01060066 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: .
s BUILDINGADDRESS: PERMITNO.
22990 CRICKET HILL RD FOUR SEASONS ROOFING 01060066
OWNER'S NAME: APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/12/2001
% PHONE:. SANITARY NO. CONTROLNO.
(408) 278-0330
O ARCHITECDENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
< _ f GJ 1"" 1-'1 L_J
Z yLICENSED CONTRACTOR'S DECLARATION Job Description
O z_ 1 hereby aRrea Nm 1 am licensed under previsions of Chapter (commencing p
will Section 7")of Divlsm 3 the Business and Protctoomr,Chad my license
c m Y�' is in full farce a ffn0 O i
ee ad License C 7 ue.a REROOF.
3` Date SDECtnr T/OFF CEMWOOD &
ARCHITECT'S DECLAR TIO
t=O _ 1 undr,DmnJ my plans shall be used is polike remNs ,I
�Oa � INSTALL 1/2 CDX 40 YR. COMP.
i K po Licensed Professional,OWNER-BUILDER DECLARATION !
w- : 1 hereby i f imt that I am exempt from the Contractors License Law for the
F following reams(Section 7031.5.Business and Professions Code:Any city or county
I FCC which nN.ima is perm t to cmmorch,doh,improve,demolish, repair wit,swctum
�III its tla SL.. QUj.alt requires
m PPI tf hpert,t fl signedstatement. _ ... ...... ........ _....
I mv.l rn c t ret L"'it, (cl la 9
' .�, .r, .Sq. fJooll'-Ater (- 1 Valuation
w m n higwthl t Its rif Div 3 fth hornless'ndlrq(ession Code) 1- ) L,..^k C. 1 t1 e'. s.1I eili,,.� k_.1�ii�''
or that he is exempt thcrefmm and to basis for the alleged Acmpsioi.Any violation -
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty . , •!•[®Q�VOancy Type
T not more than five hundred dollars SSS). APN Number f r
l
❑I,as ownerof the pmpeny,or my employees with wages os their sole eompeasnBar,
-'will-do'the work:antl-the'.etm mon is not intended a,offered for sale(Sec.7044, ----
IBusiones and Professions Code:The Contractor'a License Law does not apply Ina. 34241005 . 00 Requiredlnspeetions'� "
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided Nat such improvements arc not intended or 1
:oKercd for sdle.'If;howevd,the tiuilJin - Tis sold-wishin dric'c3r of - ----' -- ---- -'"'-" -"---- -"-"-""-"-"'-"-' '-- '- - "--"-- ---------
completion,the owner-builacr will have the hullnoT `n n that he am not build dr 3 0 5 - FRAME
proving ) '
improve for purpom of sale.).
.3 0 7__-___.INSULATION....
❑1 s e f th p Pony, xdus ly tract i,w th licensed conmaxams t
lumuoulee project(Set.7044Business property d PPmf. n C d )Thh Cmho t 601 - ROOF TEAR OFF
LceneL tl nom 1 t lie ofl n buildso a --' 603 ROOF BATTENS
P 1
_and ha c rmucu.f s ch.pmjects th ontmotor(s)Icemwi p -.6,0 2 _ ROOF _PLYWOOD NAIL. _
-: c t t enLicenseLa - --
❑1 noesempt do Be a B&PCfrthiae uo -
OtImir te 604 - ROOF IN-PROGRESS
COMPENSATION DECLARATION
f l WORKERS COMPENS
tr Ihereby firm und r pc It of'' otie of the following declarations: : /
o ❑ 1 heve'and'will'muncim a'Citricam'br C'wimn m self-insure
for Worker's
peCompensation:ee,providm for bldinci it 3700 or a Lahr Code. for the
rformhncc of the work focwhicM1 ibis permit is issued.,
111 have and will`maintain Worker's Compensation frsumnce,u required by Section
377 of the'Lnhiir Cole,for the performance of the work'for which this permit is
is d M Wo ker's C mpensafo Inst'' ce
• car a anC Poll zrynumbera e:
� y71C HNo OM,WORKERS;CERTIPICATIONOFEKEMPTIONFR -
V fJ
4 >a $t a sle, _.'•} li,cJ'^1. .,. C�,.�• i
..,I., COMPENSATION_INSURANCE __. ...........
I(This section nreJ not be'com leied it the Permit is for one hunJred dollars 11'4• nYli••:; ,i ,.. ^
lbl W 1 or less.l
m(y that m m pert mance f the o k'for hmh th - - ._ .- - -� .".•.." •.•
I el ite mskeI t i jL: rl •.
"ah 11 i t employ-any pc n an any ma m io becom sub3en to me Woheri '1 -
C rep uon Laws of California.Dmc '
,.Apple t. .'__. ...�....: . ..,-. .,.., a
NOTICE TOs,,o he ANI':IL a onfixo ngthliwhin,m ofath Exemption,you you ould . t
Qbecomesubjecty the such PTs Coions.1 this provisionsof the Lahr C&Ie,you must
forthwith comply with such provisions or this permit snail he domed revoked.
F"ZI { It- n CONSTRUCTION LENDING AGGNCY
1 hi firm that m - construction o ding.,easy farthe performance
w p,
,..a
Le
kF M1mn'his permit' creed(S Cv.
'd rs Name .,:.. 309]. CI
..,, :w., .. ......_.
;;I.Z Ic d Address
U-� .,l cell ft'thmlhave read thin apPlacm on unJ seem thn the labovu infonnton is
fza::F ctirrecvl agree tg comply.with all ciay and county.ordinances and state laws rcluing
-V to building consametion.mid hercby'authoriie rcpresrnmtivh o(mis citymemer upon
�..(� the abovo-memioectl property for inspection purpose;.•,_, ,_.
C� �+ Iw') 6 e to Idem 'ly antl kttp handl s rye C ty I C p niroagain'aid
'V] liab In ) Jg enu t I pence hch ay in nny ay gaia.t. i
V z Cty an co sy ce fm t golm pe t - /•
- APVLICANT _ER A SAND WILL COMPLYWITNgL{-nOU �'. Issued by: Dale /Y�.,
SO E LATI t I t
sign t eprAPphcanticphtracton ". ;.... 'nal . . Re-roofs
-.;�Jl" .HAZARDOUS h1ATERIALS.DISCLOSURE: '-.. '
:; W II me applicant o f m b IdinB«c p t amrc lir n al h ard'aa material.. -Type of-Roof.._. ...._.
as dein tl by the Cupen M opal C Je Ch peer 9 12, d to H<hh and Sure,,oyt
-
CodeStin25532O ° e. - hiss...••. _
._ All roofs shall be inspected piior.to.any_roofing material.being.installed
c• W IPthe ppl' antorfuture building occupant'useequipment raevtce.which If a roof is i6stalled�Witbout first obtaining an'ins ection;I,atrree'to remove
Distinct?1 ha e'rc d the h gird s,mat n a by m Bay Are A Quality Management eine°' -all non o t soilrce r lotions Applicant understands and will comply with
B
ret az rconlum harts der all new for inspection.t, A
• i ❑Y of comm havet .p ..:... .- . ...._
P
•• en Is requirements under
'Chat 695 of the
CaliforniaHealth&Safety Cod Sections255032553Jand 255341udrst dmat
ifthe limiting dos y t at thattnmy ,responsibility to notify the
occupam a the r ire'e hich most be are[pnor m issuance of Cenilicate 4 - -
. (]cc p _ „
.p/ SignatureofApplicant - . Date
-ow ramnor:ea, g lit t, '- wee All roof coverings to be Class "B" or betier
-OFFICE