05070099 CITY OF CUPERTINO «+ -'r«a .� •�'"��' )N
BUILDING DIVISION PERMIT CONTRACTORINFORMATIONz
ix ssS.� P2¢d.'da:JNA." .R' s5 �...IQ
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMRND05070099
10926 CAMPER12Y T.A.
R'S NAME: PERMIT ISSUE DATE
L'
E: SANITARYO. CONTROL NO.
(4 nA) 278-njjQ
ARCHITEC,`ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION O O O O
FF I Many affirm that I am licensed under previsions of Chapter 9(commencing lob Description
U`t$ with Section 7")ofDivision 3 of NC Business and Professions ride,and my liomm is
's„ immnfaneaneerc Lt'47—k REROOF-REMOVE/APPLY ll/2,APLYWOOD 30LB FELT
License CI Lear
0 mm - - camuacnr ASPHALT SHINGLES 4
f-s ARCHITECTS DECLARATION
I�� I undersand my plans shall N used as public mcnrd q �v
3
Licensed Prufcssianel !
`a03 OWNER-BUILDER DECLARATION yd, c
qy�Z 1 hereby affnn Nat I am exempt from Ne Comment's License Law for the
//(AJ�J p 4 7 O✓
Ho falloWlag reason.(Section 90315,Busimss and Pmfcssinns Code:Any city ar.aunty
K g 6! which requires a permit to eumstmcL elan, w improve.demolish, repair any strma�uum g�L p fJ((
priar to its issuance,also rrquires the applicant for such permit to file a signed summer,
0 that W is loomed pursuant n dm pm.iaiom of the Contractor's License Low(Chapter 9 Sq. Ft. Floor Area val�/y )I;/ �Valua00
xr (commencing with Section 7000)a Division 3 of the Business and Professions Code)or •70
y that he u exemmdue,b
pt therefroand tasis farthe alleged esemption.Any violatif/on of c•+
Section 7031.5 by an,applicant for a permit subjects tho applicant to a civil penalty of APN Number `Occupancy Type
not more than five hundred dollars(S500).
❑I.as owner of Ne part or my employees with wages as their sole compensation, 34242015 . 00
will do the work,and the structure is not intended w offered mreale(Sec.704,1,Business
and Professions Cade:no Coovacnfs License law does not apply to in owner of Required Inspections
property who builds or improves demon.and who doessuch work himself or through his
own employees,provided thm such improvements are not intandod or offered for ale.If,
however.Ne building or improvement is sold within one year of complains,the owner-
builder will have the burden of proving that Im did not Nib w improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed rnnuacmrs to
comwet the pnjen(Sec.704,1,Business and Rofessiom Cade:)The Contractor's Li.
.emu Law docs not apply to an owner of prupeny who Wilds or improve thereon,and
who contracts for such pmjew with a contractor(s)licensed pursuant o the Contractor's
License law.
❑1 am eaentp,mom,Sec. B A P C for this moron
rcr Dat
WORKER'S COMPENSATION DECLARATION
I hereby aff under penalty of perjury ane of the fallowing deelamtimae
I have and will maintain a Ccrafeam of Consent to wlf-Usum for Worker's Compen-
.non,es provided for by Section 3700 of the tabor Code,for the performance of the
work for which this permit is issued.
JtD have and will maintain Worker's Compensation Insurance,as required by station
37110 of the labor Code.for Ne performance of the work for which this permit is issued.
My Worker's Comp1e1m,auonAyInsurance caries and Policy number art:
Cartier:- A- R •4 Policy No.: I e- -i 0-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sendistanced mat W completed ifuse permit isforow hundred dollars($100)
or less.)
I anify that in the punfu mance of Ne work for which this permit is issued,I shell not
employ any person in any manner so u to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Col iOam of EacmPtian,you should
become mbject to the Worker's Compensation provisions of the IaMr Code,you mum
.J Z forthwith comply with each provisions Or this permit shall W deemed revoked.
Z OCONSUCTION LENDING AGENCY
P:�wf/1+ TRI hereby affirm Nat Nem is a comtructinn lending agency(a,Ne Nrftdro me of
:4 the work for which oris permit is is oed(Sec.3D97,Civ.C.)
W� Q Lender's Namc
Z Lenders Add.
U O 1 mMfy that 1 have read this application and star met the above information is
U.t" correct.I agree to comply with all city and county ordinances and sum laws relating to
Ord building construction.and hereby authonne mpremmativcs of this city to indoor upon thc
abovemenuoned property fw inspection purposes
(, li (We)agrve,indemnify and keep to rrelcm City of Cupertino against
agree n aa the
h liabilities.judgments.costs and expenses which may in any way acme against said City
f this permit.
U Z APPLICpDil�11NDEjSTAsequence of the ngoNM-*4lD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC RE G NS. \
J Re-roofs
Si—�of Applictai m Dan
HAZ US MATERIALS DISCLOSURE Type of Roof
Will the applicant sur fumes building occupant store of handl.hazardous material
as defined by the Cupertino Municipal Cade.Cbapkr 9.12.and the Health and Safety
Col.,Section 25532(¢)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee 9910
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conmmin ria a defined by the Bay Area Air Quality Management all new materials for inspection.
Disuict7
❑Yes
1 have nail the hvardous materials acluiremems under Chapkr 6,95 of dm Califor-
nuHcalth&Safely CoM,Sa' 2mymxd25534.1 u=Uf thazifthe Wilding /
Joel not enrrc0 ave is my responsibility n rmtify the�uYam of the 1 O
re ,trema se/w1yeM1 me ornrssuanceofa Cenifmakaf Occu .. SignKitof Applicant Date
_ n-/6- D-t- All too coverings to be Class"B" or better
Owner or aumorizcd agcm Dam
CITY OF CUPERTINO
1� I of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34242015.00
DATE ISSUED. . . . . . . : 07/18/2005
RECEIPT #. . . . . . . . . : 30406
REFERENCE ID # . . . : 05070099
SITE ADDRESS . . . . . : 10226 CAMBERLEY LA -
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HASLING JOHN AND ELSIE
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 61000.00 126.36 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
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
OUCITY OF
P �N� Fax(408)777-3333
C /�1 Building Department
JOB ADDRES PERMIT #
,gym oSb7 00� ¢'
OWNER'S NAME•/ PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: tl
Signature Date
Please check applicable subcontractors d 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
�r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
C U P S IST I N O
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 1.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will com y with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name: c/
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
a(INU REROOF
OF
6"EkTINO PERMIT APPLICATION FORM
APN # Date:
Building Addre
Ow is Name Phone#:
/ ,
C tractor" ne#: License
a t� 7e- �O ' Uzi
o #: Cupertino Business License#:
3�Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '/�Asphalt Shingles
❑ Wood Shakes ❑`Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfg. Installation Specs.
I Have Read, Understand aild WilMoMptyWith Cu ertino's Tear Off Policy:
J Desc jpttiii000n-
Residential Com rcial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: [5
Cost roject: T f Cot ru ion: 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
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