00120009 cIBUIDIVISION o
BUILDING
PERMIT CONTRACTOR INFORMATION:
BuaDINGA1J.01s32 FIRWOOD DR FOUR SEASONS ROOFING
PERnuTNo.aa1.20aa9
OWNER'S NAME: APPLICATION SUB DATE:
DE ANZA OAKS HOA. 645 HORNING ST 1.2/04/2000
i.PEIONE: (408)278-0330 SANITARY NO. CONTROL NO.
to ARCHITECT/ENGINEER' - BUILDING PERMIT INFO
E U BIAG IILECr PLUMB MECH
OZ S�j LICENSER CONTRACTOR'S DECLARATION tion
= 1 hereby oflimnhat I am licensed under provisions of Chapter 9(commencing Job Description
F=too x ith Scolion Wall))if Division S ofobe Ra,irwas and Professions Calc,and my license
i,mmnrar«ase _rfy tb Y Z� CEhIW00D TO 4aYEAR COME
g O U License Class '—`_y lois p
11tmlc i =� Connecmh
t O ARCHITECT'S DIiCLARA ION
�co
S 1 und'so I my plans shall be used aspublic reactors
w z O O Licensed Profea,inoal '
on 0! OWNER-BUILDER DECLARATION
rYd= I hereby uffimm that I am exempt from the Constrictor's License Low for the
t Z<
following reason.(Section 7131.5.Business ail Professions Curb,Any city or county
FO whchtr ryrFntl c t I Irr p d Ish rmpo y.aucture,
printo its issuance,also requiresthe pllic t ba suchpe tt tile it signedsttement
a ma he isr t p t 1 top m.. I the Contractors 1 Laos(Clanar,9 S Ft. Floor Area
(cm g 11 S t 7000) fl] In i rine llus v_� d1 ,te„mnn,Cale) q' . - Valuation
or door he's cxc opt tl arefmmm and the cosi,Ga the alleged exemption.An,violation $9000
of Section 7031.5 by any applicant fnr n permit subjects the applicant to a civil penally Occupancy Type
ofaatmnrethan five hundred dollars ls5an. APN Number
01,.as ownernr the property.or my employees with wages as their ole compensation, .:r4s_3Sa3,:a. as
,111 do the work,and the structure is not intended or offered for sale(Sec.744.
Business cad Professions Code:Tire C,aoral License Law doe,out apply to via Required Inspections
of property Who hmids or improves merenn,an l who does soch work himself .305 — FRAME
owner
hrough his own employeesprovided teat seen improvement,oro not intended or
untied for sale.It,however,the building or improvement is sold wimin one year of 307 — INSULATION /
unpruehommeowna.bonderwdllmavamaburden nrprnviagdmanedid not nndn„r 6a> ROOF TEAR OFF
improve rnr parpom nr aale.3. _ C,
Sl,as owner at the Ptopeny.amesNusively. connecting with licensed contractorsto Fart — ROOF PLYWOOD NAIL 7g�
License et the does
no(see 7oLa owner I and Professions emdor The animists
dresser,ear s _ 603 — ROOF BATTENS
Liacme Low dna,rot apply m an owner of 1,amu who builds or improves
anJ who mmecm fur such Prnjcea sell a aontincmrts) IieensuJ pneuum mm the
cnn.,,Iawal.ieenselS.w. 60,4 — ROOF. Ihl—PROGRESS
l7 I alio uen,pt minder sae. .B m r e tar tee,reason
Owner Date m
N'ORKLR'S COMPENSATION DECLARATION
I hereby mfimr under penalty of prjury one of the following dedomtions:
0 1 have and old m.ainain a Certificate of Consent to sell'-insure for Worker's
Compenwnon, is pmv del for by Simon 37011 of the Lncor Code, for tlm
performance it but work fnr which this noil is i.,ved.
01 have and will maintain Worker's Cotnpcnution Insurance,m required by Section
37M of the Latin Code,for the performanceof the work for which this pmmil i,
owned.My Work lis Campnmtion Insurance carrier and Probey mom y
Carrier:;U9 Policy Pnbeyno.:ytl�0!�7"'0—D
CI:R'fil§CATION OF HXIiMP I'[ON FROM WORKERS,
COMPENSATION INSURANCE _
IThis section tmal not he completed it the permit is fnr one loathed dollars -
ISIWqorleas.) _
1 ceaify that in the prfnnnunce of the work for which this permit is issued.I
shall not employ any pttsnn in any manner so as to become subject to the Workers'
Compensation Laws of Colifomia.Date
Applicant '
NOTicE TO APPLICANT':It:otter m,.king Ihin Certincmo of Ikenynlon,you should
become,uhjeenn the Worker's Conmpensntlnoprovisions offit,Lubar Code,you mal
Q O forthwith comply with such provi,inns nr rhos it permshall he decanted IwAcd.
CONSTRUCTION LENDING AGENCY
a 7 I hereby affirm that there is a construction lending agency for the prfommnce
of the work for which this permit is issued(Sec.300,Co,C.)
Q Lanokr's Name
taU.1 z lender's Address
[i
carreef.O 1cmnify that l have rudrhianpplEmioo and star'un the above inbvnmtlon is '
1 agree to annply w'idudl city and enemy ordinances and state laws relating
0 U to building conaruction,and hereby amhorlm representatives oidus city mere,upon
Ibe above-mentioned prepay far inspection parp,se,.
(, L (We)agree em rave,indemnify coal keep harmless the City of Cupenino against
VJ liabilities,judgmans,costs and exposes which may in any way cease against,aid
U z City in conseyucnce of the gaming of Ibis permit.
A"TIC' UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT /�� �D
1 -Ce :GULnTy�z;. / Z� (�_O Q, Issued by: Dale
Signator f ApplicanVComm�cmr / .Oce Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the oppli,am or balance Wil inguttmpant store or handle hmardous.,oil Type of Roof
m defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cale.Section S533(all _
0Ye, All roofs shall be inspected pHer to any roofing material being installed.
• Will the nrydicunt(afuture bnlldingoentpanluse eyupotarta,deviveswhich If a roof is installed without first obtaining an inspection, I agree to remove
ctnit hazardous uu conual arms as Jclined by rhe Bay Area A.r Uuallty Manngenmm P
Di.strier' all new materials for inspection. Applicant understands and will comply with
°Yc' all non-point s rc regulations. PP p y
I have read the hvprdnus mneriuls reyuiremams under Chapter 6,95 of the
Califomla ia Health Safety CaSptiona255($,]5533 and 25534.1 understand bar
H' huildingdo tcurrentlyhave a tenant.that it is my mspnsibi1hy to notify the G}
occupant or th annlai eats which ain't be tnel prior to tauanee of a Cenificae of -
Occupncy. _
_�A/^1 Signa ur f Applicant Date
11 anmdsedagent /�e� W All roof coverings to be Class"B" or better
OFFICE