05080022 CITY OF CUPERTINO � "°y'-��'�^° '°n
BUILDING DIVISION PERMIT "CONTRACTORiINFORMATION
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMrTNO.05 08 0022
22918 CRICKET HILL RD
OWNER'S NAME: PERMIT ISSUE DATE
RUTH & ELIAS ZABOR 502 HORNING ST 08/03/2005
HE SANITARY NO, CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
fop LICENSED CONTRACTOR'S DECLARATION Job Description
U C 1 hereby affirm Mail
am licensed under provisions of Chapter 9(co rmaming p
IJ wish Sccsian]OIX))af Diviaion Jaf NC Business and professions Cade, rhe liccns is C Q In ()���
"M", incull tone end cff IfYlI II�`\Vi
5'qi L;cin elars X4%'39 Lk.« �11I O REROOF W/30 YRS . FELT &_ {ill n
e o Dam 8 � LOP
Contactor / 40 YRS . GRAND G.A. F. Q
ARCHITECTS DECLARATION
Sc C< 1 understand my plans shall W used as public mcorda
'1i9 �A05
10G Licensed Pmfcssinnel
5 OWNER-BUILDER DECLARATION
cif I hereby.(Sero that 1 1. exempt s an she Contractor'sCo !Any c Law for the I ps ss r
S O following mason.(Station 703 construct,
Business and improve.
de oro Cake Any cm Or county �LI�`I It JII + ��I
o m which myuires a pcemit a eorel; et,alcor,impose,h Permit
t or repair ed structure — _-- _
that es its�ensed .almtcquiMe the isionaof for mchpctmiuofikaaigmcdstammcnt
s shathcisiiccnudpursuenuathcpnvision5ofthe Conlrazturilicenulaw(Chapmr9 Sq.Ft. Floor Area Valuer[' Ii000
yI-� (commencing with Section 7")ofDivision J of Ne B usimss and Professions Code)or
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Sectimi7031.5 by any applicant for a permit subjects the applicant to a civil penally of ApN Number Occupancy Type
not mom Iran eve hundred dollars(SSW). 34235011 . 00
I,u awn.,of IW propmy,err mY employees wish wage u their sole compensation,
will do the work,and ocstmcmm is not ntended or offered forsale(Sec.]0a4,Businw Required Inspections
and Professma,Code:TW Commence,Luse Law does not apply to an owner of q p
property who builds or improves Ihemon,and who does such work himself err though his
own employees,provided that such improvements are not in coaled or offered forsale.If.
however.Ne building or improvement is said within one year of completion,Ne owner
builder will have the Widen of proving that he did not Wild or improve for purpose of
salt.).
I,as owner of the property,am exclusively contracting with eeemtd eomlrmlars to
contract the project(Sec.7014.Business and Professions Code:)The Conuacmr's Li-
ccnsc Law does not apply to an owner of properly who Wilds or improws Mission.and
who contracts for such projects wish a coneacor(s)Rceoed pursuant in she Contnemfs
License Law.
❑I am axempt under Sm. ,B&PC for this
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alTum.undcr penalty of perjury one of Ne following declarations:
1 have and will maintain a CeNreate of Comical to self-usum for WorkchCompen-
station,as provided for by Section 37W of the Labor Code,for the Performance of the
wart for which this permit is issued.
an and will maintain Workers Commmalion Imuurmmz,as required by Section
of Ne ISWr Code,for me performance of the work for which thu permit is issued.
MY We kces Com/pemation Insurance carrier and Polity number am: n
C.Iim /k , le{ .H
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section reed M itbe completed if the remlil is farm ebundned dollars(SIM)
or less.)
I unify Chet in the performance of the work for which this permit is issued,l shall nut
employ any person in any mmmmr so as to become subject to the Worked Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificale of Exemption,you should
became subject to the Worker's Campensmon provisions of the Labor Code,you must
.J Z forthwith comply with such provisions or this permiuhall be claimed ranked.
zO CONSTRUCTION LENDING AGENCY
F'rn l hemby affirm lost on.is a const urn lendingagemy for the pesfmmmmc of
C 7 Ne walk for which this permit is issued(Soc.3091,Civ.C)
fZl Q landeea Name
7 z Under's Ail
U C) 1 modify that I have read this application and sum that the above information is
lT. F cameo,l.,me to comply with all city and county onfinarneas and suite laws totaling Io
OU building consuuctlon,and hereby authors representatives of this city to enter upon Ne
Galave-m adcaed property far inspection purposes
(We)agree to save.imcmai fy and keep harmless the City of Cupertino against
F' h liabilities,judgment,costs and expenses which may in my way acme against said City
U zs mit.
APPLICeof Me -5NDS AND ANTUNDERS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date //'I1_ _p,r
SOURCE REGULA $—71 Re-roofs
Signatureof AIrplicanUCmiu etur Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant a future Wilding occupant store or handle hazardous mamiia]
u deRned by IW Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
We.Section 25512(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs
Will tot applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hataidous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
7D,�,aviv?❑Yes
I have toad the haeodums materials oquimmtnu undttchamr 6.95ofthe CalifonHealth&SsfctyCmc.Seedmu]5505.255)3 ad255Ja.l undcrslaM thaifdc Wildinges Out currently have a tenant that it is my nspousibility m notify t e asuPanl n(the
uiremeam which must W metyak�1�ssuanccofa ccrcamor _ Signature of Applicant Date
ner err authonmd agenar DaAI overings to be Class"B"or better
Community Development
sm
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF • Fax(408)777-3333
UPEf�TINO
Building De artment
JOB ADDRESS- // / PERMIT #
9 G1b/ l
OWNER'S NAME:' PHONE #
GENERAL CONTRACTOR ,LCFAX #
I am not using any subcontractors:')her, (5- -`2-O S`
— / 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
UPEkTINO
" 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 bg 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. There-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of'/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: 15/062 PJ�i-Vl //_IkA
Job Site Address: 2Z9/6 1. AK ,c;4
Roofing Company Name: &,&?,Q 11 T^�
Applicant's Signature:
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
k
Date:
dress:
/ —T 6& "/
Owner's Name: Phone #(
Contractor: ) Phone °8 License #:
Co tac > Phone #00,9) Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .;K Asphalt Shingles
❑ Wood Shakes / E) Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
(�u%o(l
Other(Specify) ❑ Other(Specify)
umber of existing coverings ❑ Provide 1.C.B.O.Report#
❑ To be Removed - ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic :
b Descripti
.,9 Q cs►.
Residential A Commercial Q
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Co of Project: e of struction: Occupancy group:
Qty. if
Applicable Fee lD 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