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01080032 CI TY DON PERTNO BUILDING PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. l 21230 HOMESTEAD RD BLD 12 ALL SEASONS ROOFING SERV CES01080032 OWNER'S NAME: APPLICATION SUB DATE VILLAGE GREEN ASSOCIATES 2640 PACER LN 08/07/2001 • PHONE: SANITARY NO. CONTROL NO. 4089724455 Czatir O ARCHITECT/ENGINEER. BUILDING PERMIT INFO w BLDG ELECT PLUMB MECH L=1 LICENSED CONTRACTOR'S DECLARATION O-In I hereby Birds that I am licensed under p g Job Description O i_ y v provisions of Chapter 9 and (commencing FmF.sa with Section rceandofDivision Jofthe BosinesseMProfessivmCode,andmylicrnu TEAROFF, OSB, COMPOSITION 6 m is in full Tome and e1[e{t. c co License Class_t,!—J (_ Lic.al�!PJ49 I X g Data Contractor F a.O< ARCHITECT"S DECLARATION r J I understand my plans shall he used as Public records w26p Licensed Professional °• OWNER-BUILDER DECLARATION �-'or 1 hereby.(Seto that 1 am exempt from the Commoner's od License Lew for the f- following mason.(Section 7031.5.Business and Professions seions Cade:Any city or county' Iwhich requires a permit to construct,altar,improve,demolish,or repair any structure $20000 i 3 p to itsissuance,also requires the applicant fsuch pocromit to file usigned statement ---- - -that he licensed w t to the prams!ons(othe Contractors License Law(Chapter 9 - AMU- f_,glowMen, Valuation (commencing with 5 i 00)70fDivision l fled BusinessProfessions and Code) 3b9gor or that he is exempt therefrom and the basis for the alleged exemption.Any violation ' of Section 703 1:5 by any applicaq for a p,mit subjects ted applicant to a civil Penalty of not mom than Ove hundred dollars($500), 305APN Occupancy Type ❑1,as owner of the pruriency,or my employee&with wages as their wile compensation. will rsine the work,and the brachuiod,T e C nut intended or se Lad for sale(se&.7BIa, 6 01 — ROOF TEAk_ 1j�Ins ections' 'Business andPmfcssionb Code:The Com thereon, License Low docs not apply m an q p ' owner of properly Who builds or improves t thereon,and who enes such work himself of through hissal own employees, budded that such improvemrola are rant intended or ._..-6 02 ..- ROOF PLYWOOD NAIL _ ..... _.._ -. _ complete, for sale. w however,the building m improvement is sold within one year of completion,the owner builder will have@e burden of proving shot he did not Wild or 603 - ROOF BATTENS ' improve for purpose of sale.). 604 - ROOF IN-PROGRESS S ❑I,as owner of,he rt,am exclveivel� grope y ycommningns Code:) Connector's License onswn the project(Sec. to a Business and Professions Codes Th<Co thereon, License Law arae:not apply man own,of progeny who build orimprovesthereon, ..nd.who commas for such projens.wiN a contractions)licensed pursuant to the Commnor's License Law.. ... ..... ......... .-. ._. .. .._ .. _ .... . _ ❑l vat exempt Enda Sec. ,B&P C for his reason II1l��r�UnnALE❑ Owner Data If�I WORKER'S COMPENSATION DECLARATION C(s •t 7 1 I hereby affirm under penalty of Pe jury ma of the following declarations: -DEC 1 2001 ❑ 1 have and will maintain a CertConcur m ificee of Concselbina n,for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the BUILDING Performance of thpvnMoral.e work far which this nit IMoral. ❑1 have and will maintain Worker's Compensation Insumnm,as squired by Section 37W of the labor Code,for the performance of the work for which this permit is LS M// corW a to Compenshtion Insurance Ownerand� Policy mark,aa: ner:Vt . ..t- Policy .WC3on03N1'y%y ,.. f' I ' 'CERTIFICATION OF EXEMPTION FROM WORKERS!' COMPENSATION INSURANCE' _..._.. ...__.._... ...... ........ ._ .- .__ -. ....._. _._ _. .. .. " (This section no not be completed if the permit is for one hundred dolloa ($IOoI or leas.) 1 certify that in the performance of the work for which this permit is issued,1 - shall not employ any person in any manhar m as m become e.b*l la IJk Wofker.' Compensation laws of California.Date Applicant ..- NOTICETOAPPLICANT;If,utter ranking this Cencificaa of Exemption.you should � " ' become subject m the Worker's Compensation pmvisions of the Q erred Cude,you moa O forthwith comply with such provisions or this permit shall be deemed rooked. F" Z " CONSTRUCTION LENDING AGENCY - a.> 1 hereby affirm that there is aconstruction leading agency for the performance r of the,work for which this permit is issued(Sec.1097,Civ.C.) _ .' nu - der',Name .... ... .. .. ... . - .. Lenders Addmts V � 1<nIII 'but I.Iluve fcn,l this uppllemion and stag Nat Ne above otannafoo is aomeet.1 agoa m comply with all say.ad county m imnces and ,.a laws relating' rebuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned properly for,inspection purposes. av . E. Y (We).9.to se.indemnify and keep harmless the Ciry of Cupertino.,ain, to liabilities,judgments,cosrz and expenttn which may in any any accme against said -' V Z City in consequence of the gmm;ng to thispeiond. APPLICANT UNDERSTAND. ILL COMPLY WITH ALL NON-POINT SOURCE REGULATIONS. Issued by: Date Signamrc of APPlicantCommnor -" .Date Re-TOOT$ _ HAMMO MATERIALS DISCLOSURE — © / WII'Nom "fican,orfuuildingaeratorsstoreorhandleharardommnerial Type of Roof as defined by the Cm,mro Mu -ipA Code.Chapar 9.12,vnd the Hath end Safety I, Dade.Section 25532of? i h - "• ' oYG5 °No: .. All roofs shall be inspected.prior to any.roofing material being installed..__.... • W llth applicant future bui,mingoccupantuseegnnmentordevico,which If a roof is in without first obtaining an inspection;I agree to remove e that J tic t.i sdefned bythe Bay AmrAr Quality Management al tr t all.new materials for inspection. Applicant understands and will comply with ❑Y. to 0 N all non-point source regulations._„ �.,;, t, 1 hvve'read the hazardous materials requiremedsv under Chapter 695 of the California Health&Safety Code.Sections 25505.25533 and 2553x.l understand that ifthe building does not currently have mmurt.Lha it is myresponsibilitya notify the - occupvm of the requirem< Is which must he met prior to issuance of a CeniOmate of Occupancy - Signature of Applicant Date .Owner or amnodied,gem D,Ie All roof coverings to be Class "B" or better OFFICE