01060050 CITY OF CUPERTINO
BUILDING DIVUSION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22960 CRICKET HILL RD FOUR SEASONS ROOFING 01060050
OWNER'S NAME: APPLICATION SUB DATE
diDE ANZA OAKS H.O.A. 645 HORNING ST 06/08/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
MWZO ARCHITECFIENGINEER: BUILDING PERMIT INFO
W( BLDG ELECT PLUMB MECH
Z = LICENSED CONTRACTOR'S DECLARATION Job Description
o Z-C 1 hereby affirm that I am licensed under provision,of Chapter 9(commencing
p_Fu� with Senion 00001 ofD otydpf the Business and P fess Code.anyaw license
,,ME is in full fo¢e ap�Rae 7 KY
zwa License Ln�� REROOF.
3 H Date h-�'��T— Contractor
ARCHITECr'S DECLARATIOO TOFF CEMWOOD
° understand my plant soda b u a as Pablo records INSTALL 40 YR GAF COMP
M Licensed Professional
OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
h Z a following reason.(Senion 7031.5.Business and Pmfes,ions Code:Any city or county
M which requires a permit to comtmcl,aper,improve,demolish,or repair any ameture
e_3 f° prior to its" q .Ih ppl' If Permit fl .'g al mienrm. - - --
vfD, : ❑I t phe us .L L Chiller y-„- Sc:lt-,Iloa'Alea Valuation
f eis ammin therefrom
x10ad he sonunds,alege and ProrAny mCWe) s'1 �'.
or that M1e 7 exempt therefrom and me bass for the subjects
the esempdo o Any violators
of Senione than iv anyapplicantollforapermit subjecn the applicannoocivil penalty
nrnenmmc man rive Hundred dollars Igsoal, APN Number .. $g"Uncy Type
°1,as owner of IM1e property,or my employees with wages as their sole compenwtion,
will me the,work,and Cods:
is roti,.,',Li e a Law
foes alenot(Secapply
to an 3 4 2 3 5 0 0 2 . 0 0 Required Inspections
- Rosiness a work,an o h Calc The is Conn.,.,',intens License Law Jons not apply man
owner of property Who builds or improve,thereon,and who ares such work himself
or through his own employes.ptsvided that such improvements arc not imendcd or
tofkred for sale If,howewer.the Wilding or tmpmvemem is sold within one year orcompletion.the n builder 'll have the burden of proving that he did not build or 305 - FRAME
improve for purpose of sale.).
................ 3.07....-...INSULATION---
0 Las owner of Ne pmpcnY,am exclusively contracting with licensed contractors to
I 601 - ROOF TEAR OFF 1
construct thearadical S« 76U,Busies and Professions s Code)The Contractor thereon,
hen r s t -
L' L does not apply m an owns, f p pent h builds m improves to
as n nmrans.mr.wmproleets. m..a amtt,asl.lanxed.pursaatt.w.lne. ...,_._ . _.. 602 ..-.....ROOF._.PLYWOOD_.NAIL.... .........- _. ..
01m`esemPtt`m s«. T="e&PC far m.,rtamn 603 - ROOF BATTENS''•'*::'`'::i'
- - - ow'ner DGl 604 - ROOF IN-PROGRESS
_ WORKER'S COMPENSATION DECLARATION
I hereby arOran under penalty of perjury one of the.followioff d«lrandons:
❑ 1 have and will roman in''a Cenifmoie'of Coastal to set Ginwre for Worker's
Compensation:as provided for by Senion 3700-of the labor Code.'for the
performance of the work,for which tAia petrol.is issued.
PI NA L E D
_ ❑I have and will main Win Worker's Co.....t nom Inmrunce,a,raryired by Section
3700 of the Labor Code:far therformance of the work for which this permit is
issued.MyWrker;sCompe tnIns ntteume,adPliy number am
comer AfaDrt<.dvC14— :P Lucy N .:e✓G 2L/7�.ST' � , . , t' :' 3' 1 r 'f) •.
CERTIFICATION OF E'
FROM WORKERS` f•-' ,"l' ts• b i r-t 1 �.
COMPENSATION INSURANCE
phis se,ctom need not tie completed ir the permit is Room,hundred dollar '• ' ' '
IE 1001 or�sx.1
cavity that them in
of thek f which tbls permit is issued I t t
shall not employ any person m any manner so m to become wbjen m the Work« '
Compensation Laws of California.Dae
. Appl t
O
_ __
NOTCETOAPPLIf, his should
become 63«no the
Wank f Compensation provisionsof the Labor .you mostz7onn m comply with such provisions Perrosmall be a« a revoked.
. ...... ... _ ...
r '" 'CONSTRUCTION LENDING ading du th .
W ' 1 hereby dfftrm that Here isitconed(Sec leading agency,for the perfommnce I
•s,. bath work for which this pc t Civ.C) ____ ______ __ _n 1—_.
� Q Laurie, Name .__ ._.... +.,...._ .... _.. ..__ _. __..___..
issued 309],
Le
v.Z d Adds:'
O
;c Icertify chat l h ' d to applicationd state that IM1 abs information is
t I agree'I courady.with all city anacounty ordinande,s andstate relating
mbuilding constructn,and heeny
auffionwe mprertintivs of the city to enter upon
yty the o rove-mernmed property for inspection puryoses. __.. . _...
s
(..tjL (We)agree to seve; nnk
indemnify and keep has.the City of Cuperomagain
.y liabilities.judgment,costs and expenses which y in any way seems,again said
Cly in emall,mone ofdie gto of this
APPLIGA NT UNDERSTANDS'AND W ILL COMPLY N'IT}ALL'NON�.INT /'
r 5 RCE'RE LATIONS. s a l .,i /•�G—CJ/ ISSIIOd by: Date C1'��0/
Wit eApplicant/Comonnor (s D' ..Dam' Re-roofs
I”'o HAZARDOUS MATFIRI ALS DISCLOSURE a
Will the appl t or future building x p r'no,or handle naaamb us material Type of Roof ..-_ .._ . .._ _._..._.. ..
m defined by the Carcinoma Mun c'pel Code.Chapter 9.12,and the Health and Safety
Cade S t 2553 1 1 P-�V f d` ,,s,•• ' t j ;,, j "1 .
° k " ', All.roofs shall be.inspected.prior to any.roofing material-being installed
k
Will theppl' nt him b ild' g cupan meeq p t c,dcvi,c,which If a roof is installed"without first obtaining an inspection;I-agree'to remove
enothird Ana Quality
C� PP will comply with
cont mtwm d b the Ba y - - - -
Dtstr n
p
a new_matena s or ms ectlon. Applicant understands and
°r�`� " � � all non-point s - e � ulahons. '
1 have read the h sada not mqo rents,t,order Chapter 695 of Be,
Citlificionin Health&Safety Saini.al
25505.23533 ad 25534,1 understand mat
ifthe
building dnot
ur anhaveot that if is-my responsibilityTo-notifytoe
ovempaut Rhe regmrcnenrs which must.he met prior o issuance oracertificate
of
Occupancy. _�� ..Sign_aiure of Applicant _._ . _. Date.
i,
8 rcremlimmeeagent. Data All roof coverings to be Class B" or better
-OFFICE. _-- -