01060065 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM NO.
22988 CRICKET HILL RD FOUR SEASONS ROOFING 01060065
OWNER'S NAME: t APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/12/2001
PHONE: SANITARY NO, CONTROL NO.
` (408) 278-0330
MP+d4�
zo ARCHITECTIEIVGINEER: BUILDING PERMIT INTO
be u BLDG ELECT PLUMB MECH
11--y ip ffLICENSED CONTRACTOR'S DECLARATION
OZFQ Ihereby arnthat Iamlicenxedunder previsions ofChapter 9(commencing Job Description
<t: wnIt Section70di of Division Lot the Business and Professions Code,and my license
m as inranfnteeas fi r, 9 2 D REROOF.
de a 'Licen.w Class Lic.p
dodv D01 SDECA T/OFF CEMWOOD &
nS 3 u ARC ITECT'Sourt A ON
zOY'• IutMentand my plans shall he usMsspublic rtcords INSTALL 1/2" CDX 40 YR. COMP.
i i O O Licensed Pmficour of
• OWNER-BUILDER DECLARATION
Liar=' I hereby uRrrn the,1 am exempt from the Contractor's License Law,for the
(=?Q 'following re...n.(section 7031.5,Business and Professions Cole:Any city or county
F❑ which r...ovs.a permo
it to cmaruel,alter,improve,demolish,or repair any smm
ucre
so 3 Prior to itsissuance,also million,dreapplicardf h ecormit topan signi,e]som m m.
that he is been pulsation lathep d fthe Contractors L L (Chapter 9 Sc:I [ ( lool•Alol
v I Valuation
(c hin comI t ,]oob),of Division fo ofheB ineu dProposals sC statistical
�J: ,vi,}{,_'r x� f k yr Rl s'4a„' fn� A j'..a.Y•
o that he s exempt therefore red the basis for the subjects
the
ek<mpnt t Any violas on `
of Sectiona...]0)d by any applicant rs a-cewit subjens the applicam toes rive penins $0000ancy Type
:nfnatmolemanfive nnl,drcdeonam(ssool. y � APN Number ,.,�v,;
Cl1,per owner of the property,or my employees with wages as their sole compensation; ;
"wi11'do the work;-and the swcrure'is-a.T intended or offeredfor'sale(Sec.7014; _
Bixins,end Professions code The Cmdractarx License Law does not apply to as 3424 1006 . 00 Required Inspections”
owner of property Who builds or improves thereon,and who docs such work himself
or through h employees.prov d d that such improvements rc not Intended or _.
_-or
sale:if.However:th building _ rof '— - - - --- -- -
gper Imp d of Prov Id imid one y +,•;, .
'comp)moor the owner bu Ider will have the buNen of proving that he did not bu Id or 305 - FRAME
rep rrpnm ` f. l J ' 307 INSULATION
,Ol ,a ow pthepopcnyexclusivelycontracting s Coss,)Th Contractor's 601 — ROOF TEAR OFF
-
construct sti p )cr(Sec ]OYi Business d Professions x,ons Codc)The Comrecrnr's :
License Law does not apply to an owner of l "
py proprywnanuhxarlmpmvestnelenn, 602. - ROOF PLYWOOD NAIL
. - and,who.contracts(orsuch projects with.a.roavonorls)licensed.prodan t to the -.__ ... _ _ _._- __. _-.. ... _ .._....
a ean,mrtarxurenxeLaw.t , ',.:".::. 603 - ROOF BATTENS;... . .
❑lam exempItnder Se '. .:";',. ,•,n,P
c, B&P C for this Aaron )
pew,; "Litperj ivy ^- ' 604 - ROOF IN-PROGRESS
_ 'WORKER'S COMPENSATION DECLARATION
1 hereby ufftm under penalty II one,af,the following declarations.
't PINALED
❑ 1 have rad will marmite a&rrificam-of Conserv to self-respect,for Worker's
- J 'Compenmoi ci he orkmd-for-by Section )]OU of the Labor Code, for the
'perfMniunce of the work far which this turrets.is lsxueJ,
O l have and will mainain WoHseis Cim;famaiionlnnarancc,as required by Section AUG 0 1 2001
37M of the Lubm'Code,for the parfmidence of the work'for which this permit is
1 is d,My Workers Cont,scrallon Laurance carrier and Policy number are
Ciol s ICERTIrI ATIO AP EXEMPolicPT'ION�OM� ''��'� [ SL, 7[r.'f; �'i ' a .BUILDING _.._ ..._. .
-.n e„•, .',,;',.:e-. .COMPENSATION INSURANCE .. ,M1 '—,_ .
'(This section need'..W completed if the permit is for one handled dollars
RIW)or
less.)
1 ser fy thany the pert Tina a er k f me u ch t rsork, I
•C II not employ any person m.an Date cr so ns to becomCwblcn m the Workers
Co hereto laws 1C If IDum l
-'Apel coni. -' L.
..__ .. _ .. .... ,. .. . ._._ ___..._. ._ .. .....__.. ......-__...._
after
.NOTICE TO APPLICANT eWorki It.Compeakingtp vision of the
Exemption.de,you must
Z 0 become subject comp y the Workers Compensation provisions or the carior Cole,you must
fnnhwit6 comply with such provisions or this permit.ehnll be deenmd revakeJ.
I h etiY Frnn thin th c n win 1 d ng age<Y f th pert mance'
ti of tM1 wokfo �h ch th p t s sa d(S c 309] Civ.C) '
y4A Lenders Namc- .p v _ ....... .... ..._ .. ..
�.z Lend rs Add;.
V'� y,I en Fy than 1 ha a rind thiappbcut nn and num that the above information is
�T+,F. wren:I agree to comply with all city and county ordinances and sin¢laws mixing
' 0:O to builJing conwronion,and hereby amnoriie'mpmssnatives of this city to emerupon
' Iy.(r� the above-mrntipned property for inspersion pnryoses. ,
[ rp. IWe)agreem a ” demnlfy anJk pharmles.�theCty ICupenino'a'inna,
h liab 1, J dynents,cast d expcnu h ch may in any y accrue ageim, aid
Q_z Cityl <onseyuen of th<gmnrhg of th perms _ -
"' APPLICANT,U EftsTA 5 AND WILL COMPLY W HALL NON-P01yTlahl
sou E anoN F„' . 2.0 Issued by: Dat
SignB(re fAp hcanVCommnor„ - 'I Date,? : Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
welt ppnrant ,batch,b ming rap t, r handl ll r us matt 'I Type of Roof .. ... ..
u d fln<J by th Cupen tw Mu c p I Cod Ch pt r 9 12,and th H Ith and Safety +.r,,f ]• y,; t 'a $t +,
Code
°Y" y All roofs.shall.be.inspected.prior_to any roofing material being,installed.,- __.
,wn the all
eesars as deinfie applicant r f tele budocs nt
emuseeqpin
u e t a x which If a roof is instaF'lled'without first obtaining an inspection, gree'to remove.
th b . rsdby to,
Bay
Am.Air Q.I d.rogement
all new materials or inspection..,Applicant understands and will comply with. ._
°Y P " - t -a11 non-points rce ere") tl - '
1 ha e.rc d the th.sochars-alliterial req 'reme t under Chapter 695 f.the
CaliforniaH hh&SateryC de sections 2t5Ut 2550 d25i14 derxaad that
v the buildingdce t currentlyh r
t �Yrt b'I Biy m nofythe
q�h h r h and Arim t issuanceof Certificate ofoccupy f th
a / Signatu e of Applicant Date
O he agent. rDate All roof coverings to be Class "B"or be._ter _
OFFICE.
...:A