00120010 CITY n i I c DIVISIONNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10170 FIRWOOD DR FOUR SEASONS ROOFING 0012007.0
OWNETUS NAME: - APPLICATION SUR DATE
DE ANZA OAKS HOA 6A5 HORNI146 ST 12/04/2000
IONS: - SANITARY NO, CONTROL NO.
(A08) 278-0330
00 ARCHITECDENGINIZER: BUILDING PERMIT INFO
CC BLDG ELECT PLUMB MECH
an
IyF an
ZOm' ECLARATION
Inent,tffmttttlhatiamlameduMePrDiicusofChnNc,9(,.a icing Job Description
FOt� with Sectiuo70a0)of Divisionlof the Business and Pmfn>ionn Cole.unJ my licennc
aY tvinntufnrrcun Berl 4 uea_y7.2/ 0 CF_MWOOD TO 40 YEAR COMP -
oLmeme c1aII_ 3
D:ne / i_ Cb— Co.rannr_� tai,)_
3 O oi ARCHII'ECr'S DECLARAGON
I underumnJ nay firm shall h uxd os public records
N
Livened PnJasional
F OWNERS exeniD[RDECLARATION
1 hereby affirm that 11, exempt from the Co,mnl Core:IA.,c Law for the
Z6 whichiagre mmi a,lseetluo]1131.5,Hudneo'andve,deiolihAnycity nrcnunD
O whichits issuance,
alma reconnive,mice,it forsudamnnitt fieasignnytvucmrc
$ thatfarsoho sliamusic,altamquimsth)visi cantlie Cont tminolilRw Liaedsutmem
3— commelicrnousiNarwainwithSetion7")ofDilikiism3o beBusinesLianselrwmn,Carr9 S Ft. Floor Area
lcammbe is a empt therclu rn and t e basis or t the alleged
x and io n Any vi CnJul q• Valuation
stat hn is exempt anrcfrom ran the hails it ma))urged exrmpann Any violation $9000
of sect., ,tha 7031.5 by mydredoll ler rparrot sntjer¢me affftcrnnnacivil Penmty APN Number
of nm mom Stan five hundred dollars(SSLg1). QCCnpall Type
❑I,a.sown:,r6the property,or my employees with wageem their sole cmnpensadon, 34235026. 00
will do the work,and roe ornetma is not intended or offered for.vale(See.7044, -
BminJss ami PrnfeWisix Ctrde:rhe Couto 's License law Joe,our apply m an Required Inspections
n ofh lis ovrly Who o,ec or i provided
that
such,ctrl who due,more xnd nimscll //
nr through his own employees.provrdeJ that such improvemcros arc nm intcndover 305 - FRAME
.(4red for sale. o ehowever,rudder
the building m improvement n sold within one year of 307 — INSULATION
humovei for Ihe owner-tntildrr will havo the hurdcn of proving Ihtn he did nm(wild nr
Iatpnrve rnrr orthe ntperty, 601 — ROOF TEAR OFF J
❑nwomt murine p(Sri.7rmexclusivelyit mmct,nimr,licensed eContraorsm 602 ROOF PLYWOOD NAIL
cunstmm d¢project(Sri.]fHJ..Business unJ Professions Cnde:)The Contractor"
Utoose Law doev not apply to an none,'IF 1-110,who hadd nr amprnvm theiron, 603 - ROOF BATTENS
and who onaax,s for Inch tomcat,with a ronlracb.,O) licensed notion to the
Commeme,l-wertseLaw. 604 — ROOF IN—PROGRESS
❑I am exempt trader See. 1{&P C tDr this rcmrm
Owner Due
WORKER'S COMPENSATION DECLARA'I'(ON
1 herchy affirm undine penalty of perjury one of the following declarations:
J I have and will tnuinmin a Cadilicale it Coolant ha sal(-in.mm fir Worker's
Cornom.lion, as provided for by Section 1780 of the Labor Code, for the
fterformanm of thc um,for which this permit is ismeJ.
C 1 have and will mrinntln Wad c,'s Compensation Ismntncr,a,required by Satins
171x)of the labor Cade,liar the performance of the work tar which this permit is
ismcd.Nil W'arkee,Compensation Inmrance carrier end Policy number am:
arrierf�il_fAr ,"_N,_r,Pnftry Na,: /UwAO 1117 6 Al-04%
CER'TLFICA'I'ION Or EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thi,section need not be cntnpleteJ'if the Permit is(or one hundred dollars
D Hi or less.)
