01080034 2t CITY OF CUPERTINO
14 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
21230 HOMESTEAD RD BLD 6 ALL SEASONS ROOFING SERVICES01080034
OWNER'S NAME: APPLICATION SUB DATE
VILLAGE GREEN ASSOCIATES 2640 PACER LN 08/07/2001
I PHONE: SANITARY NO. CONTROL NO.
4089724455
cceeze ARCHITEQ/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
y<ad
Z8 y z LICENSED CONTRAC"fOR'S DECLARATION lob Description
O z-o I hereby affirm that I am licensed under provisions of Chapter (commencing
F^ ,, 'w ith Seaion]WO)ofD 3 of the Business and Professions Cade,and my license REROOF. -
aw Y j is in full force and eft t.
_yw¢ License Class �-39 uc.N 4S9a9/ T/0, INSTALL OSB & COMP .
u O O H Dale Contractor
ARCHITECT'S DECLARATION
C- I undemmnd my plans shall be use
�� d as public record
wd p KLicensed Professional
„ u. OWNER-BUILDER DECLARATION
to 1 hereby.(Set that 1 am exempt from the Commcmr's License Law prime
F'Z a following roma(Section 7031.5.Businessandmpr ve dearral Code:Any city worchu e
�'o which requires a permit re c°res the alley,improve,demolish,m repmr any swclure
i3� prior to its isuance,alw requires the npPlicamfOrcucM1 permit wFile asigned slalemem - -
that heislicensed pursuant tothe previsions ofthe C°mlacmrsLicense Law(Chapter 9 Sq.Ft. Floor Area - a ation
(commencing with Section 7000)of Diemen 3 nRhe Business and Professions Code) _
an that he is neempt therefrom and 0e basis for the alleged exemption.Any violation '
of Section 7031.5 by any applicant for a permit eubjeom the applicant to a civil penalty
of net more mem Five hundred dollars($500). b Occupancy Type
01,as owner of the propeny,or at,employees with wages as their sole compensation,
will do the work,and the swclore isnot intended or offered for sale(Sec.7014," 395 _
'Business and Pmfessions Cale:The Com onors License Law does not apply man 307 - INSULATfopired Inspections t
...in of propeny Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such impmvemeam are not Intended or, . .. .. 601 . r.._ROOF...TEAR._OFF _ . . .
offered for mle.If,however,the building or improvement is sold within one year of
completion,the owncolouilder will have the burden of proving that he did not build oe 602 — ROOF PLYWOOD NAIL '
"
mprove for purpose of sale). 603 — ROOF BATTENS
°I a,owner fthe property, .cadionvol,comment,withy dcontractorsor
construct the prosect(Sec.]daa,owner
Business and property
who ns Code:)The improves
thereon.
604 — ROOF IN—PROGRESS
License Law does not apply to nt owner of propeny who halide or seimproves thereon,
L .: ...and,whoCmdoralms Liccomense
tor Lsuch.projecm wiN.a rontraotorts)licen.ved.pursmnfm Ne ...-. ._... -_- ... . _.-_. . ._-. .__.. ._.. ..__. . .., ........ .._- .. ..._. _.._ ..._..._... ..
C s IULeendeS -
❑I me pl under s' ,B&PCfor this reason LED
Owner Dale
WORKER'S COMPENSATION DECLARATION DEC1 q
I hereby affirm under penally of pecir,,une of the following declarations: C 11 2001
01 have and will maintain a CeniBate or Convent to self-insure for Worker's y
Compensation, es provided for by Section 3700 of the Labor Code, for the Ili��16.®I�yBUILDING- performance of the work for which this Permit is issued.
D I have and will maintain Worker's Compensation Insurance,ss req°Imd by Section
3700 of the Labor Code,for 1be performance of the work for which this permit is
is ed.Ma�y//Wo/t/k�r'.s Compensation Insucarrace,carrier and
'Policy number
Camer'r/1(IrhA/L�I/� "P01 cy No.IPC J✓V O9 Y� / �/_u. .. . .,..._ _. _._... . .,,. .. _, .. . .. - ...�..,-...
'CERTIFICAC ON OFEXEMPTIONINS FROM WORKERS"l
COMPENSATION INSURANCE." ... _ ...._ ....._. ._. ...,.,.
(This'uuto acidnot the compared if the permit is for one hundred dollars
SI 00)or less.)
I certify N any
Person
pert f r k f rmwhich his ct the
issued 1
shall not anionemployL ws pe n m any manner w us w;Mcome subject to the Workers '
Compensation Laws of California.Date
.Applicant
NOT . _ ..
NOTICE TOct or
Worker,aflermaking ds Certificate of
Latitptiode,you
femmeh rump m the Worker's Compensation provisions of the Laned Cade,you must'
Z 0
forthwith to cooly with such pmv s ons or this permit shall be deemed revoked.
E-4 r' CONSTRUCTION LENDING AGENCY - '
�;> 1 hereby affirm that thele is a constm oro i lending agency for the performance
t.n �a ,he k f hich iM1 perm t is issued(S Sun Civ.C)
Q "Leede sNme .._ .. „_ .. :. n. ..._ ._. -
Z Lenders Addieac _„
V Q Icent fy diet 11111 o coed chis uppl ins loll a°dxima thus the oboec;nlouuml°u Lc
correct.I agree no csnnply.wilh nil city and county ordnance,and suite laws relating
to building conslmetion,and hereby authorize represcreenees of his city to enter upon
theb mentioned
>o y (W)agree1 s c, tlf niunify Pndkep h� harmless the City of Constrain against
fn
liabilities:judgments.cost d expenses w thich troy in any ygainst.said
V .zr Cry' consequence )the grating oft _
'APPLICANT UNDERSTAND D ILL COMPLY WITH ALL NON POINT U
SOURCE REGULATIONS: .. Issued by: yy - - - - Date
Signature of A"d
gn tur: fA"d na VC t t - Date Re-roofs
_ FIAZARDOL IATERIALS DISCLOSURE /
Will Ihapplicant 1 t ildi g pa t t rc Or haMl hazardous nsasenal,
-Type-of Roof
as defined fy he 3 p rt M n 'pal Cal Ch pt 9.12 d theHealth and Safety
it
All.roofs s i
Cd S tion ZSA2( 1 - ..- i- r -
°Ye �� °"°` �: '- hall be inspected prior.[o any roofing material being,installed.. .....___
Will'he aFplcaut or future building occupant rise equipment or devices whichIf a roof is installed'without first obtaining an inspection;I''agree to remove
emth Mous air conlammmts as defined by the Bay Are Air Quality Management
O t t°Yrs Cl No _ . ,all new materials forinspec[ion. Applicant understands and will comply with ,
all non-point source,regulations'.,_ . .1 ,.,.,,, , :,•„
California Health A,SentryCode..Section' 5505 255 3 a 25534.1Chapter695 of the
p y s and25534.Iunderstand
at
d p it bf Ne requ a ent,which m i toms to "move of it}m n°utile'he
of - - -
'�Nubnldin does tc nen0 h t w t ih t tit tot -
a e ea t h tads t 1 q eme
>� pr a cemrcalghnr Signature of Applicant . . Date
C; bwneror amhorzed sept :•. -, ogle . r All roof coverings to be Class"B" or better
i.... _.. OFFICE