01060126 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10146 LAMPLIGHTER SQU BLVD FOUR SEASONS ROOFING 01060126
OWNER'S NAME: APPLICATION SUB DATE
gi DE ANZA OAKS H.O.A. 645 HORNING ST 06/21/2001
PHONE: (408) 278-0330 SANITARY NO. CONTROL NO.
a Q ARCHITECfyENGINEER: BUILDING PERMIT INFO
kL" ❑ BLDG ELECT PLUMB MECH
a i` LJ IU I__J CI
t6a
Z Z L z LICENSED CONTRACTOR'S DECLARATION Job Description
Iheuby affirm Nat lam of
Business
provisions arof Chapter 9(mmmencing REROOF. TILE TO COMP.
F H h with,Smion 7(100)of Divi 3 of the Business and Professions Cods,and my license
m fail rents dna rce_w. Z O Q
c
I,
nsecsa f 3`� ua.N 17 S FT. S
iei Date z1-�� Contractor
Ans HTTEeuse DECLARATION
1 understand my plans shall be used as public records
p O Licensed Professional /
an OWNER-BUILDER DECLARATION
vi I hereby affirm that I am
exempt from the Contractor's License law for the
t:? following rcaon.(Section 70315.Business and Professions Code:Any city or county
Z SF C which requires a permit ht construct.alar,improve demolish,or repair any structure
at prior 1.1iuus¢e.also requires the u'plicwn fnrxudi Penult,file.sintedsutemmiti 80-00'---'- '
Igmpe i;liciW{A,W,noiutA.tryc pmvisian.of the Contoclod License U.(Cnepmt 9 �.� Bt Sq.,Ft. Floor Area;,.. ttry, Valuation
(commueing with Sectlgn,70t0)of Division 3 ofthc Business,and Professions Cale) l }1 ( € ,sxi.. I '. '1' r ` s sirli l)_.��.
or ilwi he is eaempi therefrom and the basis for the allhg'cl 6emptiun.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
Occupancy Type
Iofnet more than rvehundred dollars(s5ao). APN Number '1.1
❑I,as owner of theprops Y n,orm employees with woes as thcirsole compensation. -y erne Y 6 penesFRAME
will us ea the work:and the odeTstructure is not ttemL censeed or eredLaw for does alenot apt 0 a, 3 0 7 - INSULATMiluired Inspections; "I
,easme:s ane'P7orea:ions sale The Contractor's License Law does not apply n an ,
.1th
owner of property Who builds or improvesthereon.and who does such work Mmself 601_ - ROOF_TEAR OFF
or through as awn h5weveces.pmvidcd tort such improvements are not intended or
--compIc-rot.themanctwevettwbeavetherim- - 't i:saahedidon�---r --- --- ' 602 ROOF PLYWOOD NAIL
-:i n l t me owner-baJdcr will have ins namde�or n that he ala not e�mor �' `•.,� �� t
impmveluipmposeaf.R.). proving 603 - ROOF BATTENS
--.... --- _...6.04- _ ROOF IN PROGRESS------ 7_,,,T__ -
C:a
1,as ownegof the propeny,am exclusively contracting with licensed contractors m h 't
License the project(Sec.pd 7Wa,Business and Professions Corea nD'e es dor mm's I q':,n ;t' ,. 'i
License Law a«s not r such
man owner th property who builds s improves thereon. J -
C .,and who connects for such Prolecb with a.ronuacmasl.licensed.pursuom.m the ..... —. ._ _...__ ._ ___..__—._. ._— _..__._.._- -
01exempt
ContractorLicense Law
❑lam acmpt under 5lc B&PCfar this trisect r ) iJ, •:'I'1'1 I ''I
Gwitcr Daie
LWORKER'S COMPENSATION DECLARATION
-.• i' .•..1 henbY anima under penally of perjury one of,thc following declamaons:
❑ 1 have and will mamla lire Ccnificme of Cunseni n self-imine for Worker's k
t_ ? Compensation,-as-provided for by Section 1710 oftheLabor Code, for the
- _ 7 perroinunce of the work Ter which this permit is is coed-
❑1 have and will mhininin Wanicrk Compcnsprim Insurance,a;'cgoimd by Section
-- 3700 of the Libor Coon for the pctfdmaainee of the workfor which this permit is
- issued.My Worker's Compensation Insurance carrier and Policy number aArter 7 _
Cnnicr:/\aA"vtva'1%l:/t.ti"Policy No.:UvG23� fDJ r YJ - s'•: .a I- 7r.ys'� "
RTIFICATION OF E EMPTIONFROM,WQRKERS'imss' ` j.',� �,v '
COMPENSATION INSURANCE _ ------- __-.__.__......
