05080016 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQNTRAGTOR INFORMATION ',
,
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT No.050800 16
- 22897 CRICKET HILL RD
OWNER'S NAME: PERMIT ISSUE DATE
WALKER JAMES A 502 HORNING ST 08/03/2005
INE:
SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_ 0 0 0 0
inLICENSED CONTRd orders DECLARATION Job Descri On �nn��A �®
fI herchy nor Nat 1 am limned under provisions.f Chapter 9(commencing P 11 qua
.i`vj with Section l(M10)of Division7af Jte Businessand Professions Code,mtl my license is �y�
< in mumrmandermq �
Dal -aLp REROOF W/30 YRS . FELT &
Licenu Clazs L.-'S Lk.M
-r o e Contranar 40 YRS . GRAND G.A. F.
"ppry ARCHITECTS DECLARATION aloof
C i I undcramnW (d my plans shall used as public records d
SyU
a a
Licensed Professional BUILD
1 yl fl l�g (T-II�
3 OWNER-BUILDER DECLARATION f��(I'll�ll/I'Illryl L)nI�}p9 it$ I herchy affirm Uat 1 em exempt form the Contractors Limns Law for the
20o following lesson.(Section 7151.5,Business and Professions Calc:Any city or county
<m which inquires a permit to ennswet,alter,improve,demolish,or repair any structure
uZw prior w its issuanee,also requires the applicant forsuch permiuu file aligned statement
< Nat he is licensed pursuant to the provisions of the Contrmtoh License Law(Chapter 9 Sq.Ft. Floor Area ValuaRWOOO
gHm (commencing with Section 7")of Division 3 ofthe Businessland Professions Code)or
,5_ Nat h is m
exempt brfroOn b
m and azu for the alleged eaanption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mart On.five hundred tile]..($500). 342350
I,as owner of the property,or my employees with wages az their oto compensation,
will do the work Boil On structure is not intended or orf msd forte(Ste.713,o1.Busnus
and Prefiesemu Cade:The CPntrxmeson owner
s License law 4.trot apply W sof Required Inspections
,.,0,who builds.,improves thereon,and who linesmen work himselfor Waugh his
awn employees,provided Nal such improvements an not intended or offered fursale.IL
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
❑1,az owner of the prepeny,em exclusively contracting with Tinned contractors in
construct the pmjcct(See.7044,Business and Profession Code:)ne Colossuses Li.
room Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjees with a eomnmor(s)licensed pursuant te On Conuactod
License,law.
❑Iamr.tmptunder Sec. ,B&PC(orthismason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 Minty affirm under penalty of perjury one of the following declarations:
1 hsve and will maintain a CefuCommonam of Cont to self-insure for Worker's Compen.
sam.,as provided for by Section 3700 of the labor Code,far the performance of the
work for which this permit is issued.
rhave and will maintain Worked Com,enmo m Insumne,az required by Section
of the Labor Cad,.for On pertormance of the work for which this permit is issued -
My Worker's Compensation Insurance carrier and Policy number ane:
Cartier: as • N •A • Polity No.: I";-"t a•KAY
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho section need not hceamplmcd if the permit is rm one hundred dollars(5100)
or less.)
1 certify that in the performance,of thc work for which this permit is issued,I shall not
employ any person in any mmnersu as to become subject o the Wvfkcrs'CDmpcnsaiion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this ceniriieate of Exemption,you should
become subject in On Wohcr's Compensation previsions or the Labor Code,you most
,Z forthwith comply with Such Provisions or this Permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F`N I hereby affsmlist there is a esnatsvcti.n lending agency rot On performance of
a dm work for which this permit Is issued(Sec.309'f,Civ,C.)
W Q Lenders Name
4• Under's Address
7Z
U O 1 certify Thar 1 have read this application and marc Nat Ne above information is
W P comm t I agree to comply with all city and county orJinences and sate laws relating us
0U Wilding construction.and hereby auNoriae mprescnatives of this city to cams upon the
r W above-mentioned property rot inmpccuon pufpaus
(We)agree to save,indemnify and keep harmless On City of Cupcnino against
F'p,3 liabilities.judgments,costs and expenses which may in any way scenic against said City
U Z. APPLICANT UNDEsequence Of 1W RSTANDS ArantiOf ND NDPermit.
COMPLY WITH ALL NON-POINT Issued by: Date _Q�
SOURCE REGULATIONS
Re-roofs
Signature of APPlicaH m _-_
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ILv:"heart wforum Wilding e.Chapter 9.12.
handle Health and
az on.See by the Cupenim Municipal Colic.Chapur 9.13,and the Health and Safcry
otic,Section 25532(x)?El Ycs �a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or dovimm which If a roof is installed without firs[obtaining an inspection,I agree to remove
it Iri.d.us air cm u ninants az dcfncd by the Bay Arta Ail Quality Management all new materials for inspection.
isuict? a, _u
❑Ycs ($_N
1 have read Ne haardnusmamrials requirements under Chapmr6.95 of the Califon
nia Health&Safcry Colic,Sesim.25505.25533 and 25534.1 undcrvand tndirlW Wilding Q_�
docs not currently hoc a tuna e.that it is my mspomibility,he notify Ne,occupant of the 6
requirements trstLre ismaneeoracertifnon cap3 aney. Signature of ppicant Date
$^ All ro c erings to be Class "B" or better
Owner or authunvcd egcm Date,
Community Development
'* 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME:k%A% ' m�( PHONE #
GENERAL CONTRACTOR• , A& FAX #
I am not using any subcontractors:'-) ,v,a,/ n!/rin5vzk
Signature Date
Please check applicable subcontractors and complete the following information:
61 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
A 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
J
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
400F Telephone: (408)777-3228
U P E T I N O 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 withbut first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can he performed.-
7. NOTE: If you call for a plywobd `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: W&e d4A402
Job Site Address: 2,9897
Roofing Company Name: AM& &�&�i(IS O ZAL'
Applicenes Signature: Dater s
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 0Tb
�
�CUPERTINO PERMIT APPLICATION FORM
APN # Date:
'3v2 -o_j*D
Building Address:
/ 7-
Owner
/ .
Owner's Name: Phone *
/ /! C
Contractor: ) Phone 08 License #:
o
Co tac Phone#L''`,(OA) Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ 'Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ;K Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles � ❑ Wood Shingles
�E
Other(Specify) oD� ❑ 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 Cu ertino's Tear Off Policy:
b Deseripti CA.�
,r 6
Residential Commercial '❑
Fire Zone: Yes ❑ No Confirmed with Planning Deft. if
there are any restrictions: LJ
Co of Project: e of struction: 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