00120120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING � �I�iAI DIP'S PERMIT'NO.98 RIDGEWAY DR FOUR SEASONS' ROOFING 001..0120
OWNER'S NAME AI'I'I.ICAHON Sj B 'I Ir
WEIGART ADRIAN 645 HORNING ST 1.G/n 9/2000
PHONE: (408) 278-0330 SANITARY NO. CON]SOL NO.
QpOARCHITECTENGINEER: BUILDING PERMITINFO
❑ BLDG ELCCI' PLUMB MLCH
U U CI IJ IJ I_J
to-Z
5vy mI.ICY,NSEDCON'IRAC'I'Oit'SDECLAltA'rION Job Description
" I hereby arin Nal I am licensed o
under provisions f mm
Chapter 9lcnencing
—° _ With Section 7000)ofoivi,i„n3oftheBusiriessandprofessions Code.and mylicense T/OFF CEDARWOOD INSTALL 1./c 5—PLY CDX II
C E a In lull lines and Ian p Z
ee 2 License Clava_ 3� Lis,.p O ,
a LL N ftoe�_Z-10 C,mt cony_ COMA N
ANCIII"IEEE's UIiCLMtAr )N /r
I undanwnd my pion,shall be used ria public ren,Ns
R! p O Lian,w I'n,l'ucianal
car
ON
Oat I..exempt
to.,the ontr coo
1 hereby uRm"IM1m I am exempt Imm the Contractor's Liwnu Ww for the
Z following yawn,.ISCBIor 7031.5.Ihisiocsn and Pndecsions Coder Any city or county v
at which oviafre,. p" nn I t I Ion,irr,eovi,J Ihb ,,it y someone
a i m prior t t r also ley the pplica t f such Wool I fl signed statement
c. — Thai he is braisedp tsaaon time p fd Comou,nin,L L (Chapter9 Sy. Ft. Floor Area ValuaOoIt
(co eIng is a
ith S 'uon 701 XnotDivision 3 of far m
Buaua,and 14 of c"ionx Cale)
or that Mir exempt therefrom and the bilis for the alleged exemption.Any violation
of Section]1111.5 by any applicant tar a permit unecu,the applicant In a civil penalty
ofIImom rfanrtvehurdled dnhar,(g5001, APN Number Occup"rte pe
❑I.a,nwncr of Ne no,rT ,nn my employees with wngcx rs theinnle ttna,milli m.
will Jo the wmA,and"he xlmdme in nn"intended or otidred Ian oats(See 7044.
Bain.,,and profession,Code:'Ibc Commemr's lJoem a hw does fol appy m an `'. .. eyuired Inspections
owncr of property Who builds or improves thereon.and who dae„acn work himself
nr throagh hl,own cmpinyeos.IT aided Wal umh impro lannan,are nil imcnded or
offered]or sale 1f,hnwe-,the Wilding m improvement is laid wslhm one year of 305 — FRAME
nn"pletin.the owner.builder will have mehrobnnrprmvmg that Wild not build nr ,177 —' INSULATION
co
aps c n prrpo ol'enle) d
❑l,a, ranhe proper,ae, aavdyc„ntrieting with licas"dcontraannld 601 — ROOF TEAR OFF
Dai the mdopo tree.OIDa.Iluxia...and I'ndeaQons Code l'rne Contractor, — ROOF PLYWOOD NAIL
I,iccnre Law dna,nn.apwncr ply r,no nof property who Budd,or improves divisor.
6172
and who contract,for such projects wish a contractor,)licensed pursuant m the 603 — ROOF BATTENS
Contractors L iccme Law.
❑I ant chem ander Ses. .11 n P C for this reason 604 — ROOF TN—PROGRESS
Owner file
WORKER'S COMPENSA'I]ON DIiCLAKATTON -
1 Mreby affirm ruder penalty of perjury aru of the Nllow'ing declartomor:
Cl 1 have and will maintain a Cenificam of Consent m self-Insua for Workers
Cnmry:nsalion, it, provided for by Section YRX) of the Labor Code. for the -
perh,rmunecofdla wort:for losit thl,permit is I....J.
❑1 have and will nwinmin Wooer's C.....pen,alion Insurance,as occurred by Section
900(1 of the Labor Code,liar oro redly of la,wank tar which his'Iran t,
sued.My Wlnkers Congs:...hou Insurance currier told Policy ittmMr are: �•
Cnrricl:_�ras�or µ Policy Na.:(/y/L�Q/�7----<
CHR MCAT[ON OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('nis section new fall he completed if die tenant is for one hundred dollars
1 Slap or le".)
I amity that in the perfana,unce of the work fon which Inas lemon is issued.I
atoll fol employ any peIII.in any manner so as or become ruhjaa m the Wallen'
Cmnpctnntiun Laws of Culihania.Date
Applicant
NOI ICE TO APPLICANT:If,after making this Certificate of Firemption,you should
Ixronne im,c"u,tlm W'n"ker',Cnnlperouunn pmvisnnn of We Labor Code,yon most
Q O tonhwith amply whnsuch pmvisinm or t hio fermi"shut l be declned ruvaked.
F" CONSTRUCnONLENDING AGENCY
1 he for vl'hrm That them is a sued(See1AH.leading vgency I'nr"hu pertonnuncc
W Len he wad Ino which This permit is issued(ties.11190.Civ.C)
iY 0
Lender's Wnnc
Q z IsnJcr's Address
U �+) 1 certify than I hots read this application and state that the above information is
tY !" corm".1 agree to comply with all c'ny frier...miry oadinanec,and ,cw laws relutiny
Q U :.Wilding cnmlractinn,and bereby'armod,mprexmuti.es oh
f this city ,enter upon
We above meal oned pmprny fee Impcaion pugloscs.
F„ y (We)ago.n,save indannify amt keep Ili all", Ci ry of ca per inn again"
to liabilities.judgmenn,cost,and expenses which may in any way ascots,against said
U Z City in consequence of the gmming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POHNT Issued by: Date
SOURCE REGULATIONS. y'
Si,rarnvol Appllanl/Conlc yoI' Dam Re-roofs
HALARDIDUS MA'1'HRIALS DISCLOSURE
Will the applicant orfmart building tceapam ante or handle hteatJmm tfattedvl Type of Roof
In oldinvJ by(hu Cupeninu Munrcilc,Chapter 9.12,rind the Hcallh and qday
Cale.Section 255320)?
13 Yes All roofs Shall be inspected prior to any roofing material being installed.
Will the appLcam or future Mild,,,,ocmmont aw equ,Incdeyica.wa;ich If a root is installed without first obtaining an inspection, I agree to remove'
emit emardnus air uontammrna nvle(ncJ by the Bay Arca Air Gmliry Atanagemem
Trivial I all new materials for inspection. Applicant understands and will comply with
❑toes oNn all non-poin arse regulations.
I have m,J the el, looCode.Socineal,al-
requ.25533 s under 4.1 lit of the
Ime
eWilding
il Hmltl kanlery Cwc.ave.tr255115,t itis mid25533. uy to rally
Jthat ^�
occu, I of Il Jo et vu t,ly have a mnae annel ill,my ma,ale of. to nudfy the 12——��^ G�
valpanl nl"h �qul Ia xM1ieh mux"he amt prior lI nrvanae of u Cvnipcmc nl
Occu fry.
� d Signam of Applicant Date
uwI tin Nnrisee tgtltl O Dam All roof coverings to be Class `B"or better
OFFICE