05080021 CITY OF CUPERTINO '•"'=w /�« '' "' `a
BUILDING DIVISION PERMIT Cd ONTkXt�TOR NFORMATION .*
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT N0,05080021
22917 CRICKET HILL RD
OWNER'S NAME: PERMIT ISSUE DATE
MICHAEL PONG & HE JING 502 HORNING ST 08/03/2005
NE:
SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
IC' LICENSED CONTRACTOR'SDECLARATION JobDescri tion
WU C 1 hereby affirm Our I am liecomd under provisions of Chapter 9(commencingou P
U wish Scaion 7MV)of Division 3 of the Business and Pr feuione Code.and my license is
-may in full force anderfecy.�sq LIc.M ��2-fag REROOF W/30 YRS . FELT & �8 , n � ®
ya�z License Cl s l.• V`�\�J'
F DAm Carmtracmr R I r 40 YRS . GRAND G.A. F.
ARCHITECTS DECLARATION U
W-t I unceneand my plans shall W used As public mentis
>au
s o LicensedPntfcsaional -� A tfaa j
OWNER-BUILDER DECLARATION / L
1 herebyal'fiom Nal 1 am exempt from tW Contra tin's License law for the
p o following mason.(Section 7031.5,Business and Pmfeasions Code:Any city or county fl n ter FN q"K n 2
e m l which requires a Permit to construct,after, m
er,impve,demolish,m an
repair y stmmm
c {' 11 tl B F/ wa
rm
Prior n its issuance.also mquiru the applicant for such Permit a rile a signed su.ment V
E S G that he is licensed purmam 10 the provisions of On Chairman's Lianse law(Chapter 9 Sq. F[. Floor Area L.J IJ p[L�(V Valua[i L O O
'1 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y $ that W u exempt Ocrefrom and the basis for On alleged exemption.Any violation of
Seddon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Mp MNgber Occupancy Type
not mrro man fi.<hundred dollars(3500). 34 2 3 5 0 5 7 . 0 0
Luowncr of the the my.ur mY c1moncied wire waguudle(Sec.cam.Rusineant
n,
will do theworts ands: he Contractors
Linetl or aRcrtd for sale(Sec. Bnerof
and Profusions Code:The Convector;Liana law uch not apply to an owner is Required Inspections
Property who builds provided
Oat such improvements
and who doessAm noti intended
himselfm formic his
own employees,provided mat such impsmid within
are not ear of C mpeerod formic.oner-
huilder the building orimprovement issoldwithinone year of completion.meowner-
builder will have the Watch of proving that W did not build or improve for purpose of
sale.).
❑1.as owner of do,pmpcn,,am exclusively contracting with licensed Contractors to
construct the project(Sec.7(s01,Business and professions Codc:)TW Contractors Li
come Law dos not apply m an owner of pmprny who Wilds or impmve thereon,and
who contracts for such prejeeu with a Convacmrts)licensed pursumt to the Coname ors
License law.
F-11 am exempt under Sec. .B&P C for this maxon
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 W roby aRrm under Penalty of perjury arc of the following declarations:
1 have and will maintain a Ccnifiam sic aonto nits sel6iuure for WmkeYsCompen-
sation,As provided far by Section 3700 of on,tabor Code.for me p domana of she
work for which this permit is issued. ,
1 have and will maintain Worker's Compensation lnatance,As acquired by Section
W of the Labor Code,for the performance of the work for which Nis permit is issued.
My Worker's Compensation Too carrier and Policy�numIm
Carrier. A v R v A Policy No,�_k_y
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This sevum need notne compkmtl lithe fernit is foronc hundred dollars(SIM)
or 4a)
I certify Nat in the performance at tW work for which this eomit is issued,I shall not
employ any Persian in any manner an As to Werme subjecuo On Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Ccnifiam of Exemption,you should
Wcome subject to On Worker's Compensation provisions of the Labor Cadc,you most
.JO forthwith comply with such Provisions or this permiuhall W deemed.,.kid.
Z "' CONSTRUCTION LENDING AGENCY
.N., I hereby affirm that fere is a construction lending agency far to perfarma.of
a
On work(ser which this permit is issued(Sec.3097,Co.C.)
a0 Lenders Name
Z lenders Address
U Q 1 certify that I have read this application and sum that me above information is
correct.I agree to comply with all city and county ordinances and sum laws relating to
0 building conswction,And hereby aulbonre representatives of this city to enter upon ft
r [17 above-mentioned property for inspection purposes
(We)agree I.save,indemnify and keep harmless the City o(Cipertino against
F" paj liabilities,jutlgmenu.costs And exile"•^.which may in any way&Cane against said City
U in consequence of the gmming of this Permit.
^• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ti 13 61
SOURCE REGUI0 Z
�� Re-roofs
Signature of Apphcar DDataH
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will OC Applicant or future buildingoccupant erreor aNausmateral
As defined by mCupertino Municipal Could,Chapter 9.12,and the Health
and Safety
ode,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes x}e1g,
Will the,mid cam of future Wilding oceup an sere equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hararmus air Contaminants u defined by the Bay Arm Air Quality Management all new materials for inspection.
uict7
❑secs
Ihmemad thedc,See us 25M5lsmquimments 5534.1 rChrstard m,fdo95 ethima,
or-
ria Halth&Safety Coda Lecuums 22L it is myna 425530.1 In
tle ifthe Wilding Q
Jona not currently M1me a mnanc Nat it is my responsibility m notily me mcupant of the
requiremcnuwy�ma pnorv)iuunceofacetd0a!oC1:Jfaeu�y. Signature of Applicant Date
Owner or aJhr1r zdagent Date All roof coverings to be Class ••B••or better
PTY Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
F Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS- PERMIT #
D ro�c�2J
OWNER'S IPHONE #
GENERAL CONTRACTOR /FAX #
I am not using any subcontractors
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
*CIOF Telephone: (408)777-3228
U����'�0 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. ^?'
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: .[JpiYV11r/s, 1/HE Ten /
Job Site Address: 2L7 // 691P Xea; zlz Lci�F1'i�tsn
Roofing Company Name: (1"' D,(,(4 . TT.IJC,
Applicant's Signature: Date: ,05
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
aCTYOFREROOFCUkINO PERMIT APPLICATION FORM
APN # ��� 3Sb <-7 Date:
Building Address:
.212�7 / / d
ner's N Phone #!
Contractor: 1 Phone 08 License #:
l v
Co tac Phone #�40.9) 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
Other(Specify)rk K,/0,0 ❑ Other(Specify)
umber of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
MAI I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
b Descripti �
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: U
Cc 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
0' 3 � G 3 