02060111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bfff5gDWIDGEWAY DR FOUR SEASONS ROOFING PERMIT NO.
02060111
AM !"MM OAKS HOA 645 HORNING ST �P�'G{�� b2
PHONE:
(408) 278-0330 SANRARY NO. CONTROL NO.
O 00 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INTO
ac BLDG ELECT PLUMB MECH
LJ LJ I.__I
L i LICENSED CONTRACTOR'S DECLARATION
a, I hereby o)of that If.lianud under provisions of Chapter 9(commencing RE-ROOF
YIrG_�p•Cw,lz'AEY t..jeY
f xCW with Section t000)of Divirion of the Buxin<sr and ofersio77ns Cage.en -license
16 ie m fall fade mtl cc'2 7 C.. o
s LicenuGaxa g JAN g 0 2003
Dae Comrenor
3 a O n HITECr'S DECLARATIO! -
i I and rmm�0 y plans shall he used es public rcrnrdz
ao Lmem,edProferabna' BUILDING
'w o thri I i a.a.paEo DECLARATION
1 hereby affirm on 11. ,Bump,from the Contrns Co License Lew for the $8000
h?a following reason(Senn ]031.5,Business and Professions Code Any city orcounry
D wb h requ res o pant,I c m wet applicant
improve,demolish or repair ,wren
m -pito t t n e alro eq s the pPlicam for such permit to file a signed nemmem _
th5l hqt'liven.Fd p rs /of tq thj pro l bits of the Conbuaora Lure...Law(Chapter 9 i �]��++y�A��pµ�f�v�sL. ��ppAac YYvv 5 VUIUBt100
(comtgencngwth Section BIBB of Division J of the Busipcs ynp Ptrofeps ons Code) (��,j.'vv] IY�1,'.. i r../aNs%IWC'45.340.r :�:`�'+t}"a r
or Nat he 16 esempi Ncrcfmm ana,he buss for the allegeL a a, ad.Any violation t
-of Senbn703 1.5 by any npNicmt for a permit subjects the applicant to a civil penalty
Iofnot mom thin five hundred dollars(5500). 3 0 5AFIN3. &PAE �re,�,',r.� �It) Occupancy Type
❑I,as owner of Nar m
Ne pmpm y employees witha
wgezaole com
s their spensation,
307 - INSULATION
--will dothe'wmk;'and the stricture i5 not intended or offered for'saleTSm:7ee4,- -
(Business and Professions Code:The Contmemr's License law does nm apply to an g noes l
owner of proper Who builds or improves Neuron.and who does such wod himself 602 - ROOF PL 8 f ple
or through his own employees.provided Na such improvements arc not intended or
_—._. ___.___.__—____.. ___.._ -_____
_.arreiwrrmle:Ir;ndweverfNeWaeln"earirnpmvemmttxmlewhninameyeerar - ..603_.-._..ROOF--BATT ENS----,
'completion,meouofu�ilder will have Ne burden of pmving that he did not Wild or 604 - ROOF IN-PROGRESS
improve pure
..; - .simmer of the pmpenY•am ea<IuxivelY romrmting wiNliansW contractors to _ .___.. .____—_____;—____.__._____ _`__
_-s
construct theow pros«t lga.]Oda.Business and Professions Wild,
or useContractor's I rl t C r .'s vll i,t
- License law does not apply m an owner of property who Wilda ar improves -hu.& '-s"
z" _and who eLicense Lawuch.Pmj«s.wiN.e mmrmmr(s)licroscd.pussuam.m.the.
