05080018 CI
BUILLD NG DIVISION NO PERMIT V-CON R CTO INFORMATION .
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO.05080018
22907 CRICKET HILL RD
OWNER'S NAME: PERMIT ISSUE DATE
ift BORIS & MARINA DEGTYAR 502 HORNING ST 08/03/2005
ONE:
SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIECI' PLUMB MECH
O 0 D O
ioo LICENSED CONTRACTORS DECLARATION
f G I Mrcby affirm that I am littnua under provisions of Chapter 9(commencing lob Description_ f� n
U
with Section]qKD (Division Sof NC Business and Profession Codc.entl my license is Iru'`r�' NAA E®
'oma mdn three and erlkel. REROOF W/30 YRS . FELT & [:Silj3]°�aa
Data Cl c�3 Contractor
`'l�alo8
qData cont actor a I we • 40 YRS . GRAND G.A. F.
ARCHITECTS DECLARATION
wu 1 undc,sanJ my plans shall be uxd as public records 2995
s u.G LicerLsed Professional (/ 7
`ms OWNER-BUILDER DECLARATION tl
"y<q 1 hereby O(fum mot 11. exempt from Ne Canons Co License Law for in. V �'' l� t(� p
po following mamn.(section](131.5.Business and Profevinns Code:Any Car or county ryL�. Iln "{] futy`+fry' ems.
<m� which mquima a permit to conslmel,alter,improve,demolish,at mpan any structure L:/ I C d
e-m prior to its issuance.also requires,the applicant for such remit to file a signed statement
' '< that Wislicensed pursuant mare provision orthe communes LiecntrcLaw(chapter9 Sq.Ft. Floor Area Valuat (6000
Et-$ (commencing with Section 7000)of Division 3 of the B usinev and Professions Code)or
..
that he is exempt thcnfmm and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for apa,mir subjects the applicanuo a civil penalty of ASN Number Occupancy Type
not more Nan five hundred dollars(SS(p). 34 35056 . 00
❑Las ownu of the propcny,or my cmploym wire wage uthcir sole compcnsadon,
will do t e wart and the sumctum is notinmMed oronemil foraah(Sec.]IHa,Business
and Profession Cade:The Committees U . so does not apply m an owner of Required Inspections
property who buildsorimpro ss thereon,and who donsuch work himself or through his
own employees,provided mm such improvements arc not intended oroffered forsale.If.
however,me building or improvement is sold within one year of completion.the owner
builder will have the burden of proving that he did nor build or improve for purpose of
sale.).
❑I,as owner of the propeny,ma e.CImCvcly mnuac m,with licntsed a...to
consumer the project(Sec.]Baa,Business and Professions Cade:)The Contractors Li-
cense law does not apply m an Owner of property who builds or improves demon,and
who contracts for such projeem with a contracmr(s)liaved pursuant in the Contrselors
License Law.
❑l am uempl antler Sec. ,B 6 P C for this mason
Come, Dam
WORKER'S COMPENSATION DECLARATION
I hereby aQint under penalty of perjury arc of de following dalandons:
1 bare and will maintain a Certificate of Covent to self-insure for WorkersCompon-
satipn,az provided for by Section 3]1X1 of the Labor Code.for the performance of the
work for which this permit is issued.
ave and will maintain Worker!Compensation Insurance,as mquhad by Section
311 of the labor Code.for the performance of due work for which this permit is issued.
My Workers Compaussation Ivumnce caries and Policy number art:
Came,: A• kA •A - Policy No.: Lawl 2-k1�_y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section noed not hecmnplered if Ile prornf is fm one hundred dollars($100)
or less)
I exnify that in the performance of the..,it for which this panni,is issued.I shall not
employ any person in my mannas t u on become svbjano IN Workms Compensation
Law s or Cahromia.Date
Applicant
NOTICE TO APPLICANT:If.army making mu Cendicmc or Exemption,you should
becpme subject to the WorkcrS Compensation provisions of the labor Cod,,you most
.J Z foMwirb comply with such provisions m this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-. 1 hereby affirm that there is a construction lending agency for the performaoac of
CL the work for which this permit is issued(Sec.3(Y99,Ci,C.)
W 0 Lender's Name
z lender's Address
U 0 1 century that I base mad this applieadon and sate that the above information is
F' cmmct.1 Agra m comply wit all city and county on inmtts and sate laws relating to
C) V building construction,and hereby authorise mpmsinumves or this city to enter upon the
G above mentioned property for ivpeNon purposes.
(We)agree to sem,indemnify and keep hannles the City or Cupertino again,
iF•t N liabilities,judgments.eons and expenses which may in any way scout against said City
U nnconuquencc Of the granting of this permit.
'-' APPLICANT UND NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO �I
���-- 3 Re-roofs
signmum of APPli.rUComncmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle havvdous material
as definM by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
aigliCodc.Se roue 23532(a)? $ All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building Occupant am equipment ordevicas whim If a roof is installed without first obtaining an inspection,I agree to remove
it hara,dous air contaminants as defiad by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yea
Ihave mail the hvmaterials rt M under CWRRpmr of the l
niasaf .Sectiov25%5.25533amllS11.1understandthadiDhcWilding
dos.1 carcnrl,havea mnanL mar it 4 mynsovibifly in notify daaupmt of the
requiren
O
Signature of Applicant Date
Owner mauthnrized agent �� a Date
All roof coverings to be Class"B"or better
Community Development
{� CO00 Torre Avenue
3perttinoCA 9 014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
V
PERTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME0j!2-7-r/" 4,04-0/0 PHONE #
GENERAL CONTRA OR: FAX #
I am not using any subcontractorsi/ZZdle2g e/a,.J�i
—� 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
*C1OF Telephone: (408)777-3228
U����'�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 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. iy'
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:
Job Site Address:
Roofing Company Name: �P
Applicant's Signature: Date: "OS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
lCUPERTINO PERMIT APPLICATION FORM
® APN # Date:
Building Address:
_,2 9j027 /
wner's Name: Phone #(
Contractor: Phone °h License #:
Co tac i 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 Shinglesu / L3Wood Shingles
(Ij06
Other(Specify) / ❑ Other(Specify)
Number 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 Poli c :
lqql�qb Descripti
Residential Commercial Q
Fire Zone: Yes 0 No Confirmed with Planning Dept. if
there are any restrictions: LJ
Co of Project: =_n of struction: Occupancy group:
oar
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
F216 . � 6