06040175 CITYBUILDING OFCUPERTINO `* £"'� ' " ` ttss, '§f
DIVISION PERMIT ,„xCO1�ITRA,C�TQR II��OR11�IrSTION�
BUILDING ADDRESS: FOUR SEASONS ROOFING PEfMRNO'06040175
10120 .FIRWOOD DR
OWNER'S NAME: PERMIT ISSUE DAM
DE ANZA OAKS HOA 502 HORNING ST04/27/2006
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BO EO PLUMB MWH
O
jop LICENSED CONTRACTORS DECLARATION - Job Description
I hereby afRren thin 1 sm licammul under pmvalo s of Chapter 9(commenein"
with Slogan 7000)of Division 3 state Business and Professionsde,art my Became,is
+Z imBforceandeffect. TEAR OFF SHAKES INSTALL 1/211 CDX AND GAF GRAND
iZ3
Lt....Class
Le'aU SEQUOIA SHINGLES 50 YEAR CLASS A
is• Date f,'-7'1 .. _Con DECL 'r
As that =i DEC RTION �CM �•II \��®
. l� I understand my plans Wil he usoJ u public mceeN E
e Licensed Professional
RRNOWNER-BUILDER DECLARATION
N y I bcrthy.M.that 11. exempt from the Canuactoss :A n c Law for silo q c
0 0 following mtlaa.(Sinton HDLs Business and w, euam Cade:Any city mummy JUN 2006
which requires•permit re cnnstrne4 algin Improve,h Permitdemolish.at repair any lawmen,
that a its ieauevedhO requires the thovisho and for such Permit file a signed Law
(suemcm
pp O thin he le reeved purwmn m de pmvislOna Of the Conuacmr't Ilcecense law(CMpm 9 $q.F[.Floor Area ValuaN 15 5 0 0
t�$ (commencing With Seder 7000)of Division 3 of the Business and Prefcsamv Code)w
e .. Nu he A attempt therefrom and the hese fm the alleged— pdos My violation of AN HI Clime,
Secdan 703U by any applicants fns,pumpsubjects Nn appliesntm a Civil PCwdhY of ppN Num Occupancy Type
not me.Nan livehundred dollars(S300). 3 4 2 3 3 0 3 2 . 0
0 I,as owner of the proprny,or my employees with warps u Ned sole compensation,
will do the wart,and the structure is not mended or offered fansle(S.C.1044.Busirw Required Inspections
and Pmfesalms Code:TOO Comnemss LknO n eLaw dean[apply in an own.of q P
property who buildsorimproves thoweetand whodoessuchwwk himselfor through his
awn employees,provided that wish improvements am not intended ed oRufwsaln if.
however.debuildlni.Mpmmaenttsmidwl nOneyearorcmapicdw.t wnu-
maker MB haw the had.of Proving that we did Out bead or improve f.PuNosa of
sok.).
0 1,as Owner of the Impurity,am exclusively contracting with Ilttved Contractors m
construct the pmjem(Sec.7094,Business and Profession Code:)The Contractures u.
Cents law does not apply m so Owner of property who builds or imp own demons and
who contracs for men projects with a mnusaor(U Ikcved Paramus m the Conso me$
License Law.
O l an eaempl made See .B&P C fer this reiWO
Owner Due
WORKER'S COMPENSATION DECLARATION
I hereby afllna under penally of perjury now of his following dedsmdons:
I have and will malnWna Cerditnm of Consent m elf-inmm for wok.'s Camper,
sager,u provided for by=on 3700 of the lab.Code.for the perfonnamc of the
wort far which this permit is armed.
0 1 haw and will maintain Workeh Compensation Insurance.not required!by Section .
3700of the lab.Cade,fon the performance of the work fo,which thin Permit u issued.
My Workees Campemadontrismanuce Carrier and Policy number are:
Carrier. Ynun OMS: Policy
CERTIFICATE OF FR6
M WORKER '
COMPENSATION INSURANCE
v
(This acNnn reed Out be completed frac Permit tslmam hattmod gallon($100)
or leu.)
I certify this in the perfarmanee of the wart fon which this Permit is laced,l Nall ant
employ any Fusion in my winter an as m become subject no the Workers Compensation
Laws Of Califomia,Date
Appikont
NOTICE TO APPLICANT:IL after making this CcniDnte of Exemption.you should
below subject in the Wortcss Compensation provisions of the lab.Cade,you mnsl
.,O forthwith comply with such provisions.Nin permit Nall be deemed mouthed.z0 CONSTRUCTION LENDING AGENCY
(-w Ihemhy alarm Nat them is a commuccon lerm
Lending agency for we paroorxsW
IX> 0e work for which this permit is lsaued(Sec.3097,Cl,C.)
OWi Q largess Name
7 z Lendees Addmn
U O 1 certify that I haw read Nit application W sae that the abow infomugutt is
ty P comm.I sorra in empty MN all city and county ordinance and sue laws ralagng in
O U budding canswetion,and hereby out one,mpresanurives of this City m over upon lM
W show-mentioned property for inspection purposes 11
LL (We)agree to an,indemnify and LOCI,homeless tie City of Cupcnian agaivl
v,CA liabilides,judgments.cas andexpenses which may in any way same apinstsaid City
U'Z in consequawn of we Staining of Nur permit.
,..i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
cuun
'z Re-roofs
Signatureof li onsactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de aptilictri rut.building acupantsore,or handle muude.mRMIW
u deRned by the Cupenim Municipal Cade.Chapter 9.12.and the Health and Safety
Code,S.O.25532(.) All roofs shall be inspected prior to any roofing material being installed.
QYn bNa
Will Its applicant or future building aaupant can equipment.devises which If a roof is installed without first obtaining an inspection,I agree to remove
emll huardom air eanumivm as defined by the Bay Ales Air Quality Management all new materials for inspection.
Diadn7
Dyes '�,;,No
I haw mad the h.ardtna materials requirement underchaper 6.95 of the Califor.
nla Haalth&Safety Coda,Seem=25505,25533 and 25534.1 undenoM am lftho building
does not currently Mw a an.,Nu it u my responsibility in notify two occupant of the
t muubc t�
of.Certificate _ 6(0 Signature of Applicant Date
owner w mina nn Dae All roof coverings to be Class "B"or better