06040172 CITY OF CUPERTINO '�" ' - " '"`" -
bU1LDING)DIVISTON' PERMIT 4� '1ZAG!'nRI,m`U)KM �'If11�I
a$,Y^E;zxtisx hx «• ''". � >FNaz nk-�§',�.t
BUILDING ADDRESS: FOUR SEASONS ROOFING PMovil ND.06040172
10102 FIRWOOD DR
OWNER'S NAME: PERMIT IEEUEDATE -
DE ANZA OAKS HOA 502 HORNING ST 2 0
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACT'OR'S DECLARATION 706 Description
1 hereby mint Nan I am[immune under provisions of Chapter 9(commenting S wide Section 7Mo)of seOivWonlefdaBusinessandPrefessbnsCods,andmylkenaca
m full term and 0) TEAR OFF SHAKES . INSTALL 1/211 CDX AND GAF GRAND
SO
3@g Lice La.
�' w 3 —Gnmmr A SEQUOIA SHINGLES 50 YEAR CLASS A
DaR=�
ARCHITECT'S DE LLATION fn�
A l understand my plasmas dealt he used u public records � �r
1 ted Licensed Professional
9r`EB
sO3 OWNER-BUILDER DECLARATION
f I hereby
elRttn that 1 am exempt from the Comm mos License Low for the
p a following mason.(Section 705 1.5,Business And Professions Cade:My city or county
119 which Milm ul s permit us COMAHWI,alms.improve,demolish,or repair,ray Outcome logs
13� prior in it issuance,alw requires the applicant farsuch permit ro file a signed saammt Ft.Floor Area - Valuatiy�500
C Nmu
helalicensedpursuanttodesprovislooftheContractor'sBermelaw(ChaparY9 Sq.B (emnmencing with Section 7000)of Division 3 of the Business and Nofesslotn Code)or
that he is uempt thezefrom And On bub he the alleged euunpdom My vioWl'mt of
Section 7031.5byany applieant for apermltsubject the applianua Advil pcnslty ofppNN mber ccupancy Type
Act come Nur Ove hundred dolam(S300). 3423335 . 0 b
0 1,As owner of Int property,or my employees wide wage As dmir said compensation,
will do like well.And the seuoure a not Intended m onerra far SAM(Sec.7044.Boniness Re Required Inspections
BM—
And Professions Code:The Commute,License Law don Am apply an an owner of 9 P
pmpcny who bu0dsarhoproves Nelson.andwhadeessuch work him undf or through his
Own cmployeu•provided that such improvements rum Ant inrendW moRrsed fersala U.
however,to building or Improvement is sold widdn am you of completion,the owner-
Indian will have to b adeo of proving that he did rot build m improve for purpose of
sale.).
❑1,u Owner of to property.Am conclusively eommemi,with Bmnvd mnuatom b
conswm the pmjen(See.7044,Business and Profnsimu Code:)The Cmbm.Ter's U.
cense law den out Apply in an owner of progeny who builds or Improve thereon,and
who contract fm such project with A mntmetr(0 licensed purwant a this ConuMofa
License Law.
❑IunuAmptunder See .B&PCfmthioasau
Owner Dab
WORKERS COMPENSATION DECLARATION
40 1 hereby affirm under penalty Of perjury arc of site following decAmdoom
❑1 haft and will maintain,Cenibnt ofCouem an salf-insure for WorkcYs Camper.
Older.u provided Ter by Section 37M of dee labor Code.for dee performanuc of Ibc
work for which this permit is issued.
0 1 haw and will malnWn Worker's Cmnpensidon Insur .As required by Section
3700 of the labor CAM,fm the fictionalize of Ne work fmwhich this permit is issued.
My Wa s Compenuticn baunme artier rob Polley number Am:
Garle� 4mliry ROM 2yZu4
CERTIFl COMP EXTIONIMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(This setakin need Aetbeeornpleted Uthe perm,a(mane hundred de0ms(5100) f
or leu)
1 modify that In the perfamanm of hat walk rat which Nis Permit a issued.I shall Aot
employ any person In my ma mcrm As At become subject in the Wehen'L'nmpanaden
Laws of Califomia.Dot
Applicant
NOTICE TO APPLICANT.If,afar making Na CeniOam of Exemption,you should
become"him in da Worker's Compensation provisions of dee labor Code,you mesa
.,O fmdewiN comply wide such provisions or this permit shall he domed revoked.
z'` CONSTRUCTION LENDING AGENCY
[r I hereby alnmt that there Is a construction leading Agency for the pe-kne a of
Cf the work for which Na permit is issum(See.3177.Cl,.C)
W 0 Lender's Name
7 z leaden Addaas
U O i certify dust I have rend We application end sub Nu Ne above information Is
u,k� cotmi.1 AIrca in comply with all city and contrary aNlnuxear and sub laws relating M
0U building construction,and hereby Authorize npresenutives of Ois city to enter upon me
W above-mentioned property for inspection pury nes
(We)agree to ave,indemnify and keep h mpleu Ne City of Cupertinogain"
v-t(AA Imbilides,judgments,eosu and upemes which may in say wyacomc egalMLIA, Ctry
U wZ in<oucquenec of the{rating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RFA
--Lind Re-roofs
signuureaf i tfConumnm Dna
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Ap911.1 Or f inure building oceupatmom m handle huaNau maaral
u dented by uses Cuperum Municipal Code.Chapter 9.13.and the Nunn and Safety
41 code.Section)5532(4°. All roofs shall be inspected prior to any roofing material being installed.
E3 Y. No
Will the applicant or future building occupam use equipment Or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasaNnu air conuminanu u deftmd by the Bay Area Air Quality Management all new materials for inspection.
Didn't?
❑sin u
I have mW the huudests mSbrimsminummenuumkr ,Chapar 6.95of the Califor.
niAHUIO&SafetyCndq Swdms23305.25533And25534.lwdcr dNmlfda building
does not currently haw,anonL Nm It is my responsibility b notify to occupant of the
reyaire nienm mwtaAmaI Gerir�a,�ar`aypaT.� Signature of Applicant Date
owner o tame rad bent ,�,�+ M 1 DA; I All roof coverings to be Class"B"or better