,. 1
C�
1 ha use read dhohmoaanbm. nmmmilqairemwm-unix,Chapter 695 of the
Cal fore Heahh&S ety CW Sao 25505 255114, d155s4 11 d .t dthm
' V1,h�Pn,,tldg,_dCY; < tlyhave-ammntahm ttsmy p b'I ty io baufy the t h'h' tc ;. ffasCenifme of
Signature ofApplicantDatehe t p nr agent r ii Date All roof coverings to be Class B' ot,better,
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' ...OFFICE.-