01060064 CITY OF CUPERTINO
'BUILDING DIVISION PERMIT ; CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22,980 CRICKET HILL RD FOUR SEASONS ROOFING 01060064
OwNER'S NAME: APPLICATION SUB DATE
DE AMZA PALS H.O.A. 645 HORNING ST 06/12/2001
I PHONE: SANITARY NO, CONTROL NO.
r (408) 278-0330
ARCHITECT/ENGINEER: - I BUILDING PERMIT INFO
g i BLDG ELECT PLUMB MECH
Z z y Z I hereby affirm the LICENSED
licensed undoR'S DECLARATIOP ; Job Description
O Z_ provisions of Chapter 9(commencingP
p_1-J with Section Division Jofdie Basin
Professions Code.and my license
isinblast ele 13 ' ? 2/0 REROOF.
z rc a uc<na last u<,a
36th Data Ea^F2�'— C°moue'°' T/OFF CEMWOOD &
C a o ARCHITECT'S DECLARATI N i
g 1 undersand my plans shall be used as public records tt
¢I i INSTALL 1/2 CDX 40 YR. COMP.
❑O . Lsenscd Professional
m OWNER-BUILDERDECLARATION
1 thereby maso .(Seen dna I am exempt from the Contractor's License Law for the
C= <. following reason.(Section 7 onLA Business and Professions Code:Any city or county
ISO which requires n permit requires
e construct,ahcu improve,demolish, file,
repair any swment
w3m ..P r t'issuance. s q srh<applicant' f hpemifl signed statement
d-inq sr e9kdpu ttnh"Pon i hentCatharine.,I' I_ Chronic, r y r S Fti Floor Area; Valuation
U g rapt t 70110) fDi ' nor to B eiap ProfessionsAviolation
of
>r',�t+ g fsq...,x ld'. xA.44 -l(''�-.•
of Natio s exempt any ap n'unJ the basis for Ne alleged exempnt to Any v pent an
of 7031 duck five
ydledi dollforvpermit subjects the applicant civil penult '
:Arno,mnremanr<ehantlreddonare(asoo). ' APN Number :.d" •.:$®Ot@[jancyType
01,epi owner of the property,or my employes with wages as their sole compensation, j
will
'do the work;and the structure'it not intended or offered for sale(Sec.7144,
Basilicas and Professions Cade:The Ci ntraamr's License law des not apply to an 34241007 . 00 Required Inspections
ower of property Who Wilds or improves thereon,and who does such work himself
o through If, n employees Provided that such improv ms arc not intended
..oR dfor-sale"If,however,the Sunld'n ren t' - Id N rte --.... _..____...
! impletion,the owner bu Idr will have the burden of prov ng that he did not build r 305 - FRAME i '`"'' '•r' -improve for purpose of sale.),
307 INSULATION _
const'o of N<property, m exclusivelyines:and Profusion,ng C tcensehe Cont m t 601 ROOF TEAR OFF + II
-
construct sM1e project(Sec 7144,Business and Profess ons CuJ<)The Contractor's
1 r
License Law date not apply to an owner of property whob tee: improves mht de602 PLYWOOD NAIL _ :r
ane h veep:f h protect with. cep.act rts)hcemW p 2_,. -- .ROOF
Contractor's License de603 — ROOF BATTENS,,—
Due
ATTENS,
°I n v! neasc B&PCI ma .... .
a Due 604 — ROOF IN—PROGRESS
WORKER'S COMPENSATION DECLARATION
' I hereby affirm under penalty of perjury one ol;the frim,ing dedarmions: 1
01 have'end will maintain.&mficajeof Consent to self.imme for Worker's r
Compensation, as provided for by Section 37W of the Labor Code,-for the CINALED
performance of the work for which this,Iseomitis issuad. 1 2001< c 01 have and will nwinum worker's Compensaiioii Iiiiumnce,m required by Section AUG O 1 [O O 1q
r _ 370)(I'df the Labor Cade;for the pedormance of he work f.r which this permit is
'C
ammed.My W kel's C-opentium lmor < er and Policy nuardso,mo.
