01060068 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
10118 RIDGEWAY DR FOUR SEASONS ROOFING 01060068
W NER'S NAME: APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/12/2001
/'\J-' PHONE: SANITARY NO, CONTROL NO.
(408) 278-0330
o s ARCHITECT/ENGINEER: BUILDING PERMIT INFO
x w O BLDG ELECT PLUMB MECH
to i
NILS
Z z hLICENSED CONTRACTOR'S DECLARATION lob Description
0z_ 1 hereby affirmchat lam licensed under provisions of Chapter 9(commencing
F,v,Fca with Senior]000)ofDivisionJofthe Business and Professions Calc and my license
a m f iS in full Tome an fifes ��./
ee� ucesea .� `'sg uc.n / O REROOF.
-CCS Cclnr
u 3 u. Ua" ARCHITECT'S DEDECLARA T/OFF CEMWOOD &
IunJ<nlandmyplansshallbeusedaxpublieucoNx INSTALL 1/2 " CDX 40 YR. COMP.
�D
p Licensed Professional ,
we, OWNER-BUILDER DECLARATION
1 hereby of.that 1 am exempt from the Conlraeo is Licenu Law for the
following reason.(Section 7031.5.Business and Professions Cade:Any city or county'
which acquires a permit m co sumer,alter,improve,demolish,or repair any structure
ou morm its issuance.also requires the applicant firxuchpamiuofilaa Signed statement, - -- ------ -
di
coach
.licensed comm lO the hmvolons Of the Contractor's License laa(Chapter _
gen Puy. P 1 p Sc:Ft. Floor-Area,,. . . - Valuation
Romm fie is cs;lfflfmf]nand the lisiisor t the ItiBriscasiandlon.Any
Cok) {.. Ll,^.S.[\-'il' )•�_•, .,- t_I t', ^, .
or Shoo fie is 1.5 b Iany amen and the bnsis for the alleged exemption.Ani violation.
-of S«tion 703 an. is any applicant for a Permit the applicant to o civil pewlry
mr mat mart roam rise hundred donor(s50o). APN Number t ®npkncy Type
°L as owner of the property,or my employees with wages ILS their sole compensation.
-will'do the'work:'and the structure is not intended or offered for sale(Sec:WMJ; --
Buxineas and Professions Code:The Contractor's License Law docs not apply to an 34241015 . 00 Required Inspe io
owner of property Who builds or improves thereon,and who daex such work himself
or through his own employees.provided that such improvements are not intended or - _
-... -_ . _�._.. -AUG 0-1-2001.. ... _._ .._
offered for able:acIf.however,me ll have t e c i correct of simproving ng oldthat he did
rear or 3 0 5 — FRAME
0-1-2001-
icompletion,the owner-builder well have the hnrdam of proving Iha he did nal buil)or
mprove for purport of sale.) 307..__-.--..-_INSULATION
[.-a;come, flh prP y mly ' g mlicensed Cnn 601 — ROOF TEAR _
OFF ._. I
,
- BUILDING_','
construct the project 1 7(W4,Business and 1 eonx Coded TmContractor's
License Law aaea not apply o an owner of waperty who
._ _._.._
nmina or improve:mereon,
602 — ROOF_ PLYWOOD NAI_ L
i .and who contractsfor,such projects,with a canlmcmrlx).liceneed pursuant to.lhe ..._ ... . . ._.. .. ... ......... . ... _._ _.__.-- _....._..
Contractor's License Law' 603 — ROOF BATTENS•.
order Scr.' ' ;B&P C for this reusnn
oµ^Cr,axrmelama 604 — ROOF IN—PROGRESS
❑lam
Dale
WORKERS COMPENSATION DF.CLARA'1'ION
_ Ihereby affirm under lrcpt1tkofperluryoncof,thgfallowingdralmati"ns:
Im .1
° 1 have'and'will'maimiin'v Cenilicam of'Consent m sell-ame c for Worker's
_ - Compensation. as provided for by section 37W of the Labor Code, for the,
performance of the work for which this pencil is issued .
