05080017 CITY OF CUPEW11NO
BUILDING DIVISION PERMIT �¢CONTRAC' TOR INFORMATOON
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT N005080017
• 22900 CRICKET HILL RI)
OWNER'S NAME: PERMIT ISSUE DATE
GLADYS SMITH 502 HORNING ST 08/03/2005
NE:
SANITARY NO. CONTROL NO.
(408) 278-0330
ARC mECD/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
JOn LICENSED CONTRACTOR'SDECLARATION JobDescri tion
e C 1 hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing P
$ibw with Section
reandc)nf Division Jofthe Businusand Professions Cod.and mylicenu is ff'B� 's is
t1N inmmuCh.derrLr�3 l'l'12�0� REROOF W/30 YRS . FELT & IOL 1111!!11 y�//=t��lj1��®
ya In Daenc Class Lien i
o Dam Co.tac m' CJ 2 t 40 YRS . GRAND G.A. F.
ARCHITECT'SI)
S DECLARATN
cU I undersand my plans shall W used u public record r
g"� Limmod professional � 2005
S OWNER-BUILDER DECLARATION
ny 1 hereby affirm Not I am exempt from the Contractors License Law for the ��fjpCy��'�II Io' � }s�gyp) yp�� 1n1
L n o following reason.(Sexiiun](131.5,Business and Professions Code:Anyrcit Yon county jLJ/`( A 11 Il 1f II 11\\If le-7Z4
_.
<m which rtquims a permit ba construct.are,improve,demolish,or ra ma an strocmrt
prior to is issuance.also requires the applicant for such permit to file a signed statement — ��...a
x
-[ Ihahumc
cislicensedpersuanntheprovisfonsoftheCommrsUveneUW(Chapter9 Sq.Ft. Floor'Area valuatoiS0'00
(coY F G Oat he s exempt
ftmion mm and d boom
nide Busiaged exempts and Proficison.Any vi Gado)of
y�$ Nat he u eampt tbem(mm and Ibe bnsu for the alleged exemption.My violation of
Section7031.5 byamapplicaMforapermitmbpea the applicanttoacivil pcnahyof APN Number Occupancy Type
nm roam roan five hundred d.uam(5500). 34235014 . 00
I,as owner of the pituitary,or my employms with wages as their sole compensation,
will do the work and the strvaum is not intended or offered for sate(Sec.a(Ia4,Business
and Professions Code:The Contractor's License Law does not apply m an owner of Required Inspections
property who WiLdsm mprasoathemcm.andwhodoessuchwork himself.,through his
Own employees,provided that such improvements are not intended or offered for mile.If,
however,the Wilding or improvement is sold within one you of completion.Ne owner.
Wilder will lave the burden a(proving Nat he did rot Wild or improve for purpose of
ale J.
1,as Owner of the property.am exclusively contracting with licensed contractors to
construct the pmject(Sec.7W4.Business and Professions Code:)The Conlracmrs Li.
more law docs not apply to an owner of property who Wilds or improves dmman,and
who contacts for such limiters with a contramor(if licensed pursuant m the Cantr]clOrs
License law.
❑I oro exempt under Sec. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following deet ations:
J 1 have and will maintain a Certificate of Cement to self-insum for Worker'sCom pe n-
smion,as provided for by Section 37M of the Labor Code.for dse performance of the
work far which Nis peranit is issued.
in sail will maintain Worker's Compensation Insurance,u required by Section
3700 of the labor Cade.for the performance of the work for which this permit is issued.
My Workers Comps do 1 maazra carrier and Policy number are'
GamI er: . H -/� Policy NO.: 0`a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not W completed if the permit is for one hundred dallsa($100)
or less.)
I cnifv Nat in the Performance of the work for which this permit is issued,1 shall not
employ any person in any mother an as to become subjects.the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Omtd
become subject in the Worker's Compensation provisions of the labor Code,you mum
.J z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat thea is a construction lending agency for the performance of
tY the wink for which this permit is issued(Sts.3097,Civ.C.)
Irl A Lendces Name
6. Landers Address
T..)O I cer4fy Oat T have read tits application and sarc that On love info ermts.Is
44 correct,l agaa to comply with all city and county onfinances;and some laws relating to
QU building construction,and hereby amhmian¢preseniums of this city to enter upon the
r 4H shave-mentioned PmPcny for inspection purposes.
(Wt)agree In save,indemnify and keep harmless the City of Cupertino against
N liabilities.judgments.costs and expmaes which may in any way acme against said City
U in conmquenee of the germing of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date F- 07-G'r
SOURCE REGULATIONS.
P -3 Re-roofs
Signature of ApplicanitConuaclor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building mmupam atom or handle haallous material
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
ode.Section 25533(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes IDl�
Will the apPlicant on future building occupant use equipment or dvitea whim If a roof is installed without first obtaining an inspection,I agree to remove
it le Mous it conaminams as defined by the Bay Arca Air Quality Management all new materials for inspection.
vin?
Ycs
I have rtaJ the haatdaus materialsmquimmcna under Chapmr 6.95ofthc Califnry !�
nix Health&Safety Code,Secdons25505,25533 am125534.1 undersand lhuiflW Willing y
docs not currently have a tenant Nat it is my map.nsihilky m notify the acuPam of the [-�
squiamena wn�g/tum or m issuanccofa Certificaa g'_"p% Signature of Applican Date
�LSS oof coverings to be Class"B" or better
Owner or rrrcd agent Date
Community Development
0 Torre Avenue
CuOpertino CA 95014
11 som Telephone(408) 777-3228
CITY 0, Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: , PERMIT #
GSo ao��
OWNER'S NAME•. Soil PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: ..uf�i Gyu i g¢— — -OS
Signature Date
Please check applicable subcontractors 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
acloF Fax: (408)777-3333
4UPEkTINO
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*bp 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 stated policy on re-roofing.
Homeowner's Name: 0, e c Si1�1/Lei
lob Site Address: 'L9(?(� ( /�/�� //
Roofing Company Name: 7A
l D�i(I4 0 7A
Applicant's Signature: bate: "05
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 6S /
�CUPERTINO PERMIT APPLICATION FORM
APN # Date:
�Vz s D/5� - a
Building'Address: 7
/Owner' •Dame: Phone M
Contractor: ) Phone 08 License #:
Co tac Phone#(_',W) 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
Y( �E
Other(Specify) joDEl 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 De cn'pti , i� ,.91
' ( O
Residential Commercial 'fl
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Co ofProject: 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
-3 o6 3 J
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