02060113 (2) CITY DPERO No
PERMIT CONTRACTOR INFORMATION:
B WIT"O�D I)GEWAY DR FOUR SEASONS ROOFING PERM N0. 02060113
T-r"M2A OAKS HOA 645 HORNING ST AU1(fjTgYIVU2
1 PHONE: (408) 278-0330 SANITARY NO. CONTROL NO.
o as O ZO ARCHITECDENGINEER: BUILDING PERMIT WOO
u- - BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Z�3 I hereby affirm that 1 am licensed under f Chapter 9(commencing Job Description
;�_o ya provisions p g RE—ROOF
t:u, �witnseemm t000)ar nmiamn3anne Buaineasana� aa�anaeade.ane he nae
C y; is In full 1mm;Cdc Z
6< License CI as 3 Lie.a l e
O a V Dmc Comracmr
LL 40 d , ACHIT[CT'S DECLARATIO.
1 un er.mnd my plans shall be used as public records
to
i 6,p O LicensedProfessional
o OWNER-BUILDER DECLARATION
vI hereby a 6t, oat 1.m exempt from the Contractor License Law for the $8000
C?< following reason.(Section 7031.5,Business and Professions Cade:Any city or county
F o which requires a pe it to Construct,alt r,improve.demolish or repiry swcture,
C .prion t I req the for such permiu fl signed statement __------_.
rept he 1 emeep , .tt th<pro aorta emttmcrorae (Ch,ptm9 .A3�Aq 9-Z Q7L6r..®f@a Valuation
Immmc g npa do 1q N1) fD noof the Big ipeuand Prof sl.num 1 ai�'• } . .. ! lIi• 1L 3..'Lt.tr i.�,"•,11.5 "
or that he s exempt therefrom and the box,for the a0eged edempt his.Any v olation '"
-of Smrmn 1031:5 Try anyapplicant for a permit xubjecu the epplic.m m a civil pcnalry-
-'ornptrrwrttnmfivewnareadonars(Ss6n. 3054PAI1$I1hAt4E Occupancy Type
01,asownerofinepropenyarmyemployees with wages asmeirsolecampensation, 307 - INSULATION
-will do the:work.and the Structure'is intended'or offered'for sale(Sec.1616: -
(Business-and Professions Coo:The Convector 5 License Law does not apply to an ins ections
ROUP
owner of property who wilds or improves thereon,and who does such work himself 602 - ROOF PLYW OD NKI L
or brought his own employees building
that such improvements sett not intended or _
-ofreRa'mr:ale:v:nawe.ee:tnewuain- v -tiaaole�wnni�b�� -- r. . ___..-- ---603'--ROOF-BATTENS - -'--- - --.. '-'- --._.- - -' -"- -
g or urden of pro year o
it,lnp1e6a6theawecr.buuder will nava me burden nr proving that he me not wase or 604 — ROOF IN—PROGRESS
mprove for purpou v!u1e.).
.:__.ownerv_.__._.__..._..__ .__ _ actor.._ acct._
13 1,as owner of the property. exclusively contracting with licensed comnnors to -"'
s. Pr Pe Y Yvon gwi , i..
oaa=h.pmjmt(Sec.1045,Business and Professions ills or The improves
thereon,
- - License Law Jas not v such
loan nts w of pmpeny who wilds or improves thereon,
.unci who.Son trmb for
such prvjety-with a comracmr(s).lieensed pursuant to.Ne
._ ....._ ..tact ._ .. tact - ___.---._..tato toot toot._ ____._..........._...__......__..___..._ __..... .
Connotexe pt minae Low. .. .. .
- ❑1Smeacmpt undh Sec.' r �,B&PCfor this reason
Ownat '.Date' • ..
WORKER'S COMPENSATION DECLARATION tt
t. .1 hereby affirm under pmalty of perjury me of the following declinations: F�-N A®_�•�
❑ 1 have and will maintain a Ceni(icmc of Canzcm to self-insure for Worker's �oOq
Compensation, as provided for by Section 37W of the Labor Code, for the
_ y performance of the work for which this permit is issued. J11 L
37W by rmeon U
O 1 h - tl will rm Worker s Compensation Insurance, requ r d
"we f thesew Gad f thepIRa monad r I is which thisp m n is VILDING
aauea-My w tk r Co I rvnce c e end Policy number a.: '
rc! .nt t,,czy9rx96Z7 ..
