00100039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
OWNER'S NAME. APPLICGI'INN SUIT DAPI!
7505 LEEDS AV ALL SEASONS ROOFING SERVICES00100039
PHONE: SANITARY NO. CONrROI,NO.
DE LA CRUZ BRUCE N AND D I_ACRU 2640 PACER LN 10/05/2000
wO VC) ARCH]i'11CfdiNGINEER: BUILDING PERMIT INFO
r• I11.UG ELECT PLUMB MECH
408972445 r I T L-1 1_I
yea
�N✓ LICENSED CO eirsed 0R'S DECLARATION Job DesGl'Ipt1D11
O%'�O I hereby 01Ill ool 1 an,licensed under Pmvisiom mf Chapter 9(commencing
with Sed inns, ad
ofD visinn3ortlm lluxincrn anA l'mfusmum CuJc.and mylirensc
ae m 5.J is ee roll fnrtI unJ cff t.
K 6 I.icensc ,411 Lical, ] -J
Dam_ �Q Coal, IaAr _
31-G ARCIIVECuse a,publRAf10N'
t °� DI,dersrtltJnyplamxsM1mlxa daapanfi,m,md. REMOVE COMP SHAKE TO G(a/F GRAND CANYON I
a LL's,
w = I.iensed professional
eap
laa -HUIh DIC1, RADON
OWNER
e herchY IIlrm amt ,Innn mClualacm
License Luw Es,[he
r G
Following re: (Section 7031.5.lm%irc,and Profiessicro Code:Amr,il,a county
`F C
which requiresa xeranit lo courtract, II ,improve,demolish. p nY%anarture
i3et d proIa 9 tapplicantt h1 1[ flsignedfit ten
that he is decimal portend tthe provisions of she c I tM Liven,Ln (Chain,,9 Sy. Ft. Floor Area )l:�luatif
iia n e ng with S ti 71Rm1 I D is 3 [th Ro Bess d Y dens Ina Code)
or that he Is exempt Iherctrom and the huis for In,alleged co nmmon.Any vio6elon V
of Section 703 r.5 by any applicant for a Form[subjec[a the applicant to a civil famthy
lit nor more man rice bt;nand dallies(s50(l). APN Number Occupancy Type
[]I......to tflhepropenRn,Inyentpmyeeswith wage,a,Imir.,neeampenxation. - $5756
will Jo Ihm work,end the xtrvcare is me inmedcd or offered be .It (Sec.7014.
B.'am s and Prmcs,am,s Coderlhe Cmrmcmrx Liver,Law does not a,pI,m no
Re❑+,,aired Inspections '
.net of property Who builds or improves ihemon,and who does such work himself 3661601.B. AvL
or al rough his own empinyces,polemical[hilt such improvements are not intended or
offered for sale.ll;however.[rte building or improvnncnl Is nnld within one year of
completion.the owner-builder will have the burden of proving that he did not build or
hhhhrmvc tat pntpase.nraalc.l. 305 — FRAME
❑Las owner of[he pmpeny.amesclusively. contracting with licensed contractors 1. 307 — INSULATION
innNmnl lbs pnject see.71,14.11-mese;rod Prnressions Codc:)The Contractors
.Iuem.el.aw does am apply mast owns,nrpmpeny who milds n,impoom,Thereon. 601 — ROOF TEAR OFF
and who contracts for such projects with a commends)licensed pursuant[o the
Coornca,r,Licence Law. 602 — ROOF PLYWOOD NAIL
El1 am exempt under Sec. .11 A,I'C fir this reason
603 — ROOF BATTENS
nwnt, WORKER'S COMpI:NSXIION URCLARAnON 604- — ROOF IN—PROGRESS
I hereby alf umat
ntnume,pcuWry of Penury one W the following declam[imtx:
❑ 1 have and will n in a Ceni iv,oc of Consent m self-insure for Worker's
Cnmpensatlon, a pruvidAl Ibr by Secant 3700 of the Labor CnJe, for Ihm
performance of the work for which this pemail is issued.
❑I have and will nein'ain Worker's Compo,alion Insurance,us required ry Seehioa
37M of the I.aho,Code.for the perbarmanee of[lie work lira which this permit is
issued.My 0b,kcrs Compansation Insurance came�ryannd Policy number art:
ume,:1/llVA,Policy N., yC nv,110 I
CERTIFICATION OF EKEMPI[ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars,
(E111(1)lir le".)
I cenity thnt in the performance of he work for which this,permit is isucd,I
shall not employ any person in any manner ss,as r,recon¢mbjew m(he Workers
Compensation Wws of California Dale
Appueal,
NOTICE 10 API-LICAN'1'.If,arra staking tdn Ccnilicme ml Excn,p[ios,you should
hecunse subject the Worker's Copcnsmion provisions of the Irb,r Code.you must
Q O timforlhwi lh cnntply wit It such provWens or this pcm,il ehnll h,deemed revoked.
z
F Vi GDi thee,k a on LENDING AGENCY
"I I rk For affirm this throe is n must(See.
funding agency for the Nrfnmmnm
I the work For which this Mrmit is i.awnJ ISa.31197,Civ.C.)
Q lender's Name
.ti. z Leader's AJAresa ,
U Icertify that l have read this application and Nate that he alaw'e information is
(y [r o rrec'I.I agree m cnmlly wIm all city and county all and state laws mlaJng
Q �) In building commction.and hereby scalar a representatives of city In enter upset
the nMwe-mentioned property for inspection purposes.
E" (Wel ag,ec lu s,oc,Indcnmil y and keep bmnalma the City of Cupen inn ugni nst
(; I abilitic,judgments,costs and expenses wh lch may in any way;acroc against said
U Z City in consequence of the granting of this permit.
SOURCENTUNDERSNAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signa h rumor Dale Re-roofs
7.AR000S MATIiRIAUS DISCLOSURE
ill the app cam lir rumre building occupant Nim or handle hacasbus murial Type of Roof
m defined by Ihm Cupeninm Municipal Code,Cb'apnr 9.11,and Ihm Heallh and Sarmy
Cole.Scaiu 11553Na)1
oyes 0N All roofs shall be inspected prior to any roofing material being installed.
Will he ii ican[orIutat=buildfngoaculaaluse ceaipmcntordevice,which 11'a roof is installed without first obtaining an inspection, 1 agree to remove
• emit haranlnus a,r conmminan[s as,defined by[M1e flay Area Air Quality Management
Disld,It all new materials for inspection. Applicant understands and will comply with
0y`a 01sw all non-point source gulations.
1 has,mad the azardow numeral,rcgnlrem,ms under Chapmr 6.95 ill the
California flcal[h d Safety Code,Sections 35505.35533 and 25534.1 understand that
if the run ldnnhg does at,, urread ly have a Unum.mat it is my requatcmi Ely In notify the
oecoPanl of the requirement whab nmst be sect prior eh ixsuunac of a Ce,liGcate ofV
Oc. any' \Sig o pplicant Date
��f�� All roof coverings to be Class"B" Or better
OXnt'r dra orieeJ agent Dam