Irnai ucuon Leaf not be complaN if the permit is for one hundred dollar •, l . , .., ..:D h;11.;
(8100)or lrse.l .,t u•. . ., „•..i.:,
" r I cert f fl tin the R of the orkrfor wn'<h N t . Iss A I f-• .0
Comtint employ aoy.perwn n any manter u a io become subtest to the Wwkcrs
Cn pc. t Lias nfCll Dai
_A ppl ant
NODCE TOAPPLICANT If aRcr mak ng tots Cemfcac of Eaemplion.you hould , '
hecmar
'abject to
the Workers Compcnsa0on'pr�visions of the Luhor Cale,you-must
O p (aMwit
h comply with such pmvisinns or this permit shall be deemee revokes. _ _
... . _ _ . .. _ _ ___
Z t 'CONSTRUCTIONLENDING�AGENCY t f t
1 h cby'ffimt that th i .o con.f-t lending ag y f the performance
of da,waPfor which this pemnt is issued(Sec.3097.Civ.C.)
a-Q Lcndcr's Name" - -- ,
= Z LenJer's AJdrcss _ 1''I'•i!('dt
V � (crony thatlhave read all city
and
oseinfo,retain,
0,t.. tobuilding
I scree lu cti Ply lh all ity a W ty J ate. J t t 1 a cru ng
O.V the alboe-minion n) hyamho representatives flh.cityt sorerupon //' •� ��
r.W the abovemenuaned P.1!en3_f inspectionPUlpose, -
Fa, We)agree t+ ae lldatmfyadAphcml .tcC fCptno against l
lin liab l i es rydg e t t J Peres h h y any yaccrue
c o8yinst sa d
Z City c sci oft a i'g 0th peon( -
APPLICANT l .1LR AN S AND WILL COMPLY WITF{ALL NON-POINT Issued b Date
SOUROr1RF LATA f y'
Signature afAppificortICantractor -ICJ S',Date �'- Re-roofs
1., HAZARDOUS MATERIALS DISCLOSURE
W11the aiplarat or future building occupanttore or handle bLari mcconal. - Type of Roof
us dictined by he Cstromn Municipal Codr.Chapter 9.12. d he Health ad Surety
Code,scion 2553_O- 3t3 ` : .,: '.A• •' •; t `f s . '. .
�YeS 1 All roofs shall be inspected prior.toxany-roofing materia] being,mstalled..
• t W'n the applicentarmune buldir,oic.pait incocrimarramdevice,which' if a roof is installed without first obtaining an inspection',-1-agieeao remove
'nia looitirdloui air terminations as defined by the B y Area Air Quality Management I
District. I all new materia or inspection. Applicant understands and will comply with
t OY' . : : all non-porn ,o rcere lanons,, -
I b ( ad the h:Irard a m al req t,under Chaps 695 f the
•C lfo Health rely Cad 5 to 2550515533 and 25534.b Jensmdthat
=
nftheb IJt gd n tc sly he.eet t tot li my i" blrymnot fy th 1 lJ
c5cccupam oft qw nis which'must be met pnmr to issuance of a Cenifican of r
:. z l o
pP Date
i azure of Applicant t
_ owner atnariva pee�t. _ Da All roof coverings to be Class `B" or better',
\ OFFICE. -
t