05070156 i
CITY OF CUPERTINO s 76T,
RUI DINCDIV'IS 1'N PERMIT 1C0NTItACTa6R Nk'6RMATION
BUILDING ADDRESS: FOUR SEASONS ROOFING a PERMITNO.05070156
BERLE
110 177 -C y TA
0 W NER'S NAME: PERMIT ISSUE DATE
MCCRARY DONALD E AND MARQ RET502
E: SANITARY NO. CONTROL NO.
408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
2 I hemby affirm she,I am licensed under provisions of Charter 9(commencing Job Description
ei p th Section 7")of Division 3 ardor Business and Professions Codes,and my license is
n full
rare and erceet,._ .61 p REMOVE EXISTING ROOF/INSTALL 30LB
2 Littnu clan l- Lie.N
;mac Date -1 K-.xr Co.,.., - N FELT/40YR GAF ASPHALT SHINGLE
ARCHfIECPS DECLARATION
1�< 1 understand my plans shall W used Is public records
¢o
Licensed Professional
I
OWNER-BUILDER DECLARATION
a ��•g
1 Masaereby affirm Na,1 1. exempt from,hes Con pious C h e:Any c Law far the /
io 0 following uires a Section]O3L5,Business and vet deimu Codes:Any city or county
$ which os issuance,
a Permit M Uma the plug improve,dcmnlis t fie a signed saumurt D
semi thiormiu lensed pursuant
nt to ft,hovisios or for mchpermiuoflcasiaw summcm
y < thinheicenwJpurstion7 )ofDiviomorNCComruess,ad PoreasonChapter 9ode)or Sq.Ft. Floor AreamouValuatiQ1600
F C thin he s exam t Section and?the
basis f rth al Business and on.Any
Code)or
i $
thin he u exempt pang applicant
oro and Ne bzsii for the alleged applicant
to Any violation of
Section 7831.5 by aundrediantfonpempit objects to opPlicans to acivil Penalty of APN Number Occupancy Type
not mart Nen five hundred dollar(5500). 34242025 . 00
will
L o Ibe wo of the th,tune,or my emplaned orN wages u their(Sec.
cempenuuen.
ss
will Pr Newank endo: he Conisno,intended draw do for salt(Sec.to ad,ownery
and Prtywh obu Codes:The Connector's License law docs not apply lf an owner of Required Inspections
properly who builds orimprovesthat such
thereon,and who annex such work himself oor ffered
his
sewn employees,provided that such imps mid wit are m intended m mrcercd roe sale.IL
moven'.
f.Ne buildingb r improvement is held within ane year of completion,the owner-
tiailder will M1aae Nes burden of proving Na,be did w,Wild or improve for puruu of
El 1,as owner of Ne property,am exclusively contracting with licensed contractors to
consume,the project(Sec.7014.Business and Professions Code:)The Commerori Li.
2mue Law docs nos apply,m an owner of propcny who builds or imprevns damsel,and.
who contracts for such projecta with a eon riscods)licensed pursuant o the Conmacters
License law.
I]l am exempt under Sec. .B&PC for this moon
I
Owner Date
WORKERS COMPENSATIONDECLARATION
T hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to sal binsum for Workers Comped -
smion,az provided for by Section 3701)of Nes labor Code,for the performance of the
work for which this Penni,is iaaed.
ll/
37 s have and will
maintain Worker's Compensation Inunce, Season
370ofthe LaborCod ,fr the Performance of he work for which his fromt is
issued
My Workers ComPensation Ine7l Cartier and Policy number'aJm:
Camcr. A• H ,A Policy No.: ( a� a-iL11`I _
i
CERTIFICATE ICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mos section need not he completed if,he permit is foronc hundred dollars($1M)
or less.)
I leenify that in Nes erhmarn er of the work for which this permil to issued.I.Nell not
Lemploy any person in any manner an as to become Subject to the Workers'Compcnsasion
Wa of California.Dam
,team
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject w the Workers Compensation provisions of the Lahr Code.you moa
.Z foMwlph comply with such provisions or this Terms,shall boo dcemmd mvnkcd.
'Z O CONSTRUCTION LENDING AGENCY
'fir 7, I hereby alarm that
them is a construmimi ending agency on the penrarmmem of
1 7 Ne work for which Nis Permit is oxmed(Sec.3091,Civ.C.)
V4 ;", mil
'a Name
11 Undcr'a Add.a
U 0 I 1 certify that 1 have read this application and state that the above information is
IL (•- cccl,1 agree incomply with all city and County oblinances and soon laws misting to
G t•7 building construction,and hereby authorim representatives of this city m now open the
above-m muoned property for inspection purposes.
(We)agree to rove,indemnify and keep humleu the City of Cupertino against
Fr r%j I"rffiili,ies,judgments,costs and expenses which may in any way seems against said City
V Z in immen uenes of the groming of this permit.
^ APPLICANT NDERST DS a WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC DER
7'2 ATIO C- Re-roofs
Signature of ApplicanUConmzcsor Dam
HAZARD ATERIALS DISCLOSURE Type of ROOF
Will the applicant or future building occupant aorc or handle hazardous material
as defined by Ne Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety
code,0Y;zss3xa)7 All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant r t Wilding If a roof is installed without first obtaining an inspection,I agree to remove
pp ¢occupant tau equipment Qu or devices which
Icmis ict? s air Conumi u as defined by tate Bay Arta Air Quality Managcmcm all new materials for inspection.
Diitriat
Yes
1 haveread the ha odousmamnalsmyuiremenu under Chapter6.95ofthe Calder
nix Hcalth&Safety Code.Simmms 25505,25333.,125534.1 undersundtha,ifdte Wilding - •— 2
docs not solemnly bast a¢nano Nas i,a my eespomihility so nobly Nm occupant ler Ne
mquirimcgo,i,mchmuss 0 met prior uanee ofd Certificate of Occupmcy.
Z Signature of App Ican[ Dale
owns ar aumarivada Dam All 9 f coverings to be Class"B"or better
s Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
H TINO
Ol1
Building. Department
J B ADDRESS: 9 / PERMIT#
10177 �'�ni / / I dr-o -70rsA�
OWNER'S NAME: PHONE #
GENERAL CONTRAC`r0R.ZLe AX #
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors ancom Tete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
®
Owner/Contractor Signature Date
1 Community Development Department
f.°
Building Division
;(z City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
CUP E�1 I I A I V® Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing. '
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will 2W0.4
ly with the ab ve stated policy on re-roofing.
Homeowner's Name: �
Job Site Address: .40 c
Roofing Company Name: o,r
Applicant's Signature: Dated—tea-^�
' Greg Casteel
Building Official
Revised 17/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
UPERTINO PERMIT APPLICATION FORM
APN# Date:
34Z-yL z}
Building Address:
O ner's N e: Phone#:
C act r: Phone .yo3' License#:
JO Z. dY, VWC&
t ct• Phone :yam Cupertino)� iqe License#:
2 7A 77a
Type of Roof Covering:
Existing: Propbsed:
❑ Built-Up Roof O Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles/ ❑ Wood Shingles
El Other(Specify) rr ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cuu ertinno's Tear OfPolicy:
7K%92q;,Ae 61f.1, 0ae / 30 � 1 / 4 �J
bf1
Residential "/Commercial ❑
Fire Zone: Yes ❑ NciConfirmed with Planning Det. if
there are any restrictions: LJ
t of Project: Ty f tion: Occupancy group:
�000
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING