01010009 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
22973 LONG DOWN RD FOUR SEASONS ROOFING 1
0009
OWNER'S NAME 645 HORNING ST APPIL1f)(61lVJ
GO1
DF_ ANZA OAKS H. D. A.
NH:
(408)278-0330 SAba I'ARY NO, CONTROL NO.
C 0 O ARCHITEC'U iNGINEEW BUILDING PERMIT INFO
w_ BLDC ELECT PILUMB MECH
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LICENSED r CONI'RACeOR'S DECLARATION Job Description
0 S= tion W rd(it inns ;nn live ofthecti under and ItimI of Chupter 9 turn,
o, _ P
Fm with Section 9fXXe ul UivUinn Jruf lite l{uxinca,and Pntrpainn,Cndc.and ny liccnµc u C
a=�� fill elf Ir T/OFF AND INSTRLL 1/2 v GL CDR, 40 YEAR C
a Ciento Cbna S_ Lic.If�_ tf
ll:., —,✓ — ���� G. A. F. G SEQUOIA
3 a Ouse d! C<,mmao-,r_CgQg
AHCI{I'rHCI"l IJECLARA' ION
(:=ON 5 1 undcntand my plans shall W'used a%public records
_
u��i Liren,cJ I'rofcxsimnJ OWNER-BUILDER m rbria rn the Rn'I'HlN
I hneM1y uSce slim 1 1, csmmM f,w the Cnnun,Co tAn,License y r for the
C5=M following micsne,em,
it (Smnan 7Bl,tr Business and Pmfa„Inns Code:Any city oreoumy
K tFO prior bids
i..anlennnt Iv nr.,thealit,uttoo,se.dmnoud It n,.spun,uny Xummm
a 3'_` prionoia iscummc.nlxa mquirccthe applicant fnr wch rynnhmmaus,gnvd,tmcmnn
that he is rcensedl pursuant to the prnvisinus nfthv Commands License low(Chapter 9 Sq. Ft. Floor Area Valuation
monmmncing with Section 9(XX))or Division J of the Business and Pnt(coinnw Cale)
or did he Is exempt Ihercl'rnin and dlc beds for Iha alleged umnplinn.Any violation
of Section 7031.5 1,any applicant for a permit wbjccts the oidium,o a civil penalty -
uf m u mrure them five hundred duftaa($560). A PN Number ccupancy Type
❑1.mowner nr the pro,,. or my employec.s with wagevm theiraide cam,patahtion.
rill do the work,and the gmnure is not intended or,eleven for sale(Sec.9014. 342 400 119. 00
Businns and Prufes,imns Calc:The Coutrxtor v Licenwe Law does not apply to an - Required Inspections
of pim
rupeny Who builds or pm as themon,anti who docs such work hiniser
m through hu own ando,ce,,provided thus.nen intp:nvnnems are no,intended or
rumored for wale.If.however,the Wilding ur improvement is wild within one year of 305 — FRAME
competion.the ownelbuaderwillhavetheburdenofprovingthathedidnotbuildor 307 — INSULATION
improve mm'weu
01,usowner(if the pmpeny.amcWtu%Nelycontracting with ImcnsedContractors i 601 — ROOF TEAR OFF
,wupco the porec,(See.nw,Business and Profession,Code:)the Cuntacm, 602 — ROOF PLYWOOD NAIL
Lice nsc Law Jo not apply form owlrer of Pngmey who not ldwaimprove%themon,
Dna will,contracts lot.wncb projects with a run,actu(of Beehh,ed P,Imaalh,m the 603 — ROOF BATTENS
cw on Licenselaw.
❑lmne.nuptundersee. B,rPCFor this retell 604 — ROOF IN—PROGRESS
Qwwr Date
WORKER'S C)hl1'ENSA'I[ON DECLARATION
I Denm
ny finu that,,p,r dty or pc, o
,i.,y ne a the p,uuwing dWit—dons:
J I have and will maintain a Certificate of Consent to allwinaure for Worker's
eompenxadon, a, provided lot by Section 99w (if one lienor ewlot r the O
I-rll:mtnnce nt't he wort;hu which this pnanll N icwed, /
131 have and will niaintnin Worker's Compenvtion Insurance,as inquired by Senion
3
700 of the[,.Nor Code,for the pformanw
ce of,be look far which this email is
Hued.My Worker's Cntnh,ve ?riion Inrn..or,currier end Policy nuluher me:
Cartier,- 14AC4L Mlr,y�PoIiory NAACW.N D_'/_/.LJ�Fp�
CHR OFICA'I'ION OF li%EMPRON FROM WORKERS'
COMPHNSn'I'ION INSURANCE
('Reis action reed not he completed if the Fermi is for one hundred dollars
($HX)arlu.v,.l
I evenly that in the performance of the work for which this Permit is some.1
,hall not employ uny Pelson in any manner uo as to become wbject to the Workers'
Cmrpvmsmion Laves of Calitbmia.Dote
Applicant
NOTICE TO APPLICANT'.If,after necking this Cenitieme of Exemption,gnu should
necome subject m the Waders Compensation provisions of the IaMn Cwe,you must
Q O hmhwith comply wlln on l)pravi,ions or thin Ix'rnhit shall W d,c ed revoked.
Fh CONSI'RUCI]ON LENDING AG12NCY
a > I hereby aff n that there Not construction lending agency for the Performance
of the.,,,it linwhich Inns perms is i„nod(See.097.Cie C)
S Q 1,wer's Name
Q % I<nder s Adds
U Q I tend,Ihal I halem.111 thin uPplic:ninn and cmc dial,he ahovc Inforucllon i,
4s. t.. mrrcet.I agree to comply with all city and county ordinances and state law,relating
Q U mWildi......anchor.and hereby unhowe representatives ethic coy memer up,m
Lsl the ehnva-mentioned propvmy for nspcn non purpn,e,.
4, (We)ague,to rave.nel,nmhy and Rap hamae,l Ibc Coy at Cnpcnim,ngmml
F rp liabilities.judgmnrt,costs sad nFisol ses which may in any way licence ng:dm,.aid
U Z City in cunsetluence of the granting of this pemnit.
AI'I'LICA NDERS'fANDg AND WILLCOMPLY WITHALLNON80INf Issued by: Date
A”'I- y1.AT10NS. f Y'
Signal cafnppli ntlConwnor / J Date Re-roofs
H A'l.ARIIOUS MATERIALS UISCLOSj R l
%lbyt e Cupertino)
ur rotate and iCo e.Ch tat Xlan m mane hnxal hRod Safely Type of Roof
as defined by the 32601nn P umcipal Code.Chapter 9.12,and tits Hcaltn send Safely
Cwe Section 255J2(n)? 1 '
❑Yes \c No, All roofs Shall be inspected prior to any roofing material being installed.
Will[lie upplicaut or future bonding occupant use eyuiptnent(it donees which If a roof is installed without first obtaining an inspection, 1 agree to remove
tent ha or does air conaminums at defined by,he Bay Area Air Quality Management
"an"? all new materials for inspection. Applicant understands and will comply with
0Y., No all non-p t son cc regulations.
I have read the hueurdmu,narerials nquiremene under Chapter 095 of the
Caddo.rnln llcalthitt"""Calc,Scatlnns 255115,2557:1 and 25594.1 under,land,hut
,f the buildingdoe umady lh:rvea tenant lha,it i w my m4smwibility to nosily lbs
occupant of,he res n vmems finch mus,W met print to issuance of a Cenificam of _L
Occupancy. '
Signature of Applicant Date
JO,onv u , nods%agent nate All roof coverings to be Class `B" or better -
OFFICE