01070012 PERMIT
I BUILDING fUPRON O CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERh11T NO.
20104 WHEATON DR ALL SEASONS ROOFING SERV CES01070012
DATE
TgEl"OhLIAM R JR AND PAULINE 2640 PACER LN 07/ 062 001
.t PHONE 4069724455 SANITARY NO. CONTROL NO.
w O O ARCHITEC AINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
?n< CI IJ IJ GI
S i LICENSED CONTRACTOR'S DECLARATION
..!S 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commcncing lob Description
fy(_w with Section 70o0)ofDivision3ofthe Btoirrx,and Professim,Code,and myher.e REROOF.
ayf� tamrnu rnreeana errert. .S `s�p�s� REMOVE 1 LAYER OF SHAKE &
z a
License Class C'' Lic.a
w3n� Dare o comracor y REPLACE WITH30 YR. COMP. ;7
ARCHITECT'S DECLARATION
EL O g 1 understand my Plan,shall be used as public records
of
or i p O Licensed Professional
e OWNER-BUILDER DECLARATION O
In 1 hereby affirm this I am exempt from the Convanoh License law for the ,
Z< hollowing rexsoa(Section 7031.5,Business and Professions Code:Any city or county
E O which requires o permit,o um„ma,alley,improve,demolish,m repair any smacture
no -prior to itsalso acquires the applicant farsuch permit to file a signed statement - - - _- _.. .. ... .. ............
that he isrenerlimlprc mmmpowimur,ofncorabrocam',LicenseLaw(Chapter 9 .t . f S,q:Ft Floor Areal r, ) - $100g4uation
fico rang with Smhim BB0j of Diviion 3 of the Busine nd Prohesson.Code) � j_S,e t .1,ti,- T r„O, JI1.' s! a-.xf t. � it°�s,
or Iha,he is elcmpt therefrom and the bans for the alleged exempuhn.Any violation
of Section 7031.5 by any applicant for a pemeit subjects,he appl ican,,o a civil penalty
of not room den five hundred dollars(SSW), Occupancy Type
01,as ownerofshe proprrsy or my employees with wages as their sole compensation,
will the work,and the a a re',nor sed offered for'.n1 (sec. to
aoann
B 305 — FRAME Required Inspections -
' u and Cod:'IT Contractor. License Lad ,(See l
owner ofp lamy Who Wilds ormCrove her d who does suchwork himself 307 — INSULATION
or th ggh h' employer,p ddhot. h' p ,. ,'mer&dor
'aft d f sale.If-however,,he building orimprovement- mid thin one year or -” "-' 601 ROOF TEAR OFF I'� .•. i
con,pla,(anf theownerfbbulderwll have the burden of proving that hedid not Fuldor 602 - ROOF PLYWOOD NAIL
improve Purposes
- 603 -ROOF BATTENS-
0 has owner n1,he pmprny,am elusively contracfmg with(seemed contmcomm, -
_ conswe,she project(She.7DIct.Busimss and Pmressions Coda)The Cmareaor's 604 - ROOF IN-PROGRESS ' '
:- -' License law does not apply to an owner of property who builds or improves thereon.
.. .and who contracts for such Imajreta with a matriaor(x)licensee pursuer Lto,he _. ._ .._ _.. .. ... . . . ... -. ._ __ ... . ... _. i_... ._. .. _ _.. _. ._..
Contractor's License law. 11 _ - -
❑1 am exempt under S«. B&P C for thi,reason r, , t•'t
Owner Dmc _
WORKER'S C MPENSATION DECLARATION
_ 1 hereby affirm under penalty of perjury one nl the following declarations:
❑ I have and will maintain a Certificate of Consent to sd6insure for Worker's
_ Compensation, as,proviJrJ for by Section 3700 of the Labor Code, for rhe
_ performance of,he work for which this permit is issued,
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code:for the performance of the work for which this permit is
- issued.My Worker's Compensation Inmranec cancer and Policy number'.¢:
x%B1 Policy No. f T �'. t h.�l` r1! i1 �y'i)wv .�.•v7 r Id r.
CERTIFICATION OF EXEMPTION FROM WORKERS"-
_._• _ t, _ COMPENSATION INSURANCE _ _-
.._-...._ ._..__-.._.—. —._..- ._..-..+._.._ ... ._.-_. ..
Mis'section need not he completed it the permit is for one hundred dollars - t
(5101)or less,)
I eerily Iha,in the if name of the work for which,hi,permit is iv,rmd.I
shall rat,employ any person in any manner so as to become.subject to the Workers
Compensation Laws of Culifi mix.Dare
NOTICE TO APPLICANT:It.after - _.. ... .._ . . _. ..
-Applicant hold ...- .. f
making,hisoikinaa,or Labor Code.sono t
become comply with
Worker's Cmonsortlon pmvi inns11 the Labor Code.yon ams,
s
Q Q forthwith comply with such provisions or this perosi,shall be deemed revoked.
Zd VJ CONSTRUCTION LENDING AGENCY --
F""� I hereby affirm that darn is a c0ngmalon linding agency for she perfnmame, r
We work for which this permit is issued(Seca 31107.Civ.C.I
= Z Lender'.,Addrevc"
C.7-Q I certify that I have read this application and State that he above information is
roma,.I agree to comply with all city and county ordinances and state lace relating
Q C.) tpthatilding ne't.I agree t cl ion,comply
ilh all city
andzc representatives nd staLhiscite law%muting
Ih b i nal p p ilf slact p lis.
Fey Oic)agrce,o fl atkep barrless the City ofCpertino against
Vi I'abilities.judgment, costs and exl,arroci which mat in any m cy accrue against said
UCity in consequence tflteWarning oftl pl , 7
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G ��
SOURCE REGULATIONS.. Y'
Signature or ApplicandComranor - Date Re-roofs
is definedh Will Lathe QucanioruturtcWildCoda Chapter handl
HAZARDOUSMATERIALS DISCLOSURE
PP g w enaivdound Salt l Type of Roof - .. .. _. •.-. ._., ...
.. Y 0 Pa P Hcalfh and Salty ry ys .:,.. v i p•.; ...
cnde:ovlus3vm^ • o I�. , !.... _ ash
_ _ -.All roofs shall be inspected prior.to.any�roofing.ma[enal being installed.
W Ii the applicant f wmbuilding mcupan,use equipment devices which If a roof is installed without first obtaining an'inspectioti;I agree%to remove
ct thazardousr, nae dcr d by the Bay.Area A' Q I',y M .unmen,
D p t all new materials for inspection.. Applicant understands and will comply with -
�Y" - all non-point source regulations.;
1 have He read,he hazardous materials 2 requirements 25533 a under Chapter 695 0!,he
California Hahn&Safety Cole.asea .tor.that
t itis and 2553.s.I undcrmmnfy hat
the
aterbuilding does not currently hateatensa,.,hints,my rteance of
a e ifica the
ocdup:mt of the regitiremens which must be me,prior m issuance of a Cenif m of
°a"ry' Signature of Applicant Date _
"•1 raraampn=mage 1 I Dole All roof coverings to be Class `B" or better
=1.
_. .... . . .. '_e OFFICE . .. . . .- _.. . . _ -..