01080037 " CITYILDING urvEsiONNOPERMIT CONTRACTOR.INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21230 HOMESTEAD RD BLD 4 ALL SEASONS ROOFING SERV CES01080037
OWNER'S NAME: APPLICATION SUB DATE
VILLAGE GREEN ASSOCIATES 2640 PACER LN 08/07/2001
PHONE. SANITARY NO. CONTROL NO.
4089724455
al O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT, PLUMB MECH
i C_] L-A L—] 1=1
ph z LICENSED CONTRACTOR'S DECLARATION Job DCSCiIphOn
,=o 1 hereby allium that I am licensed under provisions of Chapter 9(commencing
F 4It:m with Section 7000)of Division 3 afthe Business and Professions Code.and my license REROOF.
y -1 is in full force and etre
¢w< Lmenseclass 34 Li<.. 70!Vl T/0, INSTALL OSB & COMP.
K n U Date Contractor
ed 3 u. ARCHITECT DECLARATION
r=so g I understand my plans shall be used as public records
z�¢Z
In
L¢enud Pmfesstonal
n m OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
E' a falls,mg,beaker.(Section 7031.5,Business and Professions Code:Any city or county'
H❑ which requires a permit to consumer,alma improve,demolish,or repair any structure
ad 3= prior at t. al .q the 111' oat f hpemu' fl signed staemearc. _ _-
nthe is licensed put(0 the provisions of the c tactor. License Laos(Chapter e SqFtFloor Area ua[ion
(c mm me ng wltn Section 70M)of Division 3 f theBusiness ad P f ssiam Cod . .e) - . '•-y
or that he is a kempt therefrom and the basis for the alleged ekemptlon.Any violation
of Sermon 7031:5 by any applicant for a permit subjects the a,llcant to a civil pe erin, 32 6ROP '
of not more than five handred do][.(SSW). oth er Occupancy Type
❑6 as downer athe property,m my employees with wages fe their sole<ompens7W,
will'do the work,'antl the xtmetura is oat immnJd or offered for sole(Sec.]814, '
Business and Pmfessi an Cafe:The Contractor's License Law does not apply to an 307 - INSULATI]tP9uired Inspections '
owner of property Who builds or improves thereon.and who does such work himself
orthrough his mploY provided tnt: ch' p, vementsamnotntededor ._ 60.1..'._.ROOF TEAR OFF _.,.,
offered for al If however.thebuilding improvement s sold within ane year of '-' - ._ _ _ -- - -
completion,the ownerhuilder will have the burden of pecking that head not build or 602 - ROOF PLYWOOD NAIL -
improve for purpose or sale.).
603 - ROOF BATTENS
QIasowner
pmjmt pry, exclusively ancontractingi with dmontmnorsm 604 — ROOF IN—PROGRESS
License the project(See.7144,Busowner
d arty who
Cade.)The ves thereon.
License Law does not a I man owner of r improves
apply property who hu Ids or "
..and who rantmens far such Prolects wnh.a contracmr<)licensed pursuant m the p t�=�_ ..... ... . ... . ... ...! ._. ... .. .. ...-. . ,. ,..
Cotta. m s License Law tom- a V//�'�llrm L'v -
❑I am exempt under Sec. - ,B&P C for this reason
Owner .. Date .. DEC 1 1 2001
WORKER'S COMPENSATION DECLARATION
^' . I hereby affirm under penalty of perjury one of the.following declarations:
❑ I have and'writ maintain'a Cenificam of Comvnm t self-iresure for Worker's BUILDING
Compensation, as provided for by Section 3700 of the Labor Cade, for the
performance of the work for which this permit is issued..
111 have and will maintain Worker's Compensation Inkumnce,as required by Section
37W ofthe Labor Card.for the performance o1 theworl f which this pe mit is
is.a d.My W rkers Compensation Insurance carter and Policy number are
C r. I �S[.,� ".Pol'cy No C��f�f7 I� I�� _ t
t' iCE fR FI`AK#'oPEXEMPTION FROMWORKERSi"
t
.,.a... .. COMPENSATIONINSURANCE.J", . ....__..-. ,.. ..... . _. .._.._. _....,._ ._ _....,.._.. _. _.- .,,.. _ ....._._...- .
This se`crnn need not tic completed if the Permit is for one hundred dollars
Ig I W)or less.) '
1 cert fy that in performance f the k f rh tFs p l issued,I -1
shall not employ any Person
n n my manner so as m becarmme sublect to he
Workers
Compcnsntion Laws of Calil'omia.Data
NOTICE TO APPLICANT'If,after making thinCertificate - - - - - - -- -- - -
Applicant
sf the xempti m you should
become subject m the Workers Compensationrrtis permit insll the cement Cole,you must
Q O forthwith comply'wilh such provisions or this permit shell be deemed revoked.
CONSTRUCTION LENDING
lending
or Performance -
`�` Ih by %inn that thereg gene f the
-,...,r efdrwalk Car which his pe.it"isiued(Sao 3W].Civ.C.)
.Q Lender s Name' . - ... .- r.... .5 . . - ._.... ... ..... . ......_..... . . ... ..._._-.
dress
LenderFAd a'I
-� I cattily that I have c,iddhikapplikauumaid rt nua tho above af nar is . . .
F.. correct.1 agmeat,comply with all city and county ordinances and statelaws relating
V To building construction,and hereby humarim representrovev of this city to enter upon
W the above-mentioned property for inspection purposes.
-Pr (We)agreemsave,indemnify and keep fumbles,the City of Cupertino against
W liabilities,judgmenmk,ca=ts and ekpenses which may in any way acome apalnn said
City in consequence of theJMRIALS
pe it. -
r'� APPLICANT REGULATIONS,
OhIPLY 0.TTH ALL NDN-POINT' Issued b DaYf� -. —�
SOURCE REGULATIONy:defined by th Cuper Chapte 9 T', ddl Health end ateri Re-roofs
Signature of Applicant/C ,Date
HAZAIALS DISCLOSUREwuy ppuperta - panteta 2.handle iHealthna Safe,, ..Type of Roof. - .... .e.,...
ry
Code,Sector 25532O - Y
All roofs shall be inspected prior to any roofing material being installed..
•
Will d--' iitev t rfutuabepr g pa ay A.Pu,Q t d teawm<h If a roof is installed'without first obtainingan inspection;-I'agree to remove
emth artsapli. t� sdcfndbythertuAreaA el Itymmnawhichibroki P a
D i` 'oY Na' all new materials for inspection.. Applicant understands and will comply with
f -. .. -
all non-point source regulations.
I have read th ha. d us materials racrame ems under Chapter 6.95 of the
California Health&Safety Code.Sections 25505:25533 and 25534.1 understand Nat' _
if,the building does not curmany have a meant,that it is my responsibility to notify the -
occupam of the requireek w '<h ust be met,prior m issuance of a Certificam of
-• Occupancy.
Signature_of Applicant. Date
4 'owact ar anlbarixed igen Date All roof coverings to be Class "B" or better'
' 4. . OFFICE. _. .. ... .. . .. - - .._ -