01010008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RUII.DING ADDRESS., PERMIT NO.
22865 POPLAR GROVE SG FOUR SEASONS ROOFING 01010008
OWNER'S NAME: APPLICATION SUIT DATE
KIBLER JOHN W JR ET AL 645 HORNING ST 01/03/2001lli
VSH: SANITARY NO. CUNI'ROL NO
I
24081278-0330
BUILDING PERMIr INFO
D U❑O 1l AHflll'1'IiC'f/F.NGINIiER: BLDG ELECT' PLUME MCCH
1=1 =1 I--1 I-1
rF�ay
O V Z LICENSED CONTRACTOR'S DECLARATION Job Description
pp I hereby afmnn That 1 am Iiccmea under provisions of Lucia"9(commencing
O t—W with ticconn 9111)) t Dlvi.xion 3 no Business unit P nresninm Cod,and my license
am x naln,reeanitleer. CEMWOOD TO 40 YEAR COMP
Y hittn.xe class_ Lie.x—(/
a 3 a Duro_/�_ / q Cuntmcn,/
ARCHITECES DECLARNTR N
C I unJcotard my plan,mall he used an public records
cON
ca p O Licensed Pron,unnul
DWNER-BUILDER DECLARATION
1 hereby aline that I am exempt from the Contractor's License Law for the
C%Q
following re,win.(Seen..7031.5.Bri,iricss and Profic,sion%Code:Any city or county
$m
which mqtiimO agerruir toconstruct. It prove,theitiolish.or repairY structure
3p
Poor lon, re,ac,the Irl '. t ho such"nom ifile a limadI'I nen
that lie is licensedpursuant ithe p ,ofthContractor's License Law'(Ch pe() Sq. Ft. FloorArea Valuation
(ermtmen,ng w:th Sermon 70Xu r l Dt F on 3 o,f tla liminess and Prolesamn.Cedc) $9000
or that he is exempt mererrum and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit wbjects the applicant m a viva perulty
of not,mote than live hundred dollars($500). APN Number Occupancy Type
❑La,Ownernthe nrnlerly.many employee,wohwo,asa,mcirwlcin pensation, 34233018."00
will it,,the work,and the structure is not intended ,,offered for sale(Sec.7114.
Business and Professions Code: Me Contractor's License Law does not apply to an Required Inspections
owner of property Who builds or improves thereon,and who does such work nim.elr 305 — FRAME
or through his own unplovocs.provided that such improvements are out mended or
onemn m,sale.II:1,owcvcr,the bubalng or impinvcmen i,,nm within one Year or 307 — INSULATION
ir;mpletion,the ownerrhudder will have Ilse burden of proving that he did not hind nt
r,rve forpmpawar,,R.f 601 — ROOF TEAR OFF
0 1.ax owner of the pro,coy,am exclusively contracting with licensed camoracunsoo 602 — ROOF PLYWOOD NAIL
iconstruct me project(See.VOW,Business and Profession%Code:)The Contractor's
ic' ,haw dnc n,arnlY ,an owner of pros,erty who builds or improves thereon. 603 — ROOF BATTENS
and"who ',Liceo lin wen pmjaL with a xanl,aear(s) licensed pursuant the 604 — ROOF IN—PROGRESS
Cnntrm exempt
pt unde lax.
❑1 am exempt under tics. .Ii k Y C for this maven
Owner Date
WORKER'S under
IDlyof pe ATIQN DECLARATION
' I Imrchy allinn under Anally nl perjury one of the following declarations:
C I have dna will Provided
n a CbnilSecti of 37(g) o to wLabor for N'ot the L
Coni have cit as )niched int by Section Com a the Lamar Coda for rho
Irerf t the urk o, I'lh dr,pc 1
❑1 h d will paint w lon,,Com,a,atiunI uruna,a,rx,ui,cd by Section
37(X)ofth LidLidor Code.for the performance of the work for Much this permit is j
issued.My Worker's Ci I t Insurance J Policy number an, '
ca„ I4nC41J.�Jpubic,No,
ZI1NI'I PICA'nON(11;EXI?MI'I'[ON FROM WORKERS'
COMPl.'NSAT'ION INSURANCE
(Thi,action need not be complemd if the pe,,air is house hundred dollar,
(5101)or he".)
I scrod,Ihel in the pe,kc...ace ol'the work Ii,r which this permit I,Issoo d.I
,hall noI amploy any person in any nunner so m In become subject to the Workers
Conyenution Laws of California,Dine
Applicant
San pcE rO APPLICANT':If,after nuking this Ceniticate of Exemption,you should
because subject o de Worker's Compco,stion prvwki.....it true Labor Cale. unions,
Oronhwltl;comply with such provisions sir this pcnnR,l all be demred revoked.
z !n CONSTRUCT ION LENDING AGENCY
CL1 hereby affirm that there is a construction lending agency for the performance '
W
"he work for which this permit is issued(See.3097,Civ.C.)
d A i.c fic,'s Nnmc
;5 z Isndvr',Address
U 0 I certify that 1 have read this application and state thin the above information i,
las Pcornet.I agree to comply with all city and county ordinance,and.state laws miming
Q V ,n buildingconstruction.and hereby auto nrire apresentativeanf this city to enter upm ,
the ubuuw,ncnlinncd praperty Ibr In.....I I pugmwrc.
(We)vgrecrosavc,iudenmily.,,it keep harmless the City ofcupcnino nguin,I ,
V] liabilities,juJgnents,acids and expenses which stay In any way accrue against said
U ^ Ciry in umwquenw of true grunting of this permit. /� �Q
AYPLICA UNDERSTANDS AND WILLCOMPLY WITHALLNON-POINT
Issued by: Date
Sig;,uwm nr AppLealNCanmunr ! Dote Re-roofs
IIAYARome, MATERIALS DISCLOSURE ,
sum y t epCopam x,rature 1,pit[Cg xc Chapter stare oT annum ha.:woan SaRty Type of Roof
c1,Sed by the Capcninn b unicipA Gale.chapter 9.11,dna the Ecahh and SaICIY
Cala Satins 25532W)? '
El Y, e N„ All roofs Shall be inspected prior to any roofing material being installed.
Wil the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
mit hwardoms air continuum t a deeded by the Pay Aria Air Quality Manage nscnl
imtmrr � all new materials for inspection. Applicant understands and will comply with
IFF El yes "n all non-poi n our�cle regulations.
1 have read Inc ery Cove,,mater 2 505.2ex,mount,on,s mWcr Chapter O,I of Ili / r
ifthebuilding dnhSulcur Gtlyhaveatenan505,155N enos,sit 33.Iumdenmof that l`/•'_`-- / � _ ^
i(Ihebuilding does non curcn0ycasea ItheitmetiIi,my n,pnosibil'ny ernotify the U
axapam nr m r rv'm rem,which roma be met prim to i,wamee sir a certificate m �
O"apa1eY Signatu e of Applicant Date
ffw nothontedagcot Dale All roof coverings to be Class "B" or better
OFFICE