01060006CITY DNGDSIONO
BUILDING DIVISION
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10181 FIRWOOD DR
FOUR SEASONS ROOFING
01060006
OWNER'S NAME:
APPLICATION SUB DATE
DE ANZA OAKS HOA
645 HORNING ST
06/01/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)278-0330
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u u u L_1
LICENSED CONTRACTOR'S DECLARATION
I bemby affirm that l am licensed under m visimas i f Cm,a,, 9 (commcncing
Job Description
P
with Section ]000) of Division 3 of thc Business and Professions Codec. andel my
Dense
rsinfull rone d��i(acs7 L ���yyy
c License Cl xs an
ClP —""' Lic x i
RE -ROOF TILE TO COMPOSITION
p Data •+'fI Contract.
-
ARCHITECT'SSDEOECLALARATIO
S 1 undemand my plans shall be u>al ns public mcoNs
3
Licensed Prnfessmnal
c OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Commnor's License Law for the
following muoo. (Section 703 S, Business and Professions Cade: Any city or county
which requires a permit m comms,], alter, imprnse, demolish, m repair any sdunure
3 p t is i' 1 no,aines th appl antf h .it to fle a,i,amd Imemem.
ceased p
dp bot to the pirrayismas atth Contractors LienseL (Chapter9
(
.. - - _ _ _----- ,--
_c
f S Ft. Floor•Area s
$B tYpluation'
0
ten ng th5 t n]IYN)) fDi .i nl flheBusi ssanJPrnfessia,ode)
sq'
r i a. ' " t v "� t , s A' '' t
or shut he a exempt tbeiefrom and the buss fnr he ulle-ed exemption. An
P e P Y violation
-r'
"
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of am more man five hundred dall.ill .
3428�EldNtPb29
Occupancy Type
° 1, as owner of the progeny, or my employees with wages as their sole compensation.
will do the work. ad be swmure is not intended or offered for side (Sec. 7044.
Business end Professions Cade: The Contractor's License law does not apply to an
3 Q 5 — FRAME Required Inspections
owner of progeny Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvement, ate nm intended or
307 — INSULATION.
offered for sale. If, however, the building at improvement is sold within cans, year of
completion, the owmarthWarden o
bullder will have e f proving that not
he did Wild or
601 - ROOF TEAR OFF
improve for ta.W. c of sale.).
-602 —. ROOF. PLYWOOD. NAIL
111. as owner ridge property.am exewsimra
vely inmracdng with licensed coevarato
construct the project (Sec. 7044, Business and Professions Coded The Cmamcmrs
... _
603 — ROOF BATTENS
ia does not apply to an owner of property who builds or improves thereon,
License nseh LL o contracts
hdnes for suchprojectswith v rommemrls) licensed pursuant to the
"
....604 - ROOF IN -PROGRESS.
Contractors License Law.
--
❑ 1 vin exempt under Sec. , p or P C for his reason
Owner Dam
- WORKER'S COMPENSATION DECLARATION
1 hereby order penally of Perjury one of the following rkclamtionx:
Ylfirm
° I have and will maintain v Certificate of m seLaboute far worker's
Compensation. provided for by Section 3]00 of Ne Labor Code, for the
3700 o
Performance of the work for which this pcmtit is issued.
° 1 have and will maintain Workers Compensation Insurance, as ray ed by Section
/
37M of the Labor Cod f theperformance of the work f hich this is
l
gamut
Soured My Worder's.0pdon Iniumnce carrier and Policy numberare:
&W 41 Y3'7
Cart -Policy
CERTIFICATION OF EKBMPTION FROM WORKERSr
I
. _ COMPENSATION INSURANCE
(This section need not be completed if the Permit is for one hundred dollars
-
(Slq)) or less.)
1 certify thatin the performance of Ne ooh for which this permit issued. L
shall nor employ any
y Paten in any manner so as to become subject to the Workers
Compensation Laws or Califcamiz. Dine
- Applicant
NOTICE TOAPPLICAN-reWork If, making thisCertificateof of Exemption, you should
Co
Compensation provisionsll the Labor Cale, you mull
become subjectcapy
it such pr
forthwith comply with such provisions or this permit shall be deemed revoked.
his
CONSTRUCTION LENDING AGENCY
1 hereby alfinn that hem is a construction lending agency for the Performance
of the work for which this permit is issued (Sec. 3097, Civ. C.)
-
Lender's Name
Lender's Address
I codify shut 1 have read this applicutinn and n0e that the above information is
come' I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter upon
the above-memioned pmpmty for inspection purposes.
(We) agree m save; indemnify and keep narrates, the City of Cupeninn against
liabilities, judgments, costs and expenses which may in any way acerae against said
City in consequence of the granting of this permit.
,
APPLICANT;'NDERST.WDSANDWILLCOMPLYWITHALLNON-PObrr
SOU�R��'E R ALATIr,N
Issued by: �. %� ys-��JA--�./ GC. r Date �` /'t7/
_
`^ �Ti,/a,,
Signature of yplicam/Conuamor —
Re -roofs
' HAZARDOUS MATERIALS DISCLOSURE
Will be applicant or future building account,store or handle hazallous mmerial
Type of Roof
as Jetinod by the Cupeninb Municipal Cock, Chapter 913. and the Health and Safety
' -
Cole.Section 255321a1'!
•'l .
°"s
... All roofs.shall-beinspected prior to any roof3ng.material.being installed. _ -
Wintheapphcant, or future building omnpamtoo equipment ordevices which
evnll hamNous air cantaminams nv defined by due Bay Area Air Qualhy Mroar,emcm
If a roof is installed without first obtaining an ifiS ection', I agree to remove
g P a
District"
°YC9
all new mater als for ins ection.-A licant understands and will complywith _
PP P y
all non -poi source reguplations.
1 have read the bavallous materials requimmenta under Chapter 6.95 of the
ifthe ulim. Health &Safety Code.Sections 25505,t255 itis and25534,1understand that
the
d'culted dingd snmrooms currently hhmost
f
ls.�
bmnhmltismyrcsabox, of
occulted rcquimm^en¢ which mon 4 ten Prior m rsauance of a Cenifcarc of
unties
y -�✓ 6— Y-�i
Signa re of Applicant Date
All roof coverings to be Class "B" or better
Owner ora Ihw¢ed agate Date
-- - OFFICE - -