06050111 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT -CaNTqgy" `g Xp, MTr,.rroo '
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNO'06050111
23038 CRICKET HILL RD
OWNER'S NAME: PERMIT ISSUE DATE
DEANZA OAKS HOA 502 HORNING ST 06
IS: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3oe
LICENSED CONTRACTOR'S DFCLARA71ON IObDescription
I h.reby affirm Nat 1 am Reacted under Provisions of Chapter 9(Commencing
I� with Section TON3j orDivialon 3 of Ne Business and PrOwssuns Code,and my lice.¢i,
+� nrmlrow.sal frac TEAR OFF SHAKES INSTALL 1/2" CDX AND GAF GRAND
in
eaa Llo..y7'ZIDB -- _
D,md( Z C.atrara +r .Sand:Rc .' SEQUOIA SHINGLES 50 YEAR CLASS A
ARCHITECTS DECLARATION F�IVAI.ED
l I understand my plain shall W TS u Public recons
Licensed> u
sQ LiceeJ Professional
`+
OWNER-BUILDER exempt 1;herebymrso ,(firm that 11. exempt from the fessions C l e:My C law for Ne JUN /,/ 2006
i p O following recon.(Sermon 7031.5, t,Business and Professions Calc:Any city Of county I"-r L
S$♦ii which regvirts a permit a cnmWc4 alter.narrow.demist W.m repair any auurum
Zi prior m its Issuance, ]an mqutm the applicant forsuch permit on Oie a signed men,
g@FF< That he is licensed puniest to de provisions of the Contractor'sLicemc Law(Chapter 9 Sq.FI. A@Mqr
VaIUBCI 500
Cd9 (comm...os with Section 7000)of Division 3 of the Business and Professions Cade)err
t+ 'hot W h.tempt therefrom and the buB the for alleged es.mpdon.Any violation of
Section 7031.5 by cry applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
Cot .Nan Live hundred dollva(5300). 3VA
0
❑1,an owner of the property,or my employees with wages as their sets compewdon,
will do the work,and the structure Is not intended ar offered farsele(Sec.7044,Budnen Required Ins actions
and Professiam Codc The Conlrxwrs Licusse raw 4—ml apply In an nown of q p
property who build,or improwa thmeon,and whoAces such weak Wandf or through his
awn cmPlayees,provided that such impmwmmin are nothumaled proffered(oraleif.
however.Ne building or impmwmmt b wld within am yev of enmpkurm,dm awaer-
buildm will have the burden of proving deal he did not build a improw for Purpose of
axle.).
❑1.as mvmr of the prepeny am exclusively commcting with licensed co menexas of
eomtmr the project(Sec.7044.Business am Prof esiom Code:)The Contractor,U.
cense raw does coliapply to an owes of property who Wlloa or Important thereon,and,
who commom for such projem MNamntracur(s)flamed pursuant to Nm Contsaclors
Licence Law.
❑1 am esempt undo Sec. .B&P C for this recon
Owner Dose
WORKERS COMPENSATION DECLARATION
1 hereby afflrm under penalty of perjury arc of the fallowing declaallons:
I haw and will maintain a Certificate of Consent W Self-insert rer WO mesCompCo-
amlon,u provided far by Section 3700 of the labor Code.for Na perfarmorce of de
work for which this permit is Issued.
❑1 haw and will m tinism tolerates Compensation WtnvrCo,as required by Section
3700 of the labor Code.for the performance of the wink for which this permit Is Issued
My WOrkda Campemetlan Insurance artier and Policy another am:
Cmbn,APrwigf 14...M HX.PolicyNo.,`U Z44
CER77FlCA77i KEMPf10NFROMWORKERS'
COMPENSATION INSURANCE
masmairm need Cot ho completed little permit Is foram.hundrtddollan($100)
or Ins.)
I ceriry Not in the perform rnme of the work for which this Permit Is issued I shall am
employ any person in any monmrso as to became subject to the Workers'Campemulm
Laws of Calif neic Das
Applicant
NOTICE TO APPLICANT:IL ager making this Cerincae of Exemption,you should
become mbjm in the WorteM1 Compensation provision,of the Iatmr Code you mac
.,O forthwith comply with such provisions or Nu permit shall ho deed rewkd
document
Z CONSTRUCTION LENDING AGENCY
y
t-, I hereby amrm this dere is a communist lending agency for Of performance of
C > the work for which this pend is issued(Sec.3091,Civ.C.)
QLanders Name
z Lenders Address
U Q I Comfy that 1 haw rad this application and sum Nu the show information is
k,PcurrecL 1 agree m comply with all city and county on inamea and mato laws rthdnI in
U building construction.and hereby authorise mpmsenutiws of Nis city to onto,upon No
r W ahovc-mentioned property for inspection purposes.
F LL (We)agree to caw,indemnify and drop homeless the City of Cupertino 314imt
w. Cn liabllldes.judgments•cine and espenus which may in any way amuc agalut said City
U Z APPL CANT UN Eences of the RST ag of this S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2-G!a
sou ULATIG
11 Re-roofs
Signatum ol'Appli ' orOn
r Dau
RDOUS MATERIALS DISCLOSURE Type of Roof
Will the appNo=Wilding occupant some or handle hazardous materiel
as deRmd by do C .a.Municipal Cade.owner 9.13.and the Heslth and Safety
Code,Section 2553x(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No 41
Will the applicant or future Wilding mupanl use equipment or deviCa which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wsound air Imnts u defined by the Bay Area Air Quality Momgemenl all new materials for inspection.
Gimlet?
❑Yea No
I haw mal the heraNmi dalsrequimn under Chaptesd93 oftho Califor.
nix Hcal"Safety COd..Sectiass 25303,35333 an125534.1 unEemmnd Natifllc Wilding
Jena mlcumntly how a unano my,amenability m mury doa
oupont or the
BowasianteRnlihich rnwa he t a ssu era coldfiuu ar cu � Signature of Applicant Date
Owncrar wthorivnA, C/D7-a All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 7 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34240029 . 00
DATE ISSUED. . . . . . . : 05/12/2006
RECEIPT # . . . . . . . . . : 34375
REFERENCE ID # . . . : 06050111
SITE ADDRESS . . . . . : 23038 CRICKET HILL RD
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 888 . 72 005538
TOTAL RECEIPT 888 . 72
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