02070093 ik
OF
CITY
IDIVISIONNOPERMIT CONTRACTOR INFORMATION:
Y) BUILDING ADDRESS: PERMIT N
22958 CRICKET HILL RD __ FOUR SEASONS ROOFING x2070093
OWNER
DARWIN H 645 HORNING ST APPLICATO 5J8U 2002
HONE: SANITARY NO./ l O/ CONTROL NO.
pQi (408) 278-0330
µno ARCHITECT/ENGINEER: BUILDING PERMIT INFO
88 BLDG ELECT PLUMB MECH
I c_I L:j 1—
LICENSED CONTRACTOR'S DECLARATION
S ypp 1 hereby affirm that I um licensed under provisions of Chapter 9(commencing Job Description
with Section 7000)of Division Sof the Businessand Pmfessinns Code.and my license REROOF
is in full force and n. e+ 6,
oU License Clms `•'� Lica Z
Data Cmwaor
!i G A HITECT's DECLARATIO
,a 5 undennnd my pl...
ns shall he used ex public rte s
Sao Licensed Professional SAN 2003
's OWNER-BUILDER DECLARATION
u� I hereby aPum that I am exempt from the Contractor's License Law for the 8 000 O O
h
G?< following reach.(Section]onstr Business and Professiom Code:Any city or county
F G which requires a permit m construct,otter,improve,demolish,or repair any structure
3$ .pdonoi.s issuaae.also s immu Neeppla.mforsuchpermitmBkasigtsedmtemem --- - - - ---------- -_— ___
Dim hiz,0kirised(xiisuinnoilK GMtlsbu of the Convano'.License Law(Chapter 9 .. 3 "ff6 B'Yde3'1�Q•,A -- --Valuations
(commencing with Section 71)00)of Division 3 of the Buipess and Professiau Code) x t•�_ �" at. .._.t (..N J,�z i 3 t
or that he is exempt mciafrbmi-end the basis for Ne alleged exemption.Any violation
-of Section 7031:5'by may applicant for o permit subjects the applicant to a civil penalty
'of not mole than five hundred dollars($500). 30APN N]RHME DCCUpanCy Type
❑I.as owner of the PmPi em is eae with wages ar their scale compensation. 307 - INSULATION
vxy r, rr a a
,will do ma work.,-bred the ode:The is not-:mended or Lied for sale"(gee:10 x, _ -
owner
Business arid Prey Who
Code:The Contractorsthatch,
License law does tort apply m an lOUS'
I� TT. •n
owner of p his ow em bolds or improves at such,end who encs such work need or 602 - ROOF PLY 1VXL
or.rots h his awn haw.,,ms provided!that such improvements I, rt not:mantled or _ _
cRercdfor wle.owhowever,the biddinge urdenof proving
Id emir not year or "- '"'" 603 =""R00F" BATTENS c "„ - ;
----
completion.for Neowner-builderwdl have the burden of pronng Net he did not build or 604 - ROOF IN-PROGRESS
improve for puopou of seleJ.
ioft . ra_. with ..__ _...... ._ _
❑1:as owner of the proPcrtY•atm udusivelYcomracang with liccmW<onv.emn to � � -_--- --- �"� _�---- --�-�--------_--- t
cars.the project(Sec.701 Business aM Professions Code:)The Commuter's f:I(', r;,' '
`, 2-,u
Licanse law does not apply m an owner of property who builds or improves Nu
eom,
.arW.whs,eamorm.for_sucla.projects with..commnor(I)Airmsed.puncoom ..,he. _ .._ _.._._..._._..._..__.__._._____....,..._.___._.___._._.._._.._:_',.__.._.__-----
Convince,License Law, „, _-
plemmpt
euunGerSec.” B&PCfm Nis moon .rIC' ! .:Clii'G OIi
Owner.. I. '.i.•,.t;t, Dote.
WORKER'S COMPENSATION DECLARATION
' I hereby eflirm uMtt peulry of perjury aria of Ne following dalwtions:
❑ 1 hive and will'mainain a Cenificile'of Consent to self-insure for Worker's
Compcnsmion, as:provided forby Section 3700 of the Labor Code, for the
performance of the work for which"L permit is issued.
