03050047 CITY OF CUPERTINO =` .- t
BUILDING DIVISION PERMIT CONTR'A,C-TORINFORMATION �";
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WING ADDRESS: FOUR SEASONS ROOFING """03050047
2,2997
CRICKET 14TI.T. RD
OWNER'S NAME: 645 HORNING ST P""ffn2/2003
S & YUN S KIM
ONE: (408) 278-0330 SANITARY NO. CONTROL N0.
ARCHITEC lENGINEER.' BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
p LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm deal I am licensed under provisions of Chapter 9(commencing Job Description
mU wish Section 7MK)ofDwiaion 3.f We Busimas and Profcesom Code.and my license,is
^=a in full force and effect O REROOF ��yy a� ` t�r
z:� Damnm Cu t'�� ConuaMr - FI Y9ALED
n °j ARCHI'TECT'S DECLA ATION
��� I undersand my prom shall be used as public records MAY 2 12003
aroLicensed Professional
5 OWNER-BUILDER DECLARATION
1 emby alrum Nal 1 am exempt form We Contractor's License Law for Inc BUILDING
p O fallowing reamn.(Section 7(01.5.Business and Pofevioa Code:Any City Or County
m which rtquima a permit to cornu L sun.improve,demolish,or ti my Mai
F Z y prior m its issuance,atm raptures to applicant for such permit in rile a signed statement
ppmm<
that Wislicensed pursuant toWeprovisions ofWe,Conuacmr''sLicense Law(Chapter 9 Sq. Ft. Floor Area $41l}p[ion
(commencing wit Section 7000)of Division 3 of to Business and Professions Coax)or
$ that W is eaempl therefrom and to basis for to alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects to applicant to a Civil Penalty Of 3444a4&tQIr7rt8CIO 0 Occupancy Type
not more Who fin hundred doles(SSW).
I.u awna of to pmpmy,a my emptoyaes wit wages u tieir role c,mpenudon,
will do We work and We swcture is nolintendedoroaered forsale(Sec.7041,Business — RR
and Professiom Code:The Contractor'sLiaae law docs not apply m an Miller of 307 - INSULATn�d Inspections
progeny who builds or improves thcmon,and who dors such work himself or through his
own employees,provided tatsuch improvemena art not intended oroRenA formic.If. 601 — ROOF TEAR OFF
however,to building or improvement is mid witin We year of completion,We owner-
builder will love to buNen of proving tat W did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
ate,')' 603 - ROOF BATTENS
I.as owner of We prnpeny,am exclusively contracting with licensed conuxturs m 604 - ROOF IN-PROGRESS
consoucl We project(Sec.7044,Business and Pmfemmas Cade:)The Contractors Li
came Taw docs not apply to an owner of property who Wilds or improves Whereon,and
who convects for such projects with a contractoRa)licensed pursuant m We Convactora
License Law,
❑1 am exempt under Sec. .B It P C for Nis mason
o er Dare
WORKER'S COMPENSATION DECLARATION
I hereby alfmt under penalty of perjury one of We fallowing dalarniam: -
I haw and will mainuin a Cenifieme of Consem these f--insure for WorkerYCompen-
vtion.u provided for by Sawn 37M of to labor Cade,for to perfarmmce of to
work for which Nis permit is issued.
1 haw and will maimuin Workers Compensation Insurance,u inquired by Section
3700 of to LaWr Code.far Ne performance of Ne were for which Nis permit is issued.
My Worker'sdC�ompensation insurance canner and Policy number art:
Cmi SSM.)(4C. F\f J P Policy N,.: DIV C,C>,' p�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
Gnus section occu nm becmnplc¢d 1f to pcoo t u forme hundred dollars(SIM)
M less)
1 cmffy Net in We performance of to work for which Nis permit Is issued,I.Nall nm '
employsnypersqrynanymm�q WheC�omc mbjecuatc W,rkeri Compensation
Lof Calif,rpyp 4�( A'3
Applicant J�w/.alY'1
NOTICE TO APo the .IL after making air Certificate of Liter odyou should
become comp y to W,has Compensation or this Permit
iA,m of Ore Taber Code,.you most
.,O foMwit comply wit such provisions or this permit shall be domed xwted.
z s"' CONSTRUCTION LENDING AGENCY
(—i 1 hereby alfrm that Were is a construction lending agency for the performance of
W> We work for which Nis permit is issued(See.3097,Civ.C.)
W Leaded Name
=Z IaMCYs Addmas
J Q 1 certify Nat 1 hew read this application and sou Wan We shove information is
I, P CMMML 1 at.m comply wit all city and county onlinances and sure laws relating in
OU Wilding communion,and bereby,autonx repcsemauws of this city to enter upon to
shove-menuuned property for
ande penes purposes.
(We,)ague m saw,indemnify and keep harmless the City of Cupertino against
Z inconsequece of We grunting
and expenses which may in anyway a<enm againn mod City /
V z APPLICANTCUNDERSTANDSthis
AND WILL COMPLY WITH ALL NON-POINT Issued by:94T�(aDate
SOURCE REGULATIONS.
Signature of a
ApplicVConDau Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We c Cu(pmt or(trove Wilding occupant n,rt or handle Dealt and
u defined by to Cupertino Municipal Code,CTaprer 9.13,cede to Dealt and Safety
Cale,Secu,n35512(a)7 All roofs shall be inspected prior to an roofing material beim
❑res � P P � Y g g installed.
Will to applicant or future wilding occupant use equipment or devices which If'a roof is installed without first obtaining an inspection,I agree to remove
mh District? us air conaminmts a defined by to Bay Arta Air Quality Management all rte aterials for inspection.
11C
i t hazardous
az
❑Yes dNm—
I have rad We hvardousmaterials"Woemen s underChapier6,95 of to Csiifor. )i1
ice Health h Safcty Codc,Sections 255)5,25533 and Z534.1 undersand tniftc Wilding tJ C
ity haw•onmt,to it u my re,NMhititY tu notify to occupant of tcyuirtismarnc,of.Crookaofacovmy. Signa[ureofA plicant Dale
wnermmt n c 'Dow J All roof coverings to be Class"B"or better
Community Development Department
Building Division
a�v�, City of Cupertino
10300Torre Avenue
CITY Of Telephone: (408)777-3228
C U P S n-p I N 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 without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of Y4" 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 wllith the above stated poli on re-roo�f/ing.
Homeowner's Name: �YV l 11 Y 5 :7
Job Site Address: 02 0,(3 c77 Cr C(�t ��
Roofing Company Name: twC
A plicarit's Signature: Date: S 03
Greg eel
Building Official
Revised 1/30/03
Pdnled on-Recycled Paper
a
CITY OF CUPERTINO 0
REROOF /
CUPERTINO PERMIT APPLICATION FORM
APN# _ Date:
Building Addresss:
Cr«t4
Owner's Name: 1. >fAN Phone#:
Contractor: Pone #: License#:
I-ouS cr S Cyts ��� •y a�3-�3�� cc �
Contact:.J�r,SPhone#: Cupertino Business License#:
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Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ^ Asphalt Shingles
tR--Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) .9
Number of existing coverings ❑ Provide I CIB.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic : ❑
Job Description:P eysn�
Residential Commercial ❑
Fire Zone: Yes ❑ . No ❑ Confirmed with Planning De t. if
there are an '
re cttons: u
Cost of j t: p
Type of Con Occupancy o
Qty. if
A 1' ble Fee ID Fee Description Fee Grou
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
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