02070150 • CITY OF CUPERTINO - - . 1'' -
BUILDING DIVISION CONTRACTOR INF
PERMIT ORMATION:UILDINGADD
Y
822950RCRICKET HILL RD FOUR SEASONS ROOFING Pte' 2070150
DSW9'5.K SHARON L AND RONALD 645 HORNING ST APPLICAT pp S/M12002
PHONE: U / L 4/
(408) 278-0330 SANRARY NO. CONTROL NO.
!QIn FARCHITECTIENGIINMER: ' BUILDING PERMIT INFO
hCBLDG ELECT PLUMB MECH
`8 su C-1 L. ) I'Z" fion that
CONTRACTOR'S under S DECLARATION Job Description
Z= I hereby oRrm Division
1 nm of
licensed under provision¢of Chapter (commencing RE-ROOF
with ftllSection.end o(Division Jofthe BuainesaandP 'scions Code.and my licenu
I is in f II rte and eR
z a Linens ss Lica
3 a u
are - Comma
u 0Ia ARCHITEC('S DECLA N
S 1 understand my plans shall W used u pub records
I g M O Licensed Professional -
'°'T�
OWNER-BUILDER DECLARATION
-m I hereby affirm that I am exempt from the Convector's License Law for the
L?o following reason.(Section 7031.5,Business and Pro .'a
ode:Any city ar county $8000
s which requires.�.it to construct,al repair (Chapter prior wits iuuence,al g yviolation
.. .. .._._.._...__...__...._........_............
exemption.An � l,)_ - - -
t or rc e an awaurc
o Ole asi nail naumem
Owt ne i'e,Otensea '�q�tlmfm n e commoner License Lawg Y.�, 3�¢ ��Ib&ctTY@a' Valuation
(commencing with$e on. ,)of Di vision 3ofsheB a;s and Profusion Code) t;�'+ j• s.9 v'f':!}'•,
or that Na is exemputieiefidm entitheb�7{isfp(dy{�
of applicant 7011:5 by anyoppllqtBIIytoffpp,m,,VIIbJeM applicant to a civil el
'of not mom then five hudmdmlM'jS500).t 30 B+PN PR1RAME :r:' -:r Occupancy Type
01as.a fit e pmpeis tar my_em 10 unebsma compensation, 307 - INSULATION
will Edlbe-woend t&Ecru qy icd Por vele(Sao: _
B6siness end Professions Cade t tee e s nose Isw does not apply to an u' eynec
owner of pmpeny Who builds onmproves therm.,i nd who d.,.ch work himself 602 - ROO1 11 F PLYW OD I� I)S4
or thruu h his own employees,provided that such improvements art not intended or - _ - -_
a(faaall g p y - '6'03 '=' ROOF- BATTENS -' -- --
of vele.If,however,the building or improvement Dent is veld within one cu of Y
improvmn,urpose of
will hove the burden of paving that he did not build or
improve to purpose of wle.>. 604 - ROOF IN-PROGRESS
01:es owned of the p(Sm.7 am exclusively d Porro ng with 1 censThe Con cmrs tocon
License
me does
n(Sm.7044,Bu6nersawaser o and Pmfesho b Code)The Conthe m e.
add whi Lew does nm apply m an owner of a comy who builds se improv¢thereon.
- and who.emvans focmch.projmu with a convwmr(q treenail purauanbb the -
�'- ,' Convmmh License Law,
a 0 I am,empt under,See.' )' 'Bd:PC(w this ancon t,!•-(1''n7•J;• .
- _ O"ai ' Date
WORKER'S COMPENSATION DECLARATION
I hereby aRnt under penalty of perjury one of the following declarations:
pA , ❑ 1 here and will maimeine'CeniOcme of Coneni to ulGinwrt for Worka's
Compnunion. u provided for by Section 3700 of the Labor Code, for the
p ubradanca of the work for which this permit is Wood-
0
uned
- 01 ban and'will maintain Worker's Compdtution Inu once,u ro uirad tiYSection
3708 of the Labor Code,for the parformanm of We work for which this permit is
isw My Wakefs Compenumon Inure c c end Polity tuber art:
Pal. jPoli�czLtv18az6i�
ry Sy r s l l ; t�'io �.r^ A 4 a ti 1
k+f4 R E%EM ON FROM WORKERS L- ii C l -
OF H p 0,INSURANCE, _ , .... ,....,. .._�it -_.. _..,_._.._ .�..._. ._.._....,.
pp�� � -, ..
t3at•\ ' a..COMPENSATI
vi
(firs umion'need'not be cam Imed tithe permit is for one hundred dollua
($I00)o has.)
