01080039 [:2=1230
ITY OF CUPERTINO
Pf BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
SS: PERMIT NO.
ssr OMESTEAD RD PT # D ALL SEASONS ROOFING SERV CES01080039
NER'S NAME: APPLICATION SUB DATE
VERY CONSTRUCTION 2640 PACER LN 08/07/2001
PHONE'. SANITARY NO. CONTROL NO.
4089724455
M O O ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
F.
I=-]
N66
LICENSED CONTRACTOR'S DECLARATION
0 Z y 1 neren mrtn mat 1 am bmnsed anger Job Description
O Z-❑ y o provisions of Chapter 9(commencing
p,-n t_ad with Section 70001ofDivi"on3of the Business and PmassionsCde,rad my license TEAR—OFF TORCH DOWN
s c-' sin full force and effec.(f p r
¢ License Class �' / Lip.p �-s9 o9(
3 LL N
Data Command,u.O ARCHITECT'S DECLARATION
f-- < I understand my plans shall be used as public records
z�6f
m 5p O Licensed Professional
°' OWNER-BUILDER DECLARATION
i5 Fes-' 1 hereby affirn that 1 1. exempt from the Cessions o License Law for the
F i a following reason(Section]031.5.Business and Professions Cade:Any city or county'
$3000
Sa H❑ wh'mn require n permit requires
e uiresme almc improve,demolish,ore aur any stmcmre Cyy�fpg-t.{IIII{y���+pp
p t t ' al 9 .m applicantof the
Contractors
Permit sgnw hapen-m 320V Du6b that he dpanthe pwsi ftheConbate License Law OD�e& Valuation
., at he is astab Sepia.ALn and tDiv i n 3.f e le edesv rid Professions Code) �S A t'
of mut he is 31.5 b therefrom"and the basis for the alleged exempnt to Any violation
of Section e'he.5il any applicantfor apermit subjects the applicant to acivil penalty
nrnot are men me hundred aoliars tssoar, 305 APN . „ Occupancy Type
°1,as owner of the property.or my employees with wages as theirsole compensation,
will me' PmEsnd-the suracode:T e is not intended a offered for sale(see.704 4. 307 !NSULATIGN
6 01 — ROOF TEAkgF}PTJ Inspections
Business and Professions Cade:The Commnoro License Law does not apply to an "
owner of through his o y Who builds or improves thereon.and who encs ren wank himself
oedfor ms own employees.provided that such improvements ancon intended or _ 60.2-..-....ROOF...PLYWOOD. .NAIL
offercdfon sale.1[boweveq the building or improvement is sold within one year of
completion,the owner-builder will have the burden of proving that he did not build or 603 - ROOF BATTENS
ra
improve rpaepaee of sale.). 604 — ROOF IN—PROGRESS _
_ —
°1;as owner of the property,am velaContracting with licensed contractors to
ransomer the proect(Sec,7044,Business and Poor essimp,GodsO The Contractor.,License
, d• {
Law does not apply man owner ty who builds improves thereon,
and who contracts for.such protects nthth a c ntianm(s).1 censm ed.pursuan to the .... .. ._ ._ _. ._. ._ ._... .._.... . ..-. .._...__ .._._.
O l earl tar s pt anse low.
❑Ivm uempt under Sec � B&PCfor this reavon
Owner Date DEC 1' 1 2001
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of he jury one of the following declarations: p�
° 1 hove.,to will maintain a Certificate of Consent to self-insure for Worker's �Wr/��®nay
Compensation, as provided for by Section 37W of the Labor Code, for the BUILDING
VG
'performance of the work for which this permi is ssucd. ,
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
370(1 f,he L bon C d for the poifo aide,
work for which this proad is
Cs d-My lW 4L x ComPf s'' !nmmrtm
Policy numimi-me
, CER IFICATION OF EXEMPTION FROM WORKER ', -
-, COMPENSATION,INSURANCE;._. .. .... .. . ........_.
(This sedtinn nein not be completed if the permit is for one hundred dollars t -
(41W)orlesa) ,
.. .... - -
1 rt fy thany the pain of the work for co h th s P t e Workers'1 - - --
Com not employ any person m any man«Peso as to been tie subject m the Workers `t I" • 's'YI 1
C pe'-t un Laws of California,Date
_N
Applicant - -
NOTICETOAPotheWoT.ITtintermak ti np Cisions fExemption,you sh most
femorasubject to the smehp's Compensation provisions the Brand Come,you must
Z ld
O f vh nh comply w th x h p resigns r this permit shall he deemed revoked.
F+� CONSTRUCTION LENDING AGENCY
. lYi.,7 1 hereby affirm that there Is a tan.[ n n lending agency for the perfonmmv:e
,..,
of the k for whi h th.permit is issued(Sec.9091 Ctv.C.)
Leader.Ado a,
I Band,that ILisp•readth'u,Tbeatimt and etam Wmtheulm'c infb al alis
correct.1 agree to comply.with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter aeon
the al a menf mild Peeper,or inspec n purposes,
(W) gees indemnify and keep h - ss the City f Cipenim against
Vi liabilities,judgments, .t and expecte h y in any 3 accrue against said
C
CityE R consequence ofthe gm t n di tan `
r, SIONS
OURCANT U DER
i' COMPLY WITHALLNON-POINT Issued by: Date '
Srgnemr"atAapli'a UC t t r 'D to Re-roofs
"'. f it,0,DOU 1 TERIALS DISCLOSURE
.: W II th"up
a t r fold u d g p.man,re o ha dl n N material
Type of Roof, .. .... ...
as d f n d by nM1 C penm M c' or Code.Chapter 9.12 d theHealth and Safety
Code,Scott..us3x 1 . All roofs-shall-be.°Yes" " ;. Nay �..., .... ..
.. ., _ "'' f." all be.inspected.prior to any roofing,material.being.installed..
" W Will theN .applicant future building pant use equipment or devices whim If a roof is installed without first obtaining an inspection;I agree:to remove
th rcontaminants as defined by the Bay Area Air crafty Management
District all new materials for inspection. Applicant understands and will comply with
°ve °No all non-point source regulations'.,
I have read the huiardous materials requirements tinder Chapter 6.95 of the
6alificama Health&Safety Code,Sections 25505 25533 and 25534,1 understand that
:.tf[lab in'
does note eyyLy,hvmaten tenant, Ctism responsibility to notify the
.v P q le n S. Ic the -tis" r.I. ce of Cemficam of
Overton,
there
Signature of Applicant_ Date
owner or authorized agent,•-' Dna All roof coverings to be Class"B"or better
.� .: .. .. __ OFFICE _. _