01060127 NO
CITY iiN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22956 LONG DOWN RD FOUR SEASONS ROOFING 01060127
OWNER'S NAME: APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/21/2001
• PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
w O O ARCHITECT/ENGINEERBUILDING PERMIT INFO
t2 m E BLDG ELECT PLUMB MECH
CL i
a r CJ L__I CI
LICENSED CON'TRACTOR'S DECLARATION
v1.Z Ihembyaffro,Net1amlicensedunderpmvisicnsofChapter9(commencing Job Description
°„Lw with Section nwo) fDiviirn3dmBaslnessa�nd/P�refesslonsCost dmyBanse REROOF. TILE TO COMP.
zx f is in run force andeff�tt. 1 7 SQ. FT. S '
z c 6 License Cla,�s CC... � Lia.x
j(O i U Date _ [[y /=ate I Ca ntma or
fm 3 a{n ARCHITECT'Suse recordsDECLARATION
a O g 1 understand my plain shall be used as public cords
�Yon
E:c C Licensed Professional
OWNER-BUILDER DECLARATION
=' 1 hereby affirm that 1 am ucmpt form the Connector's License Law for the
F z a following reason.(Section]831.5.Business and Professions Code:Any city or county
xr o which requires a permit to construct,alter,improve,demolish,or repair any structure
i3`='_' prior to its issuance.also requires n,eapNicamrorsucb pcaut to filea.signed stutemcnl - 8.0 .8 ...
th'tafGis,hernyNEmpnbhi lAmEprosidm,snitlm Coinasto's Li em u,.L,m(Chup,cr9 Sf rPt. Roof Area: uluation
(commancing with Sc:tions1088)of Division 3 of the Business and Professions Codc) I_ 1,� ! t;!'„11'li \.ri i'I,r :.l <'-
nr Ihai rte is edempt thciefrom and the basis for the alleged ekemption.Any viulmion
-of
hot am
anyapplicantfor apemut subjects the applicantmacivil penalty !
:nrnntmotethan fire hundred dollars(Ssoo). um er (:•:,,•, : •. , Occupancy Type
01.as owner of the property,or my employees with wages a their sole compensation,
will do'the work.and the structure is not intended or offered for sale(Sec.7014,, -
Busirces-and'Professions Calc The Contncmr's License law does not apply to an 307 - INSULAT I Wuired Inspections-
owner of property Who builds or improves thereon,and who does such work himself
m
r through
I
rougn
n th own employees.pIrolvldsept such improvements ie net intender or 601 -- ROOF TEAR -OFF
rrseal sal Ira the olaig improvement said o year of _j_
ROOF
have Thebrundmidpacivit,dialM1 dJ or - PLYWOOD NAIL”1
�:
improver purpose r sale.). 603 - ROOF BATTENS
of-aM of p prabusivelye mag ml d tmiumm604 ROOF `IN PROGRESS
constructthe projest(Sm.] ap Businacks and Pridessions Coded Tlic Connector's
License
Law does not apply toaowner of property who builds p es thereon,
liand.who contracts.f such projects with a connotations)happrised.pursurant
_ —
_
-
to theContractor's License Law.
/❑lam esempt under,Scc t B&P C for this reason ul` i+;•.,. :jl1 / - _ __-
_ Owner , r Dine '. O/
WORKER'S COMPENSATION DECLARATION
,-• I hereby affirm under Penalty of perjury,mfxofthe following declarations:
1 ha
❑ ve and will maintain a Certificate of Ca,mm to'self-insure for Worker's
Compensation, as provided for by Section 37W of the Labm Code, for the
- performance of the work for y,hlch this permit is issued.
01 have and will roar main Worker's Compe,isaiu Insurance,as requited by,Section
37W of the G,bor'Ctide,pride,perfurmanee of the wort for which this permit is
issued My Workeh Compensation Insurance carrier and Policy number art:
-aerie ♦. , •'Policy NONFROM470 J7 V-� / .1:�•.
/�.•"CERTIFICATION OF EXEMPTION FROM WORK � I,Y.h • _ ,
s
"' - COMPENSATION INSURANCE _
(Th's scamp need not be comPlcmL f the Permit is f me hundred dollars •`� " - — t-/l•.'
r(SIW)or lcs,l,y ' '
I c my that i the performance of the work for which this Permit is issued,I
ihSll nee employ•any;person us any seem,m an as to become subject to the Workers'
Compensation Laws of Col'dmolo..DaveApplican '
pcnst • t ,
NOTICE TO APPLICANT If, ft k g this Certificate of Exemption.youshould '
tiecortie subjecC
t to the Workers mpenaofthtmn provisions e Lapp,Cale,you must
O fonhwith comply with such impassion,m this Permit shall be seemed revoked.
.. .. . ... .. . ..... . . ... .__ ... _s . - . _ .. _ _ . . . . ... .. ___. _ _ - _
F=� ' - n• . '%"CONSTRUCTION LENDINGAGENCY ° `t
a Ihaehy;affirm that thersis amn.iuuetion lending agency forth-performance
,.., of the work for which this peon it is issued(Sec.3W).Civ.C.1
GI Lender's Name.. -: "" __ ,. ....
-Z Lender's Addrds- .. i „ a ,i•.,.I u.i t.",.
V . Il mnify tM1:n�l have read this application anJ-tine that the above infn,mmihn i<
Ga,-F c tioeet.I agree to comply with all city and county.ohim are<and sure laws relating
0'U to building construction.and hereby authorize representatives of this city to enter upon
�.'(rt the aMrve-mentioned property far inspection purposes. „_,
F L (Wii).greelosave.indemnifyand kcepharai the City of Cupensno_against
-V1 Mobilo ex.judgmen costs and expenses which may In any way accrue f'romst said lib»
U,Z City m eomeyfm life ranting of this
A
PPL1 NT I' ,RS DS ANDW'IL7
LCOMFLYWITH ALL'NON y'
-POIYf Issued b Dale
- SOLI 'T RE .-ATIWS: "�: �. /»O
SI „mrq A,puppotCm,trmaorr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will theaPpliani lir future buidag mcupant store or handle hm-vdous material Type of Roof -- - •---- -• --- - - -- - -
--
asrefined by the Cupertino Municipal Code.Chapter 9.13.and,he Health and Safety
Code, Sectio 255321,Rttl l:,. No's„t,a .fit/�_r,, 3.,;.-. ... ,:. gyp•.'iis i
_-All roofs shall be inspected.prior to_any-roofing.material being.installed.,
• Wpm appu r t�ahingoccupant nseeq , e to de a=,which If a roof is installed without first obtaining an Inspecnom Fitgreeao remove -
crosth N itsono ts as defined by the Bay Area Air Quality AP,agement
District? .. all new materials for inspection.,_Applicant understands-and will comply with
DY No all non-poi .Dore- egulations.
1 h read thehazardous ,te l requirements ora Chapter fi 95 of the t
California Health&Safety Code Sections 35505 25533 and 25531 1 understand that Z /L epy
tfthbu Id,nBhesnt -tlyh t t,that msponetb1ty to notify the l� `J
occupant of rcgynem pts vhich must be ma prior m ssuance of a Certficin-of
Signature_of Applicant _ _ , Date
Owner praampr;rxa.,,at Dam All roof coverings to be Class"B”or better
.OFFICE.