,. _ . _n. ._., .. .. ..... ... .. ...... -.-, .._..,...._.
C'17 Ir POleyNafrczY78S9 y.1 f_ r; ;I n +. r r ; BUILDING
{ CERTIFICATION,OF EXEMPTION FROM WORK bei '4'R.". i 3.. _.l a +S:..T+J _ (4 J
ITh
cation not be completed f the permit is fur one,hund
-- AnON INSURANCE
in ft(I do11N1
(SI Wl oo less)
I
u... ....,.. ... ..,.,,.,.T.. ...
I parifY}ht in'he pirmlan I are,a Irl 'kirwhich omesu subject
to Works
Compensation
II s mPloy eny person many-marine as to become b) s so Ne Worker'
Comps. ti n laws of Cabfomna.Dine
Applicant __.... ._..... ._ .___
}NmICETOAPPLICANT If;aper muk fit an tart or Lxemption.yon'shanlJ -�- --_�-- _ i _„ k
become iubjen ro the Workers Compensauan provisions of the Lanor Cude.you mon i•.
O O fprthwidi comply with such provisions or'his Permit snap ba deemed.,.ked.
Z --
Ey „' CONSTRUCTION LENDING AGENCY,
epi 71 h rcby)1'vin th t rh" .s cnpa t n le J' g ag n Y f the performance ,), i.
r� run Lo k f -hien sit pc l zsu d(S c.1097,Civ.C)
cndcis '. ••-_. .- -_._._ _._....
�"'Q Lend Name
L dos Add
r.!3
V � ri
1 certify Nat I have read this application sand state that the above information is
40r k" impact.1 Ogres tocomply wish all city and county,on inxncex and state laws relating
. CV re building construction,and hereby authorize representatives of this city m enter upon
the above-mentianed moron,far inspection purposes.
F.. M (W) greet° a nJmmfy and keep bramlosadho Ciry of C'pemaL against
Z liabilities.judgments, t d expenses which may in any way acersam gains said
V .Z-r Cloymcon,
coenue fine granting of bit remit
APPLICAR ULANT DE_RS�aADDS AND WILL COMPLY N'tfHpL[,hON P01N't' r" Issued by; Date
C' OL
URr 6LA— �,
Sig at m 'AppincomfContmao - r•':. Date Re-roofs
" HAZARDOUS MATERIALS DISCLOSURE
l: Will the',pplica.orft building occupantore orhandle namoutomaterial. Type Of Roof -. ... ,.. ..__.- ...._.....-„ _.._.
md0ed by duCepartimoMmicipal Coca,Clumeril.12,ordlIsm Heahh ands fly
coaesiondSSJO ',1 lc ' - - : ' :'.\i"C. It epi;to'u't
r
-_All roofs.shall be inspected prior to.any_roofing material being,installed.
o.. Will theapplicam rl meb'10 g upamuueq tpmemorde'<s h h If a roof is installed without first obtaining an inspeetion/I'agree'to}emove
n, If rcomm Lv a�tl byhe Bay Area Air Q ItyMnag em as
D° C1 / r all new materials for inspection.,Applicant understands_and will complywith
.. 1 0.. 9 p 6.95 oft . ._
Occu OYeg Ne hazardn s N all noZpoinSOklrce re ulatiOnS g Califom Haahhc matens rc u rc t u der Cha to dhe
me h chct on 25s0s 255JJ and 2553) 1 d Mand Nm06cPus fthe s mn
I nae tl /pogo
&Sa(<ty Cod Se
fthe buW do y
ma file met print m s arc of a Certificate of
r'a _ Signa[ re of Applicant Date
-' —'
Uumalor almamuned,.,an, Dare All roof coverings to be Class"B" or better
OFFICE - -