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04070035CITY OF CUPERTINO ��'^' ai' �" •' CO77 �iTRACTOR INFQRMATION - - -- - - BUILDING DIVISION PERMIT BUILDINGADDRESS: FOUR SEASONS ROOFING PERMITNO04070035 10236 OWNER'S NAME: PERMIT ISSUE DATE DE ANZA OAKS HOA 645 ONE: SANITARY NO. CONTROL NO. (408)278-0330 ARCH ECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACT'OR'S DECLARATION r� j� /Y p y - rlptl0n I krchy affirm that 1 am faoxd under provisions of Chapter 9 (commencing II\`\aVI�IU/p^\\`\Ill 0 With Section 7000) of Division 3 of the Business and Professions Code, and my license is IIOLr, flea I,L��U in mu rose ande'i.3 see.a�t Z o Licenx sea Illi REROOF CarCl �g s1 7��►� b Dam Contact. L ARCHITECT'S DECLARA ON 1 undersand my plasu shall k used as public memos �l r r <. a. fl n p n Licensed Pmfossi OWNER -BUILDER DECLARATION O l�p\�n fit exempt from the Contns Law the I hmaso ,(firm the 1 U ®�ra 1. Cc : Any c Ca lc: Any tiny or county followingmason,(Schon]colour, Business and co I'ryIS rmfcasioli alma Improve, or any streetcstatement whim requires , permit w tams er it 1 the h Permite 2 Sig prior to its issuance,anus "dims the theapplicant for suchrearm'mice s Law(summers )p1DnA.,uofthe Lit emslsw(Chode)., Sq. Ft. Floor Area Valuation oBusin ss Cmlc)ser bem rnmeccnwitpumtion7 of3 of the Business and (commencingwith Sexioa]rod) of, basison. Any Net he is exempt thcrtfrom and dm basis for the alleged exemption. Any violation of q �Ia.e 2\111filtallier0 0 Occupancy Type P Y YP Section 7031.5 by any applicant for a permit subjects Napplicant to a civil penalty of nut mom than fin hundred dollars ($500). El T, as owner of the property, Or my employees with wages as teir,mle compensation, Required Inspections will do the work, and the structure is not intended or offend for sale (See.]814. Business and Professions Cpde: The Contrmwrs License Lew dead not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements m notin aided eroffered for sale. If, however, the building or impmvcment is sold within are year of completion, the owner - builder will have the burden of proving that he did not build art impmw for purpose of sale.). E) I. as Owner of the property, am exclusively contracting wit licensed conuacwrs to conawm Ne project (Sec. 7014. Business and Nafutlom Code:) The Contractor's Li. amt Law does not apply w an owner of property who builds or improwa demon, and, who contracts for such projects with a consr is or(s) liamed purmmt to the Contractor's Licenx Law. ❑ 1 am exempt under Sec. , B At P C for this ruson Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ore of the following declarations: no self -insure for Worker'sCampen- j how and will maintain a Cenificate of Contiu 'satmn. as provided for by Section 37W of the labor Code, far the performance of the work for which this p .it is issued. I1tkPw and will maintain Worker's Compensation Insurance, as requited by Section *0. f the Isbor Code, for the performance of the work foe which this permit is issued. My Worker's Compensation lnsum ee rier and Policy numberg .1 Cartier: �Ll /5-a's'iil/ti'ti 1 Policy NoWr'D YOf rlrXsji� , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Coussoction reed not be completed if ek permit is for one hundred dollars (SIBD) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ, any person in my m rsoas kcoeesu bra mtlie Warkefs'Compemasion ed Laws of C,lifomia. Da ;;nM ' NOTICE TO APPLICANr. If, after making this Carl ficam of Exemption, you should become subject to the Worker's Compensation previsions of the Labor Code, you must forthwith comply with such provismas or this permit shall k deemed oinked. CONSTRUCTION LENDING AGENCY I hereby affirm that tem is a construction lending agency for the perfurmmec of the work for which this permit is issued (Sec. 3099, Civ. C.) Lender's Namc Lender's Address 1 certify that 1 have read this application and sum that sk show information is correct. I agree to comply with all city and county ordinances and state laws relating to building concoction. and hereby stard m apresemuuws of this city to enter upon tc above-memioned property tar inspecuen purposes (We) C. to sew, indemnify and keep harmlea the City of Cupertino against limilisieajudgments, cost and expenses which may in my way accrue against said City in consequence of to grmsing of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO EGO C6c- Re -roofs Type of Roof Sig c of AppllcamVConuamor Dam HAZARDOUS MATERIALS DISCLOSURE Will to applieam Or future building Occupant store or handle hanzrdous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety ode. Section 25572(,)? 71 Yes �l Un 1� e All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or Jevica which mil hazardous air contaminants as derided by the Bay Arca Air Quality Management all new materials for inspection. Di ix? C] Yes I haw read thehvatdsws materials requirements under Chapter 6.95 of Ne if - M3 Health Safety Code, Saumu25505. 35533 ands 5511.[ondcrauM dutif the Wt tag - �� doss nal cutmnslY haw m at it u my responsihility to notify dm deep,of the a� n cr styles tlfmg e, w tsssuma of a Cmufcaic of IXcupaacy, r Signature of Applicant Dale c� All roof coverings to be Class "B” or better Owner or ager, ' D„� CITY OF �UPEI�TINO 0 JAd1hL i Owner/ Contractor Signature Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: /023 Ca.MbpiL PERMIT # 615:2/s OWNER'SNAME:Ar\ok4 r �, PHONE # GENERAL CONTRACTOR: %v ri SPG sow �' FAX # I am not using any subcontractor Signature Please check applicable subcontractors and complete the following information: Date 7 d' C/ Date 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 oofing Septic Tank Sheet Metal Sheet Rock Tile 7 d' C/ Date A.... CITY OF PEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 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. IMPORTANT: 1. Flat roofs must have a minimum of " 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: Ct U 0, 16+'C- � `� 17 Job Site Address: I b 7 (o Roofing Company Name: A plicanYs Signature: a e: Cy ® Greg teel Building Official Revised 1/30/03 *l MY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORINT APN #Z ,,11-Z Bldg Permit Fees Date: 612–C716 C Building Address: D Z3 Cmc b�� Owner's Name: f Phone #; p6-2 p Contractor: Phone #: License #: Dulr� ? si��•-- S /t ev Z.7,5S q7Z /D g Contact: hone #: Cupertino Business License #- BUILDING - Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles pfr.Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles P� Other (Specify) CZ -21 -UA -17,-2 ❑ Other (Specify) Number of existing coverings ❑ Provide I.CB.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply olic With Cu rtino's Tear Off Policy- Job Description: Job Residential Commercial ❑ Fire Zone: Yes ❑ No 24—� Confirmed with Planning Dept. if there are any restrictions: Q Cost of Project: Type of Construction: Occupancy group:: e-yw CZi.17L-i✓ 1't/ plile Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees . BUII.DING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING