03090163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONhTRACTQR INFOI�MATfIQ,N
BmLDINGADDRESS: ALL SEASONS ROOFING SERVIC 9A9TND.03090163
1179 CANYON ITTSTA DR
OWNER'S NAME: 2640 PACER LN PERMIT ISSUE DATE
COMPASS MANAnFMFNT
NEI 4089724455 SANITARYNO. 2 2 9 CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j O j LICENSED CONTRACTOR'S DECLARATION Job Description
1i1 hereby of tma that 1 am licensed under provisions or Chapter 9(commencing p
s< with Secsion]pMs)af Divialon3of NC Business Professions Code.and mylicenmb
< mfullfomesnd ff 7 p9 REROOF FINALEO
Liccnx lea _ Lic,a
3 Dam Coo"In O
AR CHITELTS DECLARA ION NOV 2 4 2003
I 1 undcrtmnd my phos shall E used u public rtcoWs
7h
G l7 LicevmJ Professional
x 3 OWNER-BUILDER DECLARATION e _ ��
c e F 1 hammy.('firm than 1 1. exempt from the Contractor's Co :License Lew for the BUILDING
p o following massa permit
t ]1171.4 Business and sue.Professions Code:Any city or county
S$ which its requires a permit re coroner.Out alter,improve.h Permit t ni a sig any structure
primmim cense unloosed
to the rW absi..ot forthe sucCropermiuoienseU.(Chartered t
< (commiscingwitpummel 7")of Diviov of sheGBusines aLbmrimssio(Charter Sq. Ft. Floor Area Valuation
p{ $ Oat Section the
Oivision3 of the liminess and Professions vi Code)or
L�� that he Is exmps therefrom end the bnsh for the alleged exemption.Any virdadon of 356028033 . 00
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mart Nen Ove hundred dollars(g5D)).
0 I,as owner of the property,or my employee with wages as their sole compensation,
will do the work,and the structure is not intended ar off ered for sale(Sec.7014,Basin.. -3 Ub _
end Professions Code:The Conlrxtor's License Law dans not apply to an Owner or Reqaired Inspections
property who build or improves demon,and who dims such work himself or through his 307 — INSULATION
awn employees.Provided that such improvements am not intended or offend for sals.q 601 — ROOF TEAR OFF
however,the building m improvement is mid within one year of completion,On owner
builder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
01. 603 - ROOF BATTENS
❑1.a owner of the property.,Business exclusively connecting with:)The C<onaanon Ie
court La does not apply.? n wneoanerty who
nsds or
pro Cmlrxon'.Li 604 — ROOF IN—PROGRESS
cove Law dao not apply m ts owner of property who Wilds or improve Nemo.and
whocompactsLacm for each projects with a contractor(s)licensed pursuant m de Canuenoh
License Law.
❑Ism exempt under See. .B&PCfor this moon
Owner Data
Adh WORKER'S COMPENSATION DECLARATION
y 1 hereby affsml under penalty of perjury oro of the following decimations:
I have end will a arrom.C,n rO.re of Covent to mlFinsum fm Work es Comped
tion,as provided fm by Section 3700 of the Labor Code.for the Performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as inquired by Section
37W of do Labor Cade,for the Performance of the work far which this permit is issued.
My Worines Camps tion lmumoce easier and Policy number me: �p�j
Cartier: Policy No.: DO.II .3(a Z-Lo
CERTIFICATED EXEMPTION FROM WORKERS' T
COMPENSATION INSURANCE
(This sectio need not W completed If the small Is foram hundred doth.(SIM)
arks.)
1 cenify dot in the performance Or the work for which this fermis is Issued.I shall not
employ any person in any manner an as to become subject to the Workeri Compensation
Law.of Caliromia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ceniticam of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
QQ forthwith comply with such provisions or this permit shall be decreed revoked.
'Z "I CONSTRUCTION LENDING AGENCY
R
(~ .., I hereby amn that Nara u.covuuetinn lendinggm¢y for the Performance of
UJ the work for which this permit is issued(Sec.3097,Civ.C.)
Q Under'a Name
z Lender'sAddm..
U Q I cenify Oat I have read Nis application and nate that the W.information is
g4E comic.1 gree to comply with all city and county ordinances and trod Iawe relating to
C) rVbuilding cons"ction,and hereby audorim represemnives of this city to enter upon the
W shove-me booed property forialwelion purposes.
w
d On .&me to sa ,indemnify and keep harmleu the City of Cupertino geinel
N Iiabilide.Judgments.cana and expenses which may in any way deem against mid City
V z in consequence of she granting of this Permit.
F-tI APPLICA DERS NDS AND WILL CO LY WITH ALL NON-POINT Issued by: Date
S Ec
91Zo Re-roofs
arc icanUCo On re
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de appiicam ser future building occupant sonev handle hazardous material
as dented by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,ScNu 25532(.)?
Oyu �No All roofs shall be inspected prior to any roofing material being installed.
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
it hovsfduus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
inns?
❑Yes IQNe
I have mad de havrdnusmareHah requirements under Chapterei.95 of the Califor-
nia Hcald4Sdety Cadc,SccOon9255O5.25533md25534,1undcmmndthoifthc Wilding
dans no y he tenant.Oat it is my resp Oility re richly the we pan,of the I 6f
ram i bed aCmiricamofOccup sere f (Cant Ie
Z o�
narant .nada ant mic All roof coverings to be Class"B"or better
r Building Division
10300 Torre Avenue
i Cupertino,CA 95014-3255
Telephone: (408)777-3228
F= (408)777-3333
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspeclion 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: •o
o Z MJ
Address: U7
Reroofing Comp y Name:
Applicants Signature• Date: z 7
tJJoee Antonuc
(Chief Building Official)
6/25/01
I
1 I
63 �
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Ad ress:
h '
Owner's Name: Phone#:
Contracto : v License #:
D
Contact: Phone#:
11 vckt(l 1/09 97/ - y
App icant/Co tractor: Fax#:
LU'uS r 5/0 —9,'17
Building Permit Info:
• Bldg Elect Plumb Mech
Job Description: a.r arts t ert
Residential: C Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
7100 °=
Architect/Engineer: Valuation:
Type of Construct**�fOccupancy Group:
KG.
Qty. if
A p p W64b e Fee ID Fee Description Fee Group
BPERMFEE BIPermit Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
2