01060007 OF
NO
CI BUILDING DPERONNO PERMIT CONTRACTOR INFORMATION:
UILDING ADDRESS: PERMIT NO.
B-1
FIRWOOD DR FOUR SEASONS ROOFING 01060007
OWNER'S NAME: APPLICATION SUB DATE
SHARIFF KARIM 645 HORNING ST 06/01/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECIOENGINEER: BUILDING PERMIT INTO
O
<U� BLDG ELECT PLUMB MECH
�« =1 LI — I L_I
8 H i LICENSED CONTRACTOR'S DECLARATION
ZO Z�2 G I hereby o irm that I am licensed under provisions of Chapter 9(commencing Job Description
:I_w with Section]000)of Divi,aian3of the Business and Porm,sions Cede,andmylicensa
�y f wj in full force and a t.
� <
is mann =3 4 .rum; /F p y 17 SQUARE FEET RE-ROOF
K O O Dam (e— r�� ( - Commn°r
w 3 d.t' ARCHITECT'S DECLAR TIO
t a O Ng 1 understand my plans shall be used as public records
reO O L¢cnscd Professionil
e� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Comracmr's License Law for the
L?Cfollowing reason,(Section 70315,Business and Professions Code:Any city or county
which requirain pennit no comsmal,at p demolish, p any structure
a3� P tot ' I. y thef hpcntt fl 'g dwmment
that hlicensed puu u theprovisions Int Contractors LicenseLa (Chapter9 S Ft.;Floor Area „ . , $ kkvvnua[ion
(c - g the t 7ggp) fDi -- nJ tib Bu d Prfessons Corel q'k ., 80 VW
o that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a Permit subjects the optical to a civil penalty
'of notm°m than five hundred dollars PS500). 342M108n?V6 '- Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
will do the work;and the structure is not intended or offered far sale(Sec,7011,
Business and Professions Cole:The Contractor's License Law does not apply to an 305 - FRAME Required Inspections
owner of propWho builds or improves thereon,mal who does such work himself
or erty thmugh his own employeesprovided that such improvemenm arc not intended or 307 - .INSULATION.
offered for sale.If.however,the building or imprevert is sold within one year of -
completron,the ownc1builderwill have the burden ofproving that hedid not buildor 601 - ROOF TEAR OFF
improveforpropm, ofsale.).
602_. -. .ROOF PLYWOOD NAIL
❑Lasowner ofthe pmpenyam business and trofessiins ldepseJecmnorsm 603 - ROOF BATTENS
I.M.'License
the project(Sec.70xa Business and Profess its Cak:I Tlrc C°ntmcmrn,
License Lawd«a no,orsuc roanowner with
pmpenywho builds
ensed provestM1to the ...604 .- "ROOF IN-PROGRESS
.and who's Liberia
lot such pmjec¢with a comrunnr(s) licensed pursuant to the. ."
_ Cantmnors Lic<nsc Lnw.
❑I am exempt under Sec, ;B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penahy of perjury one mom following declarations:
Cl 1 have and will maintain 3 Certificate of Convent to sel6imure for Worker's
Compensation, as provided for by Section 3700 of Ne labor Code, for the
performance of the work for which this pemdt is issued. 10
////
O I have and will Labor m Walker*,, fthe work
hperaSection
37 00 f theLabor Code. the pCompensation f h work I required
this permit is
issued..Mfy'Work�erxCompensation nsa1 so carrier
ansd..P Ir y umbe .,
. . Caodmh! ,Clw (!A P f y No. SLz �SY
CERTIrICATION OFCOMPEN COMPENSATION
INSURANCE WORKERS' - '' .-t —r s Vis.
COMPENSATION INSURANCE Y
olty acct un need mat be completed if the permit is far,one hundred dollars t
($I00)or less.)
I certify that in the performance of the k for which this pemrt is issued 1
shall not e ply any person ny manner so.ii to become subject to the Workers t -
Compensation Laws orCalifomia,Date
A,,Iirabt . . _
NOTICE TO APPLICANT It,after making the Ccn fcam of Exemption,you should -
become subject to the Workers Compensation provisions of the Lubm Camus
le,you t
0 fonhwith comply with such provisions or this permit shall be deemed revoked.
F ,. CONSTRUCTION LENDING AGENCY
a.' 1 hereby Rrm that then isconstruction lending agency for the performance
W QofN<wofm which this permit iss issued(Sec.7097,Co,C.)
LeN
..Lender's Name -. .• - ...-...� -.. . - - _ . ... _ _ - ..
a,z Lender's Address
I certify that 1 have read'his application and cote that the above information is
tzuF.r correct.1 agree to comply with all city and county oNinanecs and cote laws manner
>, W dueto aldingtiondcontraction.perryhereby
for
purposes, ufthis city mentor upon
�,,,,2w the obo(Wa).g.m Property for inspection p handreL
(.., d (Mk.dIume s, .,I andepensesand k which
ihamyinthe City ofcom uilmors,ns
ti liabilities.judgments,cosi and ing oft i wtrout.ny in any way accrue against said _
V Z City in consequence of the gmS AND
this CO /
APPLICANT t'NDERSTA OS AND WILL COMPLY WITH ALL NON-POINT /Q Q_ /q/!— —7 ��� L a Datey
. SOUP//CE RF,ULATIO^�' _ /—(/A/ Issued by:�
Stgualmeo Applicant/Contractor (� ( Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or lumm building aecupant store or handle hazvdous material Type of Roof
as refinetl by the Cupertino olt nicipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a):'.
Ryba + -All roofs shall.be inspected prior to.any_roofing material being installed.-
Wal the applicant or mm building occupant ase egnipmcnt or devices which If a roof is installed without first obtaining an ins ection;I arsree'to remove
emit haamdous air contaminants as defined by the Bay Area Air Quality Managament g P e
DismicO all new mate ri s for inspection. Applicant understands and will comply with
❑Year V4° all non-poin ource regulations. -
1 have read the huamd°ue adarn.11 requirements under Chapter 695 tithe
Californiaing does
Sectionsa5500.t it
and25535.Iundmsmd that
if the building does not mmor eptly chrem,te, that it is my rtsponsibilirymnotify the
occupant of en m hsh must be met poor s of,a Certificate of
Occupancy.
.
p y �(so/ Signature of Applicant .- Date
., ownerralnonaedaeent Date All roof coverings to be Class "B" or better
_. - .. OFFICE .. - ...