Committees IamaxLicense law„I i i S'V . ,, '
..,.•. .� ^'', . &PCfer Nis rcamnr--
- �� ❑I em exempt under Sec. B -
-_ Owner •1• „Date. ..p•'.. ...” .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty,of perjury one of the following declarations:--
❑ 1 Live and willimaiiio &rrifirata'offConsent or selfansom for Wmker's
Cinropertunim. a-pit ides for by Section 3700 of the Labor Code, for the
pirf-mannor of the wo kfa wh h thism,pct t uetl. r/
Ell mo—'had II ifant Wok 's Cinnotieturflom iminummiI ma uired by Section
3700 of the Laim,'Code,far the performance of N' perish's
work for which th s 6
Issu d My W k i C rope _.t n 1 seri,c c I rid Poly W re
rdl yN ' ., -... t �'..�.�•t a.de(ss '.u. pa
IyE,,CBRTIPICATION OF EXEMMONFRQM,WORKERS t' ;'� t t'•. 1. 5, a .i r.i A I'I la_ Ill,,
r '- COMPENSATION INSURANCE`
If' ifiI be bomplciedf the Permit is for one hundred •'dollars
(5100)orless) ,.:.,.,r,.. .. .q....,
.•... _._ .,�... -. . -•. . -v ....,. .. ->'. - _. .:-e.:,.-tom
I cert f hat in the Performance th th dt f r which subject
Permit e Wored -
Y ,....,. ,
shell t employ,any permit m vny manner so at to Ixcbme sub3ect to the Worker¢
Cpplica ”' '* of California Dem ` •" - " " '"
-Appl curt -. ., - - .. .. .. .... ... _ - __._. ._- __
NOTICE TO APPLICANT If aft making thisCmBarc of Ex pro y xhould .,'.I'(r;� \ t -,) ,,,
Z bid wbi co n the Wok p Colons ort p mitt shelf a Labor Cod you must
C)
O foMwtN'comply'with such provisions or permit shallhdamW avoked.
vc: T f 'Ghatduc mrstrION LENDINGAGENCYAlb . - ""'" I':.I" t. .��
a ' 'f t I h by which Nm there t a commtn o lend g v C) fo th pert rmena' -
W o!N work for which N perm i s t� W IS '3097 Ct C)
-CeiMera theme ..•r: -+.�.._w -u-�.. -.:�.n.:.. _
y,o
.U,z LandersAddrcs : . .%.. .._...: ,......c . .:•a i�YS,: i`!Id0
I •'
.� , .. 1 c n fy 0et I have d tht applic t d tam Nat th abo a mfonnnion is
far E„ cdirecL 1,gra to corpply th ell,cny and county o d nerves endnem laws reining
Q'.V to bu ld nge mwciion,antl hereby mNonxe rcpreuntatives of this city to cnmi-ti'm
,7�,rr W ilia W e n em W properly f r pit pennon p,poser
L Y 1 We)eg a i7mvc pd'ten fy end kttp huwl ss ihfC ty of Cupen,no age
LLL
LIDI'ab 1 t ) dgm<m,c s rid apes h ch m y,n any ecru,agi zt said %
U 7�.. Cityy m d uqu a of the nl ng f this Pennh // _ `
A1RT9 ANT DER. S ANp tVB.L COMPLY ON POBJT
sot BR use Ns �,--v Issued by: Date
S' (Appl canUC t n L D m; Re-roofs
N' 'HAZARDOUS MATERIALS DISCLOSUREI '
"; WII tKe appheam fm W Id tlg ocsvpmt tort or handle harmdo s mate'el Type Of Roof. .
ac deEncd by th C pen M P YCotle Cb pt 9 12 end Ne He IN d Safety VI
it ! , --
cure
_ All roofs shall beinspect d prior[li_ariyxroofing material being Installed. _......_
W 11 Ne ppl este, f t e b 'Idtng oc upant use equipme t devttts which 'I'
If a roof is insialled'without first obtaining an ins ection'jd a ree'to remove
emit heaardo elr comem,nanu es defhed by the Bey Area Art Quahry Mmegcment g P g
D stns a new mate 1 $ ction an U d $ O l
11 rads r inspection.. Applicant n er lands and 11 mp y with
all non- Glint rc gU18C10DS
I h B rad thehazallous rpetedels regmrementi under Clvpmr 695'of.the
«cu of th bi nu high mut met SJ3 end 25534 I u derstestd that
Qalifom HeeIN&SHet Code Sentona 25505 25 y roe nab I sy to
v ufy the
- - - -- - / - -- -
y
tftheWldmgd of currently ho e6anml Nat s
9 p r td isi ce f a Cen rca(of '
Signatu e of Applicant Date
r,
own« authonud agent .Date,... All roof coverings to be Class"B"or better
OFFICE -