00120078 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS I PERMIT ND
101.59 RIDGEWAY DR FOUR SEASONS ROOFING 021120078
OWNER'S NAME. APPI.ICAI'ION SUB DA]1i•
DE AhIZA HOMEOWNERS 645 HORNING ST 1�/J.3/20100
0NH SANITARY NO. CONTROL NO.
(408) 278-0330 1
O m V ARCHI'I 13C'I'IBNGINIILR: BUILDING PERNHTINFO
Pt O❑O❑ BL.IK ELECT I'LUMB MGCII
Sulu I� I_1 r _I 1.1
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NL LICENSGD CONTRACTOR'S DECLARATION Job DCSCrIpfiDll
Omz m I tion 7 )0Odf That 1 Imt Ilfcnecal nodes pro,lsion,.of Chapmr H 0.vnnmmncing
FUOi with tullomean)of Di " 3ofmhe Buviness renal'rolcsnionsGdc,rend linmse
—_� iaminuR,recand m Y TEAP. OFF CEMWOOD, INSTALL 5 PLY CDX AND
e5 e,z a Lirfn.e =V3nr1 I.io e_ - ` _ d
�pk!u Dof_t t_ mo nhmmenr a� 40 YEAR COMP GAF G. S.
ARCDITECr'S DECLAKATI N
F O Icall...Imy Ina's'hall be usell as public retools ILa�rc'L� -
a, �T
uaC O O J,,rad Profcnsional
y o OWNER BUILDI?It OECLAItA'DON
I hereby alliin that 1 am exempt from the Contractor'.License Law for the
7 r I1,I1owing ween.(Section 7031.5,Business and Pod•sslon,Cede Any city or emery -
Y o which requires a permit to convuoc,,alms.Improve,demolish or repai,any.condole
it prions its issuance.also requires the upplieant for such peaulto file a signed vummem
road he i.decm.srd,mrsrartm the panesinn..or the Contractor.License Law(Chapter v Sq. Ft. Floor Area Valuation
(commelu:ing with Section 71X10)or Division 3 of the Basins,and Poll'es,innv Code)
or that he is exempt therefrom and the basin for the alleged exemption.Any violation
of Scetion 7031.5 by uny applleanm fora pfrn.it uhj,,l,Ihc'npph,am it,a civil penalty
,if nmmore hall to,himareddollars($5a). APN Number Occupancy pe
❑I.asnwnet it the pmpety,nr try employees wit it wages as their sole compensation.
will do the work,and the doware is nam intended or aarered far vale(Sec.70414. 3424 t
lboirl and Prnfe..ien.gale:one contractor s Liceme Law mw,nm apply m an — squired Inspections
owner of property Who nullas onimps s thereon.unit who doessuchwork Limwll
or through his own en,ployms provided that such improvcmcas arc not bonded or
offered ror sale.11,however.the building or improvement is sold within one year of 305 — FRAME
completion.the(as'nenbdder will have Behburden of pnaing Ilial he aid rot build or
improve ferparpetrnf..me). 307 '— INSULATION
❑I.as none prop:rty,a xelmivdyc nnaehng w int l iern.fd conrafmr.m 501. — ROOF TEAR OFF
Jml the poral Isle.7(t.Haslam and Pndessions Cade:)The camraem.n f r' — ROOF PLYWOOD NR I I.
ecnte Law dont one apply to an owner of property eho builds or improve,Iheram, 6¢t_
mud who amlracts lot such projects will,a contour.lieenwd purwmm in the
Comracmry License Law. 603 — ROOF BATTENS
❑I um ascmpclmder See. .11&P C for this mre..... 60It •— ROOF IN—PROGRESS
Owner Done
WORKEII'S CONIVENSAIION DECLARATION
1 hereby apron under penalty of perjury one of the following declarations:
I have and will maintain a Certificam of Consent to sell-insom for worker's
' mprnsatiun, as provided for by Section 37mp or the Lahr Codefor the
pedimnance ar the work tier which ILPo Iwrmit i.,issued. e`]
❑I have and will maintain Worker's Congwnsatil Imurnnre,as required by Sermon
31(X1 ol'the IaMa Code,for the performance of the wok for which thu permit Is
issued My
Wo`rrk�e(s Compensation Insurance carrier,and Policy number am:
Carrier:_�,Q r ISI'-I,CGI'I(N6 5.1111 No R oL+OOR'ERS'lk
CIIMPBNSZON INSURANCE
(Obis section need not be co ripleted if the is mai,is for one hundred dollars
IS ISS or
I omit,tha,in the pertann:atce of the work for which this permit is issued,1
shall not employ any person in any manner so d%to basmre subject m the WurkeJ
Compemaden Laws or California.Dam
Appncam
NOI'lCE T(1 APPLICANT:II:of,,,making this Ca,unicaf of rxcmpaon,yon should
iZIwai a subject in the Workers Compens:lien pro .inn.ofmhelahor castle.>nu nus,
O O tanhwith comply ply with such provisions or this permit shall hi deemed revoked.
Z ` CONSTT RUcrioN LENDING AGENCY
F I hereby a0hnn lou their is a,lado,ctinn lensing agency for dm pedommncc
t� of the work hir which this permit is i.su.d(See.3(91.Co.C.)
L Q Lendar's Name
Z Linda,',Address
V 1 cenlry that I have read thin application and vam that the all information is
sores.I agrea It,comply with ill city unit county"'finance,and sale laws cloon,
O V :o wilding construction.and hereby apthodm representatives of this city it)enter upon
the dove.memianfd property far Inspcctann purposes.
(We)agree to,ave. ndrrmiay antl keep hanule..s the Cary of Omani nu against
t�o-1 liabilities,judgmeno,costs and egKrsdcs which may in any way accrue against said
V APPLICANT UNDERSTANDS AND WILL CO
'.min'of do,
COMPLY WrI'IIALLNON-POINT Issued `� Dale
SOURCE REGULATIONS.
y'
Signature of A,imumCoatmctnr Data Re-roofs
HAVARDOUS Nt ERIAI S DISCLOSURE
Will ate apphcmu or Iinnre building oeetpam vmm or kindle mlradnn,material Type of Roof
es dcfinN by mhe Cupedino Mmnicilul Code.Chapter v.12.and the lhadth and Safety
Code.Section 25532(¢)7
E3Ya, DANr_ Alhroofs Shall he inspected prior to any roofing material being installed.
Will the drill daunt or future budding,wfupant use cynipmem al,devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit he,aubms m,could nd as JuJed by the Bay Are,,Air Quulhy Mnnegral t
wrirn all new mater'als for inspection. Applicant understands and will comply with
�t
El Yes EI No all non-poi Source regulations.
I have read the haanrdauv mmerids reyuimmems under Chapter f�95 of the
California l lcalm k Surely Coda Sealnns 25505,15533 and 25534.I anJrrsmnal that
if the buildiill not emnandy have a(mal thin it is my m,pnmlhi lily to notify the ,J
occupant of he fC tirememx N' mY4 be ,to print la iNYanCC of a Gfndlc'vIC nl
Dec°I'°"a Si gnat e of Applicant Date
/z '�3-e
Gwremanthmiael agr.nt Dor All roof coverings to be Class`B'• or better
OFFICE