05070154 CITY OF CUPERTINO ' ¢ *� 7:d 4 " ` + •^`
BUILDING DIVISION PERMIT CONTRACT�O' R,INFORMATION is
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO 05070154
OWNER'S NAME: - PERMITIS5UEDATE
� WATT JOHN T
NE: SANITARY NO. r 19 CONTROL NO.
ARCHITELTIENGINEM: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a 0 0 0
_oo LICENSED CONTRACTOR'S DECLARATION
F I hereby affirm that 1 am limned under provisions of Chapter 9(commencing lob Description
Z`uj
with indlo)ufDivision 3ofmhe Businrss and Profcssinm Codc.anti myliccnu is p
^?y in fullll toinmehand cRa TPA '
gqi uam
cenwCl �' '3`� L¢.« �1�2(ak REMOVE EXISTING ROOFING APPL'Yj 1/2 PLYWOOD
=moo Dame —) -zf cantnr F-$2 INe 3LB FELT, 40 YEAR GAF ASPHALT_SHINGLES
^ s,J` ARCHITECT'S DECrwLARATION
uU I understand my plans shall W used u public mcnre s
god Licensed Professional
` S OWNER-BUILDER DECLARATION
af I hereby affi.shut 1 oro axempl From On Contractor's License Lew far the pppCCmtltltlaaa mf 1 ddd aaa
oO following mason.(Section 7131.5,Humans and Profusion Code:Any city or county it 1! ki A A
<m�i which milmons a pconot m eonumet,eller.improve.demolish,m repair any structure I�p rj Ip' "�j
y Z i prior to its issuance.also require.,the applicant for such permit to rile a signed imminent ..,. m atv v
< Oat W u
is licensed pursuant the provisprovisions or of N<Convector's Gcvc law(Chapter 9 Sq. Ft. Floor Area ed MWal'uatipg 000
YFo (commencing with Section 1000)of Division 3 of she Business and Pufassiost Code)or
i Nat W is exempt Oertlmm and the basis for on alleged cmmplum.My violation of
Section 703 M by awry applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred Collars as0o3. 34242027 . 00 P Y YP
I,as owner of the property,or my employees with wages m their me compensation,
will do the work and the swcwrt is not intended or offend or ale(Sec.1044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or The
themon.and who does such work himself or through his
own cmploycm,provided thin such improvements are nal immnded or offered torsade.If.
however,the building or improvement is writ within o«year of completion,On owner-
builder will have the burden of proving that In did not Wild or improve far porpase of
.1,)
❑1,as owner of the property,am exclusively contracting with licensed contractors to
camtru<t the project(Sec.1044,Business and Profusions Code:)The Conbactor'e Li-
come law docs not apply to an owner or pmpe ty who Wilds or harrows ss themon,and,
who contracts for such ymjects with a contractor(s)licensed pursuant to the Contractors - -
License law.
lam exempt under See. .B A P C far this moron -
.. Owner Date
WORKER'S COMPENSATION DECLARATION ' - - "-
1 hereby than under penally of perjury,o«of the following d«lantiom:
I ham and will maintain a Cenifieam of Consent 0 self-insure for WorkersCompcn-
ation,as provided for by Section 3100 of On labor Code,for the performan«of the
work for which this permit is issued.
c and will maintain Worker's Compensation Insurance,ei required by Section
3100 of NC labor Code,for the perimouracc of the work for which this permit is issued.
My Worker'sCC;r,enau�a3 lmunnee caroler and Policy number a¢: ys n
Cartier. 11 f gT •r•s Policy No.: I 1 p
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section recd not W completed if I c prrmit u form=hundred dollars(gl9p,
nr In.)
I c rhify Nm in the performance of the work for which this permit is issacd.l shall nut
employ any Person in any manner in M to become subject to the Workers'Comp rciation
Laws of Califomia.Dan
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
b«ome subject to the Worker's Campcmetion pmviuons of the Ia or Code,you must
.J O forthwith comply with such Frovlunm ch this permit shall W decided revoked. -
Z '"' CONSTRUCTION LENDING AGENCY
I Wmby affirm that then is a construction lending agency for the Performance of
O: the work fur which this permit is issued(Sec.3091.Civ.C.)
W Lender's Name
.'7 z 1<nder's Address
V C I certify Nal 1 ban mad this applicmion and scan,that Ne above information is -
U, PCorea I agree to comply with all city and county aNirnmees and sum laws relating to
C U Wilding construction,and hereby iuthanremprescnutives or Nis city to cnmr upon the
r imcin-memioned F.Fery farimpecuon purposes.
f+Q. (We)agree to ave,indemnify and keep hatless the City of Cupcnino against
fn liabilities,judgments,costs and expemu which may in any way accrue against aid City
V 2 in consequence of the graining of this Farm it.
'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4��Ca Date-2-2 ,(- s"
SOURCERULATI /. — `
�- G Re-roofs
Sipcanreof A,pIicanVCd;ua< Dan
H USMATERIAISDISCLOSURE Type of Roof
Will Ire applicant or future building«cupam store of handle triummus mammal
as defined by the Cupertino Municipal Code.Chapter 9.13,and dre Health and Safety
Code.Seetian 25532(')1 All roofs shall be inspected prior to an roofing material being❑Yea (8 All
P P Y g g installed.
tool the applicant or ramp balding«captor are equipment at devices worm .If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disuictl �S
❑Yes IZCRy.Jp
1 have mail the hvammas man,rbirre parormnv underCWuwr6.95 of ds Califon-
nu Hcalth&Saf<sy Codc,Somiam 25505.15533 and 25534.1 unJcrsmnd thaifthc Wilding
does not currently hart a ennanm.that it u my m i amibilay in unify the occupant of the
rcquircomm t pour to issaan¢ofa Ccrtihciaor Occum Sig Of Applica Date
�7_ZS
Owner or io`. age Dan roof coverings to be Class"B"or better
CITY OF CUPERTINO
I� 2 of 5 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34242027.00
DATE ISSUED. . . . . . . : 07/26/2005
RECEIPT #. . . . . . . . . : 30508
REFERENCE ID # . . . : 05070154
SITE ADDRESS . . . . . : 10197 CAMBERLEY LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WAIT JOHN T
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2633
RECEIVED FROM . . . . : CARLOS CAZARES
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ __________
BPERMFEE VALUATION 6,000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00
___ __________ ----------
TOTAL PERMIT 126.96 0.00 126.96 0.00
i
r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OJPEkTINO Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT #
/o/JVZ 0-ro-70/
OWNER'S NAME: PHONE #
GENERAL CONTRACTO FAX #
I am not using any subcontractors: os—
Signature Date
Please check applicable subcontractor and complete 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
Community Development Department
Building Division
i City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
CUPEI�TINO
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 comply with the above stated policy on re-roofing.
Homeowner's Name: rJf vc%4i
Job Site Address: L-O
Roofing Company Name: ua cs
Applicant's Signature: 1 Date: f vs—
Greg
yGreg Casteel
Building Official
Revised 71/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
Ty
�UPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
o/ l
`Owner's Name: Phone#:
Y
ract Phone #: Lia nse #:
se
Phone#: Cupertino Business License #:
O�4
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shinglesl ❑ Wood Shingles
Elml Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Coftly With Cu ertino's Teaz ff Policy:
o Description:
Residential X o ercial ❑ _
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
t��roj_ect: Typ f o ru tion: Occupancy group:
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