Carr policy No. t�5 { ♦ L 1 '!`� !
't CERTIFlCATION OF EXEMPTION FROM W RKERS s ,
COMPENSATION INSURANCE ;' '
-•roe ..-. +..m._,.coot .tact acct., tato__ _ ._ __ -----------------
I
..M -(This Semon need nm be completed it the permit is for one hundred dollars ( ��"i• . . .
SIW)or less) ,
Olt1' e'fy that in pe p000hnfe f0 kf 'tich tM1 point, ..uN,I I `t { , 1 !h]P. _ �� . . .,r �••
itiall nm employ any Bersonm any manner so as to become subject m the Workers
Compensmionlaw cifesifomia otac" "
Applicant.
NOTICE TOAPPLICANT:'If.after making this Cenificme of Exemption,you should •n,
O di hLaver Cod<you ur
frth i% toW
h comply with sisch previsions or this permit
built he deemed revoked
__. _ __ ._..,_. _ ..._...- .. _ ,. coat.. .. .. .... . .. .... .
= •i r'% CONSTRUCTION LENDING AGENCY " f
`�'',4
'I hereby Spirit,thin shim is a conswmion lending agency for iteper 6aruc
of 0e work for wh%ch his permitI is n'.,it(Sec.3097;Civ.CJ .',' "
CCrder',Name" ".-.,-r r..._..:v.... .. .. .........._t... _ _ _.___ . ._______-_ - ._..__.._. ..._. _ .. . ._...•_.__.. tato ... _ toot
7 Z Isnder's Addrtss:'
I ocnify that 1 have read this application and amte that the above information is
Ta+w 5oirect.I agree to comply with all city and county,ordinance,and state laws mating
�;[� to wilding conswaionlvnd With,Stubmim representatives of this cnym enter upon
�• k7 the aha t nW property( inspectionparpo
(We) 8rce dame fye of mcph I 'i theCity df Cupenmdagaiml
liabilities j dgmy�ltps,c t d pe s wh ch may m an• way, cc seg ins!said �s -
U ti City in s o f t g far h Y
APPL['AN JNDo TANDS AND WILL COM JY THAI NON POINT ISslledb r Date
sGUL n s. / Y:
sgna re arAppfidanveantmmar ;,Date Re-roofs
HAZARDOUS MATERIALSISCLOSURE
Will ine pphear f m wild,rig oecupant Stott or Fa dl h -a �comet Type of Roof., . _- ._.-
a def ed by the C pen M p 1 Cod Cl pt 9 Q and theHese tin d Safety �- - - a -
Code Section 255321e7 ♦ t, is' R sf l . si 7 a ( "yi drx ..k
roofs shall,be
ins ectad prior to anY_roofin .material_bein installed,_
_._._
ventme .
ppl'wm r t b diing oce.priti use equip e t see cc which If a roof is installed without first obtaining an inspection-,'I agree tolmmove
emit ha ardour air conm•in nu as defined by the Bay Arta At,Quality Management
D„me, all new materi s for inspection Applicant understands and ver cont y with
oY _.ade�,rl t ; ' all non-poi ourc gula[lons, -
a I h a dine harard tharid,req rem t oder Chapte 5.95 o f the
C lif to Hmlih A,Safety Code SC&i.a5 25505.L25533 a d 25534 1 do t d thin
fib
Wilding
snot currently have urn t that t' my spun b 'ryt oufY the -
oecdpent of cquirc wh h must be t prior m sus ce f a Cemficam of
dc.pane i.,
” /�(rj'2_ Signat_re of Applicant__ _ . ._ -. .. Dale
ror
nmikkd.gcrit .Date, All roof coverings to be Class;`B"or better
_..
OFFICE ... ... .. . . .. .. .. toot, . .