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HomeMy WebLinkAbout01060048 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: o) ..BUILDING ADDRESS: PERMIT NO. 22938 CRICKET HILL RD FOUR SEASONS ROOFING 01060048 OWNER'S NAME: APPLICATION SUB DATE IjA APPLEBY VERNON S TRUSTEE 645 HORNING ST 06/08/2001 PHONE: SANITARY NO. CONTROL NO. (408) 278-0330i \_ z z ARCHITECT/ENGINEER: BUILDING PERMIT INFO do O O BLDG ELECT PLUMB MECH �a� CJ I=1 r- I CI z 5y= LICENSED CONTRACTOR'S DECLARATION Job Description O Z— 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing pmFl9i with, ]000)of Dlvieiun3 of the Business and fesiC de.and is in full force and E�ITeci.2 y rn Slips © plyycen. s re0 M Licenseuc.p 7C (J/C REROOF. Oats (o1--- ContractorFf _ ARCHITECT'S DECLARATI T/OFF CEMWOOD t o g I mumbstand my plans shall be used us Public records Licensed Professional INSTALL 40 YR GAF COMP aaO OWNER-BUILDER DECLARATIONa.r I hereby allirm Nal I on exempt from the Commeor's License Low for the s- < following reason.(Section 7031.5,Business and Professions Coal Any city or county Ix O which requires a permit to construe alter,impose demolish. repair any structure ce ca plialla Ill nUilied-l"'Illarl1 Iyer dial _l dpars lion pmvlao oltl c lacm L L 'Icl'per9 ; . ,Sq. - FloorArea•�. I . .V . Valuation (cmmncng with Section 1100 tion 7 )o(Div 0 3 fBusiness and Pratessions Code) ;". h1 or that he is exempt theretrem'end the basis petite alleged exemption.Any violation or Section]031.5 by any applicant for a permit subjects the applicant to a civil pmrsay C V IJRT y�P of not me Nan Five hundred do[)..($500), APN Number " - nC e °I,as owner or the prolixity,or my employees with wages as their sole compensation, _. Busmen the woro�ane the structure isnot Contractor smended or License eredLaw does sale(Sec.7(WJ, 34235007 . 00 Required Inspections `Business and Professions Code:The Contractor's License law Jncx not apply hi m an ow na of pmpvw who builds or improves thereon,andmpr who does such wink intended or othrough h' employees.provided' tht such improvements are is mdyear or .. . ......... .........._... _. ... .... _... .. ..._ .__._ co affectedf I ,If1io N b ase p of prove aalJ wah'n not rid of 'improve for he purpose o balder will nave Ne burden of pins ng Nat he tad not bulla or 305 — FRAME - . improve f puryase of sale.), _ 30.7 .-._INSULATION_ coo a owner pr the p(See 7 am es Basin ly t t g with licensed contractors m License the ors no(Sec ]to a Business and property who cnae I The conthemons 601 - ROOF TEAR OFF I '- - License law does not apply w an owner with progeny who halide ord.p eas thereon, - .. a ...ana.wnn rnntmus.(or.wrn proirea with a commnnrlo.firenaea.pursuant.m me. ._ . ... ._...6.02...-....ROOF. PLYWOOD- NAIL,_.. _. _..._.__ Contmcmrs License Law. ' ❑I am exempt under Seca ;B&PC for this reason 603 - ROOF BATTENS•'<�."rirl;l Owner Dale ^ 604 - ROOF IN-PROGRESS WORKER'S COMPENSATION DECLARATION JJ Thereby under Penalty ofpejone a(the following declarations: will ❑ I have and will mdL numb a Cenifi.m.f Consent to self-insure for Worker's Compensation. at provided for by Section 3]00 of the-labor Code, for the t/O_ performance of the work far h h this permit is issued. 01have andw11rC fm Worker's ......ftInsurance,as regmredby,Sexton .-._ 3]00 of lh labor Cade f she perfo a of the work for which the Peron n is d.My Workers Clo pc !i md.c {ter�andbPolicy number am: Ce, RM1-Cllr\GF1vW �-W Pol y No fJ/�G 5(7k_MW .,. - + �..._ _�..... .... .. .......—. _.. _ ._.. . CERTIFICATION OF EXEMPTION FROM WORKERS' -• - - •• e `I' a o i 1 " COMPENSATION INSURANCE- --. . s ' _ ` (This section heed nm be completed if the permit is for one hundred dollars ($101n oleslf I c Rfy that in the peronuarce of the work for which this permit is issued,I I shall en employ any person m any man.,so as m become mblert m the Workers " Compensation Lawx of Califomiu.Dain Appl... n NOTICEi - ':If,_ufter _,.,,isthis.. ifiome ofE: .._._o.y..ashould be maibjecto cWorhrs'Connf pwimonsuLabor LW .ainainO Forthwith ply withsixth p ns o this permit shall hed ted revaded, ... .._ .._ .._—. ._._... ... ____ .. . ._. __...t_._. . . ,. .. _.. .. . Fye '.I 'CONSTRUCTION LENDING AGENCY �..7 I herttiy afTrm Ihm them is a'con.atuclion lensing agency for Ne pedmmance ' W I, of ter work for which this permit is issued Sec.3097,civ.C.) yLend, rQ - r's Name. .. . ..... .....____. .,, ...._ ..._ ...: .____._ .. _...__...._..._.. .... ._.._. _. . ... ___.. .__._.. z Lend Address 1 merfitho,1h dthis eppl at ❑ ratethat thedst f laws relating C):rj correct.l g t Imply_ he all city and e county N J.t t Iwo enter afar O'4) rombuildingconstruction, dh inspection nspec Izrepresentativesof this city to emur upon �;-M. theabo Paned, pc tY f aspect keep p ryo M. (Wees.j agree ms costindemnifyandkeephama in the Cityof rove ag iagemn N city liabilities.judgments. u. and expense h h may any ay a againa mid CSY 4enc 'Ithe runt ming this print - APPIIC\NTU' .RS DSANDWILLCOMPLYWITkpCLVN.PIvry Issued by: Date C SOURC EG ATIt t �f Sigaature ofploade/Contmeor + Data He-roofs HAZARDOUS MATERIALS DISCLOSURE IaIt the applicant or future building excou,ped,stare or handle thatabodidurs,mineral Type of Roof as de Fined by the Cupeolno Muriel pal Code,Chapter 9.12 d theHealth and Safety Code.Section 2ss3nm All roofs.shaf °Ye "° s II be Inspected prior-to-any roofing material-being installed. _ _ All Ili ppl a a t t reb 'Id g occupant .e'equipment devices which If a root'is installed without first obtainingan ins ection;'I agree'40'rernav-e enthmd Tomo ta.dfndbytheBayAeaAQItyMugemnt P b printer? _ all new materials or ins ectton Applicant understands and.will comply with Nn - - - allnon-points rte r 1lnons - - - - -- I h d the h N oional <quvem3 t a'u d Chapter 6.95 f Ne `�� California Halth&S fey Code Set 25505 255J3 and SSW lundertta Jth t theb Id gd«sit c dy huveaten tNtit t.mY Po sbltY to daufy the - - '- a2 p t fah re' hch moth tp" 'm i. faCenifcate of Orr � _ '. Signature ofApplicant __- „Date Owrc,.m tun Tined ab t Date All roof coverings to be Class `B•• or better ., - OFFICE