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05070153 CITY OF CUPERTINO % BUILDING DIVISION PERMIT �CONTRACTnR INFORMATION BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO.05070153 29888 CRICKET HTT.T. Rn OWNER'S NAME: PERMIT ISSUE DATE INDRANEEL & SARMIS QHOFTT 502 HORNING ST 07/2.r/2005 AE: SANITARY NO. CONTROL NO. (408) 278-0330 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH L! l� uoo LICENSED CONTRACTOR'S DECLARATION I hereby of ion that 1 am Licensed under provisions or Chapter 9(commencing Job Description with Section 70110)of Division 3 of me Business and Professions Code,and my license is ;' in full force and erect REMOVE EXI STDNGI ROOF/INSTAliL 30LB a Liceam D1au �-3 9 Lie.a N 7 10 =moo Da � � Contractor FSY j lrc. FELT/40YR GAAFASPHALTy_SHI GLE n r,J` ARCHITECTS DECLARATION Sc at U I understand my plans shall W used az public records eOt, Licensed Profession.] 5 OWNER-BUILDER DECLARATION LI I hereby.]'firm Out I am exempt from the Contractors License Law farm rr�� �`' n O following reason.(Section 703 1.5,Business and Professions Code:Any city ar county pI T I� II a-2y (j n which requires a permit to Construct,.1m,improve.demolish,or.pair any structure la� ��t�ff �t poor or its issuance.also rcyuiresthc applicant ror such permits fileasignedsulemcm-�< U6a LSe"� N� �__y that he is licensed pursuant to the previsions of the Contmcmr's License Law 9 Sq. Ft. Floor Area C' Valuati$6000 iHO (commencing with Section 7")of Division 3 of the Business and Professions Code)or y that he is exempt mciefrom and the basis for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type .at more man fw hundred dollars($530). 34235017 . 00 El I.as owner of Ne pmpcny,or my cmployces with wages as men sole compensation. will do the work.and the•wctum is not intended oroRered fonale(Sec.7044,Business Required Inspections and Prolusions Code:The Contractor's License Law docs not apply to an owner of 9 P propeny who builds or improves th rcon,and who does such work himself or through his own employers,provided Nat such impmvememu are nnt inundcd oroRered forsala If, however,the building or improvement is sold wimin arc year of completion,me owner- builder will have Om burden of proving mat M did not Wild or improve for prrpssc of salcI ❑1,as owner of the propeny,am exclusively convecting with licensed contractors to construct me pmjcct(Sec.7044,Business and Professions Cade:)The Contractor's Li- _ come Law does not apply to an owner of property who builds or improws thereon,and - who contracts for such projects with a imm=tor(s)licensed pursuant tome Contractors Lice•m Law. - 1 am aempt under Scc. B h P C for this mason ... Owner. Date _ WORKER'S COMPENSATION DECLARATION - 1 hereby affirm under penalty of perjury one of me following daclaratiom: I ham and will maintain aCenficreta of Consent to self-insure for Worker's Compen- sation,az provided(or by Section 37W of the Labor Code,for the performance of me _ work for which this permit is issued. [�eFhave and will maintain Worker's Compensation Insurance,az required by Section 37W of me Labor Cod,for me Kn ormance of the work for which this permit is issued. My Worker's C,�ompen11s onIion Inalsumace carrier and Policy nun he e, Carrier. A• tY • A . Poliry No.: �� 1 CERTIFICATE OF EXE MON FROM WORKERS' COMPENSATION INSURANCE (This action need not becomplcud film permit is for one hundred dollars(SIM) or less.) I certify mut in the performance of me wart for which this permit is issued,1 shall nut employ any pemon in any manner an is to become subject to the Workers'Compewtion Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Cenifcale of Exemption,you should become subject to the Worker's Compensation provisions or me Labor Code,you must .J O forthwith comply with such provivars or this pe.it Mull W trimmed revoked. z � CONSTRUCTION LENDING AGENCY [-r.�- I hereby aRnm mat mere is a construction lending agency for me performance of IY du work far which mit permit is issued(Scc.3097,Civ,C.) fy Q Lenders Name Dz Lender's Add., ' V C) I certify mat I have read this application and stall that me above information is U, F" COMCL I agree to comply with all city and county ordinances and sou laws mining to QU Wilding convection,and hereby authorim representatives of this city to enter upon me r W shove-mentioned propeny,for inspection purposes. 1 (we)agree to saw,indemnify+^d keep humlers the City of Cupertino against F N liabilities,judgments,costs and expenses which may in any way accrue against said City U in consequence of the granting of this permit �12 6 f '-' APPLICANT UNDERSTpYq,S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO=O?/(\/ '2- Re-roofs :Z_Sign arc oaf- anUC 'or Dau Oe b MATERIALS DISCLOSURE Type of Roof Will me applicant or(Muni building occupant store or handle Health and az de0ned by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safely Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ?*11. Will me applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove n hazardous air conumimnts az defined by the Bay Area Air Quality Management all new materials for inspection. DisuictT ❑Yea &2D 1 have read me haardousmamdalsmyuimmcnu under Chapter Q95 of me Califor- hisHealth kSafctyCodc,Sesdom25515.25533 and 25534.1undersind muirmc Wilding ` ar— clo ' Jou not currently haw a m�an�,�par.�u my responsibility m notify du occupant of the G mquiremen Ibe LpdoribiMUMMOfaCerdficmcofOCCUp=y.. Sign of Applicant Date Owner or authorized agent _ Z pato All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 4FUPEkTINO Building De artment JOB ADDRESS: PERMIT # -P 'L9"(� i O S-0 -7 J 3 OWNER'S NAME: PHONE # GENERAL CONTRACTO • aee FAX # I am not using any subcontractors: 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 CITY OF CUPERTINO 1 of 5 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 34235017.00 DATE ISSUED. . . . . . . : 07/26/2005 RECEIPT 4. . . . . . . . . : 30508 REFERENCE ID # . . . : 05070153 SITE ADDRESS . . . . . : 22868 CRICKET HILL RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : INDRANEEL & SARMIS GHOFTT ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2635 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 Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 . CU PEt�TIN® 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 comply with the above 7statpolicy on re-roofing. Homeowner's Name: / / Gam/ lhwv4 — Job Site Address: TTT - a"L' Roofing Company Name: Applicant's Signature: Date: • Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper -g CITY OF CUPERTINO REROOF CITY OF *CUPEkTiNO PERMIT APPLICATION FORM APN�# Date: `t Building Add ss: ,27 Owner' Name: Tlrz� eo� Phone#: t C ractor: Phone #:,f/�c� Lice ns #: ICA i.0 ZZ C aCt: Phone#.." Cupertino Business License#: / ✓�J Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles n o ` / El Wood Shingles Other(Specify) (/�y� o � El Other(Specify) umber of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With C rtino's Tear Off Policy: Mb Des ription: f / .t e Residential o ercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning De t. if there are any restrictions: LJ C of Project: T o ction: 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