01060067 (2) CITY OF CUPERTINO
' BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: - PERMIT NO.
22998 CRICKET HILL RD FOUR SEASONS ROOFING 01060067
C7;rOWNER'S NAME: APPLICATION SUB DATE
OAKS H.O.A. 645 HORNING ST 06/12/2001
% PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
Do- BLDG ELECT PLUMB MECH
Z 8 y Z LICENSED CONTRACTOR'S DECLARATION r Job Description
O Z- I hereby affirm that 1 am licensed under provisions of Chopter9(commencing
rat u9 with Soaion TIDO)of Division 3ofine Basinessand Proosaore Cade,andm
mn
a E� is in full toe a d.R
z ueenne cl as Lilt,g 7 D REROOF.
° y Date
c., DaAce
T'S DEC ` T/OFF CEMWOOD &
LARA o0
"
ARCHITEC>
derstand my plem,:hallrt used u public records
INSTALL 1/2 " CDX 40 YR. COMP.
Fs o O .Licensed Pmfessional
g •
OWNER-BUILDER DECLARATION r
W I hereby aRnn that 1 1. exempt from the Connector's License Law for the
t_z following reason(Section]onstr Businessland Improve,
de o demolish.
or Any city or county
is x❑ which requires a permit re mm,the phew improve,demolish, Il aDrepair,any structure
n3 .p t , ' I the PPI.:m 11u,CoF per, t fl [g damemeno
,h the 9l -idsf IVI 1ho nom disc Ca,vaca 1' l lCl'pter9
Sc:Ft F-lool rel Valuation
,., e 8wah mPedbi osis a fDivsuno ,the Businessandpits 'urs Cale) d 1)•a i 15_4L t I.
E:V 1f 1,
or this io 6 31.5 bymcrefmm and the baste for the cox the exempn,t Any v penalty
Iof Section a than iv any applicant for a pctmit subjects the appllcnm to a civil penalty
larwt more may fire handled dollars(stop). APN Number 1 n.;.:i '.t$®QcQI jiftncy Type '
❑L u uwncr of the property,or my employees with wagu as their sole compensation;
-will do the work:and the structure isnot intetled or'offered"for sale(Sec:-7(l
'Bus rirai and Profealmol Cale:The Contrector's License Law does not apply to an 34241004 . 00 Required Inspections -
owner of pmperty Who builds or improves thereon,and who docs such work himself
or through his own employees,provided that such vement menrs are not intended or
� ." Read for-sole.ICFawevfr;the Mtildin _.._._.........._.___.._......_ __.__.-.�._... ._._.�.. _ -__ _ -.__._.
ger imen of proving
-sold ver min not ild of NA'LED
oprove for pumoseer-bailer will have the burden of proving that he did not build or 3 0 5 - FRAME
c s "
Improve for Pmm�ae praale.). -.3.07 - INSULATION _
_-
exc
L duct the ltfthe p(Set,7 am business a d Popt..run,1odx:)1,Coacmrs m '1/� { ,.2001 ,• -----
License theproject(Sec.]toa,Business andPopwho b Cade:)The Commreon, 601 - ROOF TEAR OFF AUG .O 1
License Law tots not apply man owner of property who builds or improves therein, h
....':': ..ana.who.cltmmen,for such projects-with a.eonaaemrtn)Imenad:pprapam m me. _........ _._6.02._.-_.ROOF PLYWOOD NAIL _ .
❑lama mptundeS `' Be PC fpr min ream; 603 - ROOF BATTENS. BUILDING
ot• "' 604 - ROOF IN-PROGRESS
Dal
' WORKER'S COMPENSATION DECLARATION
I hctvby am.under ptoah,of pefju one of the following declarations:
- ❑ 1have'end'will"maintain'n'CeriiPcate'of Consentto�self-insne for Worker's
_ Cumpenamion, as provided for by Section 3]00 of the Latour Coda for the
,'performance a the work for which this permit is issued.
- O t hove rind will nminwin Worker's Cdinpimation Insurinee,hs rxsjcirea by Section
37M of the labor Code;for the,perf.monce'of me work to,which his permit is
k h tlMW- e mpensat m
Insurance carrier and Policy number art:
irk a•�.�� carr�.r..
' Ce eIPol cy No.YR••Zy/P�/ �� t ' .�„-.
sl, .i'•CERTIrICAT10Ni0F,EXEMI'1'ION FROM WORKERS'h:' _ . ,
.... acct-,_._. COMPENSATION INSURANCE .. .. .,. ..__.__ ._,_ -_. .__.___ __._._._. .. 1.._-__._ _._...__ . ....._. ._. .__._.. _....
`lThis seniit
or,iced not be completed if the permit is for one hundred dollar - t
ISI WI or lcssJ -,
n,Y that i the pert mune f the h for Dbiah la permit's issued.l
shale n t emplom y any person anymarinerso as to become subject loathe Workers ;-
9 mpem t on Lawn fC I f''Ia.Dam l
.,Appl cum. .. I
,NOTICE TO APPLICANT.If after em ti ifs Ccn hems ofExemption.ome.you midst ..
Z Ecchwith6 mlily it Worker's Cum avipn provisions bfine Labor Cale.you muss '
O forthwith c mply with such pro lions o 11,is permit shall be it,,me revoked,
CONSTRUCTION LENDING AGENCY
I hereby Fyn this Here scon. o 1 ndiyg agency fo the pcduimarc s t;,
of mework;fof which this permn a s issued
15(S c 309],Civ.C)
Ld r Nome .acct .. ..._ ..�...
�.:Z Linders Address:-,
V 1 cenify mat 1 have mad this application and state that the above information is
correct.I agree m comply with nee,city and county ordinances and state laws relating
mbuild'mg construction:and hereby unhoriac representatives of this city to enter a Pon
the abovememloned property for inspection purposes..- -
6 (We)agree}o lave.indemnify and keep harmless the City of Cupertino against
Cf•” y liab I i s 1 dg is st d expenses which may in any Y acme against said
Z4 City slit e f i�8g nomn, f th perm t
APPLE ANT DCl/rl�VDSANDWILLCOMPLYWITHALLNON-POINT''.
30 ULAi O Issued by: Date
i
Signomrc IAppl'conucrntraaor, Re-roofs
c ':.HAZARDOUS MATE RIALS DISCLOSURE - '
..
'Will th'.6011-al le rumfumm bu'Iding oto pant store pr funis,lb ivol as m tet;al. Type of Roof .- .. _. .. _.. _._ .. . .� .,.. .._..._...... _ . .__..
as tl rn d by the Cupertino Municipal Code,Chapter 9.12.and life H aem and Safety
code Section 25532PI Elves
lP.,
..All roofs'hall.be ms ected.prior to anY-roofing material being installed. ..__.-. ._,.
Will me pphc t f t rebind gat pant use cq pmemorae'a q which If a roof is installed without first obtaminr ah'ins ection, Parree'to remove
cae�reo Heahn&s.,r�� 125505.255J1and255J4n11 dbrs9mnd�p°t all non-p a trsolurcerreeguplaDo s� Applicant understands and will tom ] with
o u t c fined by th BayA A Quality Naw enumn o P b
im mad
nor
.immatorts old,,
it the building does not currentlyfiea tenant.that is' ymciponsbilny in notify the
pct paisf t c frame t: h must b met p sur in is,Wyable of a Certificate of
Occ�,cy 6 -
ro� , Signature of Applicant Date----
mo
ate -_red D'en, /Z Date All roof coverings to be Class `B" or better
.. .. .:__.w. . '
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.,>� OFFICE-._. . . . .. .. .. .. . . .. . .. . ..