00110107 - CITY OF CUPERTINO '
BUILDING DIVISION PERMIT'• CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22930 CRICKET HILI_ RD FOUR SEASONS ROOFING 00110107
OWNER'S NAME: APPLICATION SUB DATE
DF_ ANZA HOA 643 HORNING ST . 11/20/2000 .
PHONE: SANITARY NO, CONIROLNO.
(408)278=0330 '
00 ARCHITECT/ENGINEER: - BUILDING PERM]p INFO
BLDG ELECT PLUMB MECH
LICzSN' IMmbyalLICEN:S'Dmlicensed code,ONTRACfORISrDEiL RATIOON 9mamtnandny lob-Description
�mCs sni$uU nn 7g111)ofD un 7ofthe Hu 11 I' '' 'Cndo,aul sty license' - - p
Leen°la¢lcw undslk l3 L x 77-1 CEMWOOD TO COMP - -
a d
are_l/_t[..O Oen Contractor x [eSM�•�+ ..
ov ARCHI'IECECT'S DECLARA'IOP
I understand my plan.shall he am.,public records -
C et O Licensed
Prof essinnul
e _
F.. � ONNIR BUIL DERDI tI ARAl10N /Y v
tu'�7 Ihereby$ that Iexempt
nptf theC t 1 f the
Z Q following ti S 703[.5,Business d l fi Cotd y city tie county
5hi,fic.,tiresa pwrnail after,l. p d ior repair Y,t tre
run,
u I u ! I y IM1 plI I : h1 t t b J: end
n licensedp t. top til c t t License Lt (Chapter 9
- - Sq. Ft. F'•loor Area rCV' a�(commencing withStu 70(M)ofD t ofth isiness and I'mfiessionp,Code)
or that lie is czenpi herst u arcticIssi,finhe aI A y violation /
trb'or.�q.
0
'
vl
of Section 7031.5 by any applicanuar a T<m,I st1cons the applicant c a c.'I penally
ofno[mnrethan five hundred dollars(S50B). APNNumberp yTyp
Occu ane e
°1,as owner tit the properly,or my ctupinyws war.,,,as us their sole cnmpcnsntlon, 3433008•
act do the work,and the structure is not intended a,offered for sale(See.70W, Required Inspections
Business and Professions Code:The does m Contractor's License law ds not apply an
owner of progeny Who builds or improves therton,and who does starch work himself
o.dmough his own employae„prosided that.aeh Immntint
provees are tint ended or 305
b — FRAME- ,
FRAME-
offered for.sale.Il;however.the building or improvement is sold within one year of 307 — I NSULAT I ON
ompletion.thwnec-
e ohuilder will have[tic burden approving that he did not build or
improve for purpose or crit.)' 601 - ROOF TEAR- OFF
til.a,owner othe pra,my.amexcluohelm
ycontraehngwithEeensedoomrvetm,or 6Q1'_ — ROOF k.YWOOD NAIL '
construct Ihe project(Sec,7nkJ.Business and Professions Cole:)The Cometor s
License Law does not apply in an owner or propeny who builds or improve.thereon, 603 ROOF, BATTENS
and who contracts fur such projects with a E(nbamors) Isensnl pursuant or the
Cantmcmrs Llcatnye Law. 604 — ROOF .T.N—PROGRESS.
0I va,exempt audit,See. .B&P C for this reawm
Owner D:ne • .
WORKER'S COMPENSATION DECLARATION t
t r ,
hareby NRmt molar penvhy of perjury ono of Ilio following dedarat i ns:
. 0 1 nave and will maintain a Ceniticate tilConsent bibell-inure for Worker's - ,' ,•
Compenmtiun, as provided for by Section 37W of the Labor Code, our the
perfornnmee of the work fnr which Ihid recall i.scald,
°I have and will maintain Worker,Compensation Insurance,as required by Section o
37M of the Labor Code,for the perfomtanee of the work for which this permit Is
suul.My Worker's Contpcnsmion Insurance carrier mod Policy number vat:
Carrier, Policy Na:
iv:
'[ON 0171,
FI,XE VI'[ON FROM WORKERS' -
COMPLNSAI'ION INSURANCIi
(This section nen not be completed Hive permit is for one hundred dollars
-D I00)nr less.)
I cannily that in IM performance of be work for which this permit is issued,I
shall not employ any pecan in dry manner or as to become subject to the Workers' '
Compenxminn Laws of Calilor iu.Dat, '
Applicmu
NOTICC TO APPLICANT:If,after naking this Cenilicatc of Exemption,y,m should -
became subject hmm o
t the Workers Compensation pvisiof the Labor Code,you must
Q-O forthwith comply with such providmts or thly panni)shall be demncd revoked.
F h
CONS the.
LENDING AGENCY n
I hecto, ffirrinwhich that Ihere is a construction(See
lending agency far Ihe perfommnc<
�.
Lender's
work for which this permit ix Issued(Sec,71197,Cc.C) o �.
S Q Lender's Name
V Z Leader's Address
V Q 1 cenify thin 1 have read Ibis applicadmt and suite that,the chose inlium,nan Is' t "
comet.I agree to amply wish all city and cowry odinances and state laws relating -
V tolmildingeonstmcrion.aril hereby authorize,rcprtuniatives of Ibis cinymemer upon ,
W the.Nice-mentioned por,"y for inspection parynen. r
�.,t 6r IW) g tics 1 len,c, �I I 'tlm Cly fC pcnnnagi ort
4 Z City u. jury n tits;cat d I tics h y n any y u a al said -
.V z Citymc sT enc urine t g fWI cerins
APPLICANTU' E TANDS AND WILL COMPLY WITHALLNONPOINT -
.. SO"Al?EP
P �/: Z�� Issued fs Date '
Sidnatumu pplismaArammctnr Dale RC-roofs HAZARDOUS MATERIALS DISCLOSURE
Will mc:y,pfmant at Jenne bhlding orcepam mora or handle harmdoun mmedal 'Type of Root.
us defined by the Cupenlna Municipal Code,Chapter 9.12.and the Itcallh and Safety
Code.Section 25532(a)? -
❑rc. ❑rvo . All roofs shall be inspected prior to any roofing material being installed.
-Wultheaper,artotmmnebiddingaaeupamueyvipm,nta,ddevice,which If a roof is installed without first obtaining an inspection, I agree to remoJe-
emit hmvrdous air cunmminanrs u.defined by the Bay Area Air Quality Management
District' all new materials for inspection. Applicant understands and will comply with
0Ye N11all non-point source regulations.
n I have read the ha do.,materials y n I C under Chapter fi 95 of the ..
C.IffornwHe Id &Safe,,C,alvSections 25505 25531 and2553J 1 arneuilandthe,
Wt nlca dyht Ienmtltu.toy ttqu :h lty l nli the
rcymre v which must be mel poor m rssu e'if.Cen team of
Signa ure'of Applicant Datewater deedagent - Date • I All roof coverings to be Class "B" or better- - - .
OFFICE
• I