01060049 CITY OF CUPERTINO
BUtcmNC4mVISLL1 u PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22948 CRICKET HILL RD FOUR SEASONS ROOFING 01060049
OWNER'S NAME: APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/08/2001
PHONE: • . SANITARY NO. CONTROL NO.
(408) 278-03301
D J zO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m{ BLDG - ELECT PLUMB MECH
z 8 N i LICENSED CONTRACTOR'S DECLARATION Job Description
9 Z_ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
H:t with Section 7")of Divid. of the Business alPeadmianns Cotl an py license
x f j is in full force an <f(E S
IE. a titansc :a ef3 ut.a Y z0 REROOF .
n u Date Contr«ter
u'f3a.�i ARCHITECT'S DECLARATI N T/OFF CEMWOOD
�•t=O g 1 understand my plans shall be used as public records
ca8<s INSTALL 40 YR GAF COMP
wO Licensed Pot usional
a a c OWNER-BUILDER DECLARATION
lc=, I hereby affirm iM1mI vm exempt from the Contractor's License Law fur the
t K< following reason.(Section 7031.5,Business and Professions Code:Any city or county
E x O which requites a permit m construct,alar,improve.deardidu ormpvir any soupper
c.w ' P t t -. req 'me_th applicantfor h« nil g dti statement cotmn : nl ctt , l .r IClttr9 _ S-q.-dt.FSluor-
Code) Ale)t., ;d Valuation(commerce,with Section 700)of Div 'on J ofthEast ne a and rfeaa an ,
`
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 70315 by any applicant for a permit subjects the applicant to a civil petolty
of nom
nmmthanfivehundreddollars(asap). APN Number :$@gy0FyncyType
.1711.as owner of the pmpxny,or my employees with wages as their sole compenvtion.
will do the work,and the Imucmm'is not intended or offered for sale(Sec.7014,
Business and Professions Code:The Contractor's License Law does not apply to an 34235005 . 00 Required Inspections;
no,wer of property Who builds or improves thereon,and who does such work himself
or throusugh his own employees.provided that such pr mprove t Dai not intended or
.offred f ale.If,bow thebuilding or mpmvcment' - Id within one year of
camel 'the owne b Id 'II have the buNen of pmv g that he did not build or 305 - FRAME -improve'r p rpox< r: ), 3.0.7 --_..INSULATION- '
- licensed _
01 her of the p pm am Business
asin ssa contracting with contractors to 1 -construct the does
project(Sec, to i to,ner
and Professors Cady)The Contractor's 601 - ROOF TEAR OFF
rand who
Law does not apply man owner of property who builds se improves thereon.
s' .aloe.who comme s for such protects with a.tomracmt(r).Wansed.panaam m me. . .. .. .6 02_.— .ROOF...PLYWOOD...NAIL— .. .. _ . _. .....
- Convenors License Law.
01 am exempt under Sec. ;B&P C for this reason 603 - ROOF BATTENSI. -;;i "
Ower " ewe'^ 604 - ROOF IN-PROGRESS
WORKER'S COMPENSATION DECLARATION
• �. I bemby affirm under penally of perim,unc,oftthe following declarations:
0 1 have ad will taanta' Certificam of C motor an self-more for Worker's
Compensation. ..,pro ded far by Section 37W0 of iba Last Cam. for the
Performance 1 the work f I or which this permu is issued.
01 have and will maintain Wo ke sCo pe wt on 1 ren as required by Se<uon T`_IIJA
3700 ofthe Labor Cade far h performance of the wmkfixr which this Permit is
issued My Work ,C pens,tW n Insu /r'and Policy handu�r'Jfy:
Camm�r-sS((`le✓tlJ`-(�'
Pod icy No.V G2 (
937
CERTIFICATION OF EXEMPTION FROM WORKERS - •t - - is
.. ,. e. .._. _.COMPENSATION INSURANCE _ ..�'. � `
..._._. . .._.._.. _ ..._..._ r...._.... ._-. ._
(Th'.�section need'not be completed if the permit is for one hundred dollars -`' t;
`
IS 100)he less) ,
I Lenity that inthe et fra id forwhich. p Iitis woad I
Compensation
employ any person m any nwn«r m e1 m beconm subject to Jse Workers
CompcApplicant.I Wwx of CalilomI Dam
became. g. .__.. _. .._.. .. .... .___.. _. . ....
NOnCE TOAPI'(-(CANT:rs Counivensat this visi ncoe n(Exemptiov you pho.it
rdewn comply
the such wiissims or Proms shall ons lbe,�hoc Code.You must
C foNiwith tom 1 with such Permit melt revokN. i
'CONSTRUCTION LENDING AGENCY
F 4 1 hereby offino that]here isconstruction lending agency for the performance
of Ne work for whmh this perm t s muetl(S«.3097,Civ.C.)
{r7 0 -Lender's Name_
�.
z Lender Add...
,. t
V-� I certify that 1 have read this application and Stam that the above information's
Lz E. torten 1 agree to comply with all city and county d tl state la enter
a ng
f) tohs Id'ngconstmeron peJy fora spec ze epres., ve.of tnrc city menter upon
? ;y 196 Jia nbn(Wed agree
to Property inspection and keep
pulp artle
p.rd (We)ignuto save,indemnify and k«pharmless the City prom nidoagainst
.Z liabilities,jutlgrimms,coag and Ioftasperse,which may in any way starve vgainw said
V Z City to rtes ence of the granting of this permit ',.:._
^ ApPLICA UND DNS OS,'ANO WI4L COMPLY WITH AAA ALL NON-POINT /V.
RC EGL.AT ONS:':':- 4 /`���/ Issued by: 5 Data
Signal to of Applicant(Contracmrt. .., 4 :DateRe-roofs
,.HAZARDOUS MATERIALS DISCLOSURE
WJl the applicant orfutum Nilding«cupant side or handle bazallous material Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code Section 2553]1 ) �'(
°Y / All.roofs shall be inspected prior to.any roofing.material being installed.-
!Will _
• i to ppTc fit t4 t lm la g« pant u,seq ip t rd<<ea n ch If a roof is installed without first obtainingan ins ectidn; I agree td`remove
is as defined the Ba Area P g
en hrim?5 air to t n n J Quality t Marta all new mater .s for.inspection. Applicant understands and will comply with
fJ v Management
1 11 yes
D sr ct
all non-poi ource regulations.= . ,1t - -
I arvc mad the butunchim,oplulluilsqu a t u d Chapter 6.95 of the
Culifornin Health&Sate'y 25505,25533 and 25534 I.lepill,thed that
;ifhe Wilding does Lot comemlylbsocai i.that it is payn,,pliduldlty,to notifythe
occupant of the helium,melt xhicIt east be met Prior m mantrace of a Cenoeme of
Signa are of Applicant ,.., _...,_ ..t Date
Owner or authorized agent Date All roof coverings to be Class B"or better
- j, .. ........:...._ i . :...... .:_._...... .. OFFICE. . . . _... .... . . .. _. _.._. _ .. . .._ _....... .,....,... ._ _... _..
:.:r.- .. . i . .