°[have andwill maintain Wurker's Compensation Invmance,as o neared by Secliora
_ 37M of the Labor Craft,for the pedm rroot of the wo it for which this permit is
ussne
My Workers C+mlpensation Insurhnce currier and Policy number art:
,. �tM+�rOf:-,vorcrNo!%GZY..7�J9 Y3 — .. _ _.._ _.... •... .. — _ ...----•---
.
,^CERTIFICATION OF E%EMPTION FROAI WORKERS'; s_ ' " t -'�:�.t- v 'it i.�- � s.f Si •'.::'I
------------____..-.____-_.__._._____._-__.___-.._._._._._.___.._....._-.-_....____._--...__......-.___..__........
musiconinn'need not be completed if the permit is for one hundred dollar
ISI00)or less.l
" I m y Nat as the pc Ia mf 11 k f h h Ih PC 1 issued,I 1: m 1
shall not employ any person in any number.so as to become subject to the Worked S j%<' 'I•
Compensation Laws of California`.Dore
.Applicant: ..
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you should
become subject m the Worker's Compensation provisions of the Labor Cole,you must
C O fonhwidi comply with such provisions or this permit shall be deemed revoked
z - -- "' CONSTRUCTION LENDING AGENCY _---_-
"> .' .1 hcmby of inn that them is a construction lending agency for the perfomuuae "
W of the work for which this permit n issued(Sec.309],Civ.C.)
Under'c Name• ..... .. __ _ ...,t.:- . ..._•- _ _.. ._ .. . _. . . _
Z Lelulcr'x
V 1, 1,' 1 certify that 1 have read this application and state that the above information is
tz_F comet agree to comply with all city and county ordineraes and Imre laws relating
:0-ii to building constriction and hereby aummim mpresenlaives of this city to enter upon
y the above-menlioncd property for inspection purpP.m.
E..S (We)agree to save,indemnify and keep harmless the City of Cupertino against
N liabilities.judgments,can.and a mea which may in any way accrue against sail
U .Z. City inconu ttof the
an f0is perms. ,
A A 1NDERSTAN iAND WILL COMPLY WI ALL NON-PONT Issued Date 1i
,P sE 'CATIONS. /Z�Q y'
Signature of ApplicardContnclor Doc Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
" WIl dic applicant or future fielding occupant.cure or handle hers dnm,ma¢riW Type of ROOF ... ..-_ .._.. .._...as defined by.the Cnperinn',h umlapal Code,Chapter 9,II,and the Health and Safety _
Cede:Semmn 25531( 1' m ' ' t, '' :�•' -` '�:
-erns ' ' L ) 1 s _..All-roofs.shall..be inspected prior..to-any roofing material being installed.
' 'Will th Ic t Ire bulS taste equipment ceS which ,
pp s r q P If a root Is installed without first obtaining an inspection;['agree to rAntove
eand moordmi, i"monourcm,.,deflated fi,th BayA,.AirQaa1a,Mart,carrem
Dia,i,dIall new materials_for_inspection. ,Applicant understands and will comply with.
�✓ °Y all non-point Ince r loners: ,
1 ha a ad the ha..N ',nAler I I m rot J Chapter 6,95 f the e/pyo]
Galt fl 'Ith&S lye d S I' 25505 ibs 1355 W:1 J t J hat
dtheb Id' gJ tc J t 1 tbar 1 Y Po 'M1lt 1 lythe V�� -
0,uP rot"ll t ndsl h t yrytno Ix. e d a Ccruncam of --
i� Signature of Applicant _. . Date
ow e a ;sed agent . . ,� Dale All roof coverings to be Class"B" or better
- '>" . .. .. .. -.,. . . ... ,. .�, � OFFICE ._