'
... .., a ..v- ,.
'"l ItemfNet in theperformancethe work forwinchthapeanute lseoad.I •. itt:,...' .�. . !1V., _- .^•.-..-_.e_..__-. �.
shall riot empll pam
=ploy any wn any manndd w m msubjecter n becoesubjectm t the Wmken'
Compurn L' Laws of California.Date
Applicant _,. . a CA .0 -
-NOnCETOAPithe WoTIL aompensti Iiia(aniOc,f of Labor ioma%'you Pat ,
idurs
of the work(a a CONSTRUCTION LENDING AG of the Labor Cade,you'mun
ild
O c Worker's Compensation er it shall be dammed revoked.
bcirome sub3mt m the pe p
ENCY
Q 0 foithwnh comply with nth provwona or this permit ah
a, by tin that Nero n e mmuutu n lendlq'agency for Ole perroidnance s,y sr,r
s.
^y.Q Le th ew rk W which this permilis tasued(Sec.3097' Iv.C)
Z) z Lcnde aAddrcss
1 canny that I have Peed this application and state that the above mformNon is
w-'(.., corral.1 ague to comply with tll city and many ordinances and one lows relating
OSV to Wilding mnsniction:Wd hereby,auNoriu rcprcsmtativu of this city wnumtipon
Wtheabove-Immimadpmperty(orinspmtioo puryaus, "
Oe (We)agree io sa ee demnifyandkmphanNcanhe City fCopeninoagwnet
U h liabilities,judgment,,cost.and aspera which may many y¢acme again,said
'..ZV City n consequence of diSwung of this perm,
Is ICANT'UNDEA lND$AND WILL COMPLY NT}H ALL - �PODJT°'
TA't REGAn N 'r -•:, Pr Issued by: Date /
Si`ruin.of APplicanVCorniact """t" .. ... .,•.:•.. Data'. Re-roofs
-HAZARDOUS MATERIALS DISCLOSURE '
al, I Will the epphantafuwm Wil nmaimmature a handle bazisEme ramal Type of Roof — -- -- - - - -
u defned by Ne Cupmtm Municipal Code Chapur 9 12 and the Health and Safety
Cige,*SectiOYes 13533(e) sl i Nor.'' v . •"� 4 ri, ' s S r s' 'aiY. ss' '( :' .... __._ 's L.f!"it"
:. _. i _-All roofs shall.be mspected.prior to any roofing material.being installed.,_.._..,_-.__.
w;B a. 11 ant Per mNm b ilding«mpent use equipment or devices which If a roof is installed'without first obtainin an`in's 8etion;l"a rda'to remove
Distnen t g P B
0y.
l , ( all new materialsforinspection. Applicant understands and will comply-with
. X Y Y Quality g -With,
._ .....,..
emu eza ma tat conummenudefined b the Be Area An nein Mane amen
° all non poinf.source regulations, a,;
1 have read the ba Code. met nets req 2 menti tinder Chapur 6.95 d the '
if he Wil in ode R Safay Lade Seamn 8505 t itis and 35574 1 undmuif that
if he Wilding don mlcunrnOYh ve ucnanLthat tumY respon,bthrymnotify the
mEupam of Ne rtqulrtsmnu lath must ba ran poor m iuu ce of a Certifieet In"
Q'' -� `�A �Cp" T '�Z.�" Q C.
!panty . ' _ Signature of Applicant -__ '�Date.
Ownerw uNonzpd,agem Fasa -Z is All roof coverings to be Class"B"or,better -
...OFFICE .. . . -. ..__.._ _ ..,.