O1 here ardwill majnuin Worker;aCompeimtion Imuwae,ss required by Sation
3700 of that Labor Cade,foe Ne,performance of the work for which this pcmdt u
isiii a My
IN It Co nsadim Imunnae cemritt end Pokey number.ue:
Comer �11policy No -C aYF�
t.CERTIFICATION OP.EXEMPTION FRQM,WOR FRK 5 ' `
COMPENSATIONINSURANCB'
"17�LL un'an need tar be completed if the Permit is fm one hundred dollen
IS 100)a,les.)
slinin emploNetinaigperfoi byrmamrEs a tforwhimthisct toteissued,l ��tCr^;c.i''7•Iii Fip'1F '
hell snot employ any pemwn in any manner co as m become subject m the Workm' �
Campcnsetion laws of Cali(omia.Dale""" ""
. i _ ..... _.._._....
NOT . .. .,.
NOTICECE TO APPLICANT:If,afar making this Cenificem of Exemption.you should `
Z become subject to the Worker's Compensation fervid of Ne'Labor Code,you most
Z mor Nls ter t shell h deemW revoked.
. ' ON LENDNG
F+ forth M comely iN sueA Pmv slo pe
ofN we iebr wM rChat fin CTI AGENCY ' ''
r
I ertb aRrtn that Ncrc is ecpnsWCU nlend y
h Y ``ayenc for the Performance
A h this permu rsissued(S 3097 Ctv C) „
..Lenders Neme :....,_. .:... . ... .....:.: . ..:_..- . s ... _. ._ . ._ __._. ._..__ .... .._. ._. .__ .._..... . . ......_. _.... .._..
E, LcddcYa Addreev _ . ... _. ..... '..
1 cenifY Net 1 have ued Nis application and mm Net the above information is
(L: coiihr.I ague m eomply.withall gry'i nd roomy ordinates and sou laws relating
��� to Willing convrodion.and hereby aumoriu represenimivd of Niacity to enter upon
tgj me ebovc.Inamo ned pmpeny for inspection purposes.
z (We)egree tosave•Indemnify and keep harmless the City of Copenrnoigeinst
w-y' liabilities,judgments,costs and expenses which may any way accrue egtinat said
V CItY n cdnseyve of the glenbng of this Parma "' �J
APPL1�.NT ryry99D¢¢DERS'tAND vt'GWiu.COMILv rHALLNOOV--ro'r' Issued by: Date
S0 'RRVCATT ". 7I—G 6-
fAppllca tnam,.+.,, Re-roofs
HAlARDOUSMATERIAIS,DISCLOSORE
as_ Will the epvpliamorPowebuilding meopantstoreor handle haiardoosmaterial Type of Roof
def ed.ley Ne Cupnmw Municipal Code Chapter9 17 and the Health and Safety
Code
0Y.". t.,t...
n
_ _ .A1Lreofs shall be inspected prior.to.any roofing.material being installed...
_. ...
WiI1tW applicaritor con baaein{«cup.m use equipment ordewes which If a roof is installed without first obtaining an'ifispection, l agree to-removesonar huadous ar eonumrn LL u definedd by the Bay Area Alf Quality Management
Di:met^ all new materials for inspection. Applicant understands and ori] comply,with .
f�tl ❑Yoe No,t It 't n l a: "I_ -all non-points icey�ulattons.-.
oI have lth&Se hti Coe.ecti6nals nqu 255331.under Chapter mta 0/Ne ��,, ..
ire f cora Hetlm.Sef. Code Senium ion,d t it
and]pons 1 ity to
Net
4>np p is m)mpomtb responsibility moroti(y the
u w of a n n umea0 hew a urians met t
y minfine of
i O�7 Signature of_Applican_t_ Date
w In� e ,
menLL N Vil be mel Prior to Issuance Of a�
.. _ _. .
own. pre:ed a ant oya ., I All roof coverings to be Class `B"or better `
...: - ..r. -- OFFICE - . .. _ .. ._. .. - -- " .. -- .. .. . ..
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CI 0 Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: _ �.e AJ-74- e0qkS
Address: 22- 2,L9 of r I cLe YL
� n ,
Reroofing Company Name: V r S s7 2ao �i �✓`�
Applicants Signature: dz-z�� Date: - -03—
Joe
02•-
Joee Antonucci
(Chief Building Official)
6/25/01