I ecoily that in the purfnrrrome Nine work for which this pemtit is issued,I
shall not employ my pernm in any nunner ss a,m became subject to the Worla n'
Cooperstown Lw,of Culifomia.Date
African,
NOrLp'I'l1 APPLICANT':If,after nuking this I ertlEralu of 1_ prnal ynu,lmal i
z hecunle subject to the Workers Compcamtion provisions of the labor Code,you moot
00 forthwith comply with such provisions or this permit hall be domal revoked.
CONSTRUCTION LEN DI NC AGENCY
a ; 1 hereby rffirnt rood Iberc iv n cunswction lending rgcary for the pmtornonee
of due work far which this permit i,issued(Sec.1097.Ci,C.)
A. Q Lemler's Name
z Lender's AJJre.a
1 certify that 1 have rcul this application and stat that the above noun Bram,1,
E. commit,I agree m comply with all city uad county ordinances and Imre laws roaring
0 U to building construction,and herchy a.lorm,topic...tativesofar,city to enter open
} W the more mentioned property for inspection purposes.
Lr W (We)agtccrosine,inlar mil'yand scop ltumdcss the City of Capcninoegadnet
Fw 'Jy liabilities,judgments,case and exfenses which arty in any way accrue against said
U Z City in caion,smse of the gmatiagnf this permit
APPLICANT UNDE WANDS AND WILL COMPLY WITII AIL NON-POIM' i
sou r cuL )) s. ! n Issued by: Date
Sigam oApphcaat{Cnnta Date Re-roofs
HA7ARDKUSM,NrISRIALS DISCLOSURE
Will the applicant orfuture bawrngaccuprntsame rohandle hattdonsmaterial Type of Roof
as defined by the Cupeni no Manuel fat Cute.Chapter 9.12,and the Ifcalth and Surety
Code.Section 2553260?
❑Ye, C1 No All roofs shall be inspected prior to any roofing material being installed.
Will the appliant nr future building exampom me egtripmcot or devices which If a roof is installed without first obtaining an inspection, (agree to remove
nit hazrrdun;air contnatinanrs nv turned by the Buy Area Air Quality Munagemcat
uncO Yes 0 N all new materials for inspection. Applicant understands and will comply with
all non-poi source regulations.
I have tend the limardSafety
Coons Sections
2 requirements under Chapter 6.95 of the han
iti1semiaia,illb do&Balmynadc,Seminaount,f,,it 33 kinnd rx,por4.dr,yin smif thin - /�— �/ �y�
ifthe bull ding Jncsnnmr.11 w havocmost
Is,met it mix,rponslbf Cooues tof ]— L/
cec tam n1 th rcqui is which nun be incl prior to issuance of a Ceniftcat of
O cup nay.
SignatueofApplicant Date
ower. n,.mred agent Date- All roof coverings to be Class IB" or better
OFFICE
CITY OF CUPERTINO
2 of 2 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:34235026.00
DATE ISSUED.......: 12/04/2000
RECEIPT 4.........: 14163
REFERENCE ID # ...: 00120010
SITE ADDRESS .....: 10170 FIRWOOD DR
SUBDIVISION .......
CITY . . . . .........: CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . .... . : DE ANZA OAKS HOA
ADDRESS . . . . . .... .:
CITY/STATE/ZIP . . .: CUPERTINO CA, CA 95014-2662
RECEIVED FROM . . . . : ALAN
CONTRACTOR .......: DIAZ, ALFRED LIC # 21323
COMPANY ..........: FOUR SEASONS ROOFING,
ADDRESS . .. .. . .. . . : 645 HORNING ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95117
TELEPHONE ........: (408)278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
______ __________ __________
BPERMFEE VALUATION 9,000.00 147.00 0.00 147.00 0.00
BSEISMICRE VALUATION 9,000.00 0.90 0.00 0.90 0.00
FLAT RATE 1.00 94.00 0.00 94.00 0.00 '
L PERMIT 241.90 0.00 . 241.90 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 389.80 3001
TOTAL RECEIPT •389 80
VOICE ID DESCRIPTION VOICE IO DESCRIPTION
........ ..............-------------: ..e..... ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS