06050106 CITY OF CUPERTINO ' " F q�f"m�'me ' .Rix_
'BUILDINd DIVISION PERMIT ,C'ON;TRAC' QI2��11VX? RMA'` IQI
uAMUP,
BUILDING ADDRESS: ' FOUR SEASONS ROOFING PERMITN0.06050106
23018 CRICKET HILL RD —
OWNER'S NAME: PERMIT ISSUE DATE
DEANZA OAKS HOA 502 HORNING ST 06
E: SANITARY NO. CONTROL NO.
(406) 278-0330
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG PO PLO MECH
�pp LICENSED CONTRACTOR'S DECLARATION Job Description
l 1 hereby afllrm that 1 are Iicaund under provisions of Chapter 9(commencing p
+ m ull�foracandeffect. duris
anSofthcBndMPr-Z-JnsCode,andmylknso
license TEAR OFF SHAKES INSTALL 1/2" CDX AND GAF GRAND
``'" EQUOIA SHINGLES 5
3 Dam Contractor
RCiDEC I N �(
1 I understand my plans shallall he he=it M public records v
y
sod Lherod Prufeuianal �/
d OWNER.BUILDERDECLARATION /
0 1 Mrehy.(Seco that 11. .usht from aide o CmuanCas License law for the JUN 2006
o O following rcas.n.(Saban mo Itu Busus.sand vefaal.ns Calc:Any chy m county
�$rry which mqussa a permit re uance,austo quire the alcor,improve,demolish,m repair any nructuro
ZY prior ln...dpurmntto the BC aisionor for such Contrarmirmikasigned sialcuChaps Cnr
a dwkiscCevcJpunuuntodeprovialons. theRuomusandP I.m(Chapter Sq.Ft.Floor Area aluaC 0500
zF$ (comm iscingwithheNm 70ndth Division 3.1 do alegedaeaaphon.M vi Cade)or
III
thin ka u rsmpt therefrom and or baht(m the alleged eamant W Amy l penalty
of DIN
ppl.I N be
9ttlone Man five
anyapddollforapemtit obJttts the appOcantto.civil penalty of 342408 1'00 Occupancy Type
not more Nan Rw hundred dollen(5.500). '
wi Lanownerof die foundedcolwgaortheksok70".BuNon,
will da Newark and the stenos is.,s Lica=a awned formic notapply Dan Mau ss
of
and property who
Code:The Contractors Lkwe law doe not apply lf an owner is Required Inspections
mropemywivebu110aarimpmwathermsand who amsamhende himselfedINough his
awn employees,ear.the
proWori that veer ImP�omu are cot reamed moRertd for We IL
however,the haw
or improvement is amid within oro Wild of comove for the awne>
Wilde'
will haw the buNen of proving that he did not build or Improve for purpose of
ale.).
❑1,as owner of the property,am aelariwly contracting with licensed mauxmn to
co rant the project(See.7044.Business and PrafeWaos Code:)The Conurtmfa LI-
canse Law does not apply to an owner of property"a Wilds or improves Neaman,sood. -
whoconuauf.ramhpmjceuwlthamnuacmr(Oliartsedpursuantwft Cone es
Lkena Law.
❑Iamesemptunders., .BIPC(muldinemo
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty a(perjury ane of the fallowing declaadlotx
I haw and wfil mo mem.Cenifiwm of Cement to elf-hou a fm WortcM1Campcn-
color,a provided far by Section 3700 of the labor Cole.for the perfomanCe of the
wort far which this permit is Issued.
❑1 have and will maintain Workers Compensation Worries,as required by Section
3700.(the lobar Cade.far the safmnnmc.of the work far which this permit u lsaued.
My Wo rs Compenadm ins nm artier and Pokey number am:
Grtie kW Na.:
CER I CA�ONFRO WORKERS'
COMPENSATION INSURANCE
(This dNm mea mtbec=ple ed if the permit is formic hundred doll=(310) a
orlav)
1 certify that in the performance of the wart far which this permit is Wood,1 shall mi
employ any person in any maoterso as to bacon object to the Workeri Compensation
laws of California.Dam
Applicant
NOTICE TO APPIUCANr.If,after making this Certificate of Exemption,you should
bmmne subject to the Workers Compensation provisions of the labor Coda you mud
.J O forthwith comply with such provision or this pormit.hall W Clamed mwked.
.Zi H CONFRUCDON LENDING AGENCY
E+ I Wmhy il
affirm dm there is a commeadon lending agony Tor the lxRomamm u(
C> dm work for which this Permit is uea tmA(S 3097,civ.C)
0.Q lender's Name
0 2 Lenders Addaus
U 0 1 Certify that I have read this application and tore thd the above information W
ty H concert.I agree a comply with all city and county unification and mute laws relating to
DU building concoction,and hereby authodn representatives of this city to enter upon the
above-mentioned property for inspection purywas
ora
(We)agto ave,indemnify and keep harmlea the City of Cupertino.,inet
rFa V1 IieMlida,j Wgmants,coW and Capetian which may In my way warm gain[said City
C)7 in eanagm ucc of the loading of this permit. ` /.Z y/
r� APPLICANT UNDERSTANDS OMPLY WITH ALL NON-POINT Issued by: Date ..+ L
BO GULATIONS.
1 9 Re-roofs C7
Slgria ture mf AppIiat ,n Date
xis MATERws DISCLOSURE Type of Roof
Will the appliaQ wilding occupant store or handle haardous Woods]
as
defined by the CuMno Municipal Cade.Chapter 9.13,said that HaIN and Safety
code,Section 21533iaf+.� All roofs shall be inspected prior to any roofing material being installed.
❑Ya pWo
Will thc applicant or future building accupao m equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haardnns air conumiamu a defined by the Bay Area Air Quality Management all new materials for inspection.
Dislrlct7
❑Ya ____[J-pl.
I have mail the transition animists requirements umkrChainer6.95ofdmGalifor-
has Hall Salcty Cade.Satimer25505,21533 and 35534.1 understand thildut Wilding
don not currently haw a us ban responsibility m notify do occupant of thC
m
be toe ahcrtfi a P2.
Signature of Applicant Date
0harizparo Date 0 All roof coverings to be Class "B"or better
CITY OF CUPERTINO
!m 2 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . I . . . . : 34240031 . 00
DATE ISSUED. . . . . . . : 05/12/2006
RECEIPT # . . . . . . . . . : 34375
REFERENCE ID # . . . : 06050106
SITE ADDRESS . . . . . : 23018 CRICKET HILL RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- ------ ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
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