01060123 r CITY
reposONO
NPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRFSS: PERMIT NO,
23.000 CRICKET HILL RD FOUR SEASONS ROOFING 01060123
` OWNER'S NAME: APPLICATION SUB DATE
DE ANZA OAKS H.O.A. 645 HORNING ST 06/21/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
QRZ rcARCHITECT/ENGINEER: BUILDING PERMIT INFO
w'CC BLDG ELECT PLUMB MECH
L_J LI
va
COA
LRATION
o z y 1 hereby i lirm�ha IDam licensedNTRunde,pro is ons
Fm
of Chapter9(commencing Job Description
'__° with z Section 7000) REROOF. TILE TO COMP.y f is in all forte and
spa Licen240 17 SQ. FT. S
Dam �_ Conuacha
t• ARCHITECT'S DECLARATIN t
ta Dta ch- 1 undar uad my plans shall be tired as public records -
gT
u�t E p
Licensed Professional
x OWNER-BUILDER DECLARATION
w_ 1 hereby. .(Brun that 1 1. xempl from the Contraclecu.. hi License c Us.ty. for 0e
�ZC
followingnssnn (Secy ]OJ15B iters. dPe.de Chile:Any .r o hactuY
F '° which y ar. t 1construct, Imr ' p demolish,h p rany.,mctarc [
n3� p t .' l0 9 tl ppl tl Ip 't fl r d.w nnenl. .. Y ".
. klha sloe"5 ,pp m,dB- ppvs, ob L t I to (dup,er9 Sq:Pt.,FloorAlLa , - - i 8-Q nlHaliV on
m g .itns ,7p) r tin3nnheen,iuand Preamnaconm el"t'. t - . nX1s. t..Jl:e; i.v `.'
,) or that He Is exempt themfmm and the bass for she alleged exemption.Any v olauon
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty" - P y
sof not more than live hundred donors(8500). APN Number ;I' Occupancy Type
e
❑I,d owner of Ne ad the structure, my employees wise worts ss their sole c (Sea-cion, FRAME
-
WittBus n the work'ond the ode:T Is nor mended License aw fur sacs appl ]044 -
'B ;.'and-eayWonsilds TheConuodorsndwoi due n,Work 307 - INSULATIBbIluiredInspeetions
o f p pent'Who builds or improves themon and who a such a ork med or 6 01 — ROOF TEAR OF_F
o er gh h' 'n employees provided that such improvements n,one year or ,._--_ ROOF
, - - .
-;,completion,
ompleed for ror ILhowever, will have improvementis namd he did Doe year or 602 - ROOF PLYWOOD-NAIL'"�'
bdmplaien,,he ownerhuilJer will have the burden or proving that he did not build or
imrpownfmparpnseof.aled. 603 - ROOF BATTENS
- - — -
aCmurhthe of the Property, B.Ii.ivdydPonfislicalrhl¢else commcmrsm 60'4' - ROOF IN-PROGRESS' "' ��; --'-` "'--
_;' 'b;
License
<i the does
no(Sec. loan
Business aid property
who
ills or The Convenor's
'r, License Lnw does nos apply m nn owner of pmpeny who builds s improves thereon,
the
_andwctors License
Law projxu.wi,h aconuacmrts)licensed pursuent.m the _ .. .. .._._.._.__.._........- ___.. _
' +p
Contractors Licrnu Iaw..•.
F .
v c ❑1 e7 Is,mPt undc,S „`5 IGL •s B&FCfor this mason 1:! ,. . ..1 ')•.' //
Owner
" a WORKER S COMPENSATION DECLARATION
. fn' .i hereby offimi under penaltyof perjury'ane-of,thc following declarmiats:
in'n
❑ I have and will mainucenitsa m of Centocor to self-insure for Worker's
='c + Cnmpensa,ion; as provided for by Section 3700 of the Labor Code, for the
performance of,he work f ir.which this permit is issued...,
u: ❑I have and will maintain Wmkrl'iiC.rprn1n,imr InsurSnc m required bi Semio r
3700 of the Labor Code,for the performance of Ide wtak'for which,his permit is
C issued,My Worker's Compensation Insuranc carrier and Policy number ate
- Carnd"tP'KJ`s^4 A/i 'V' +•=.P ICYN �CZ170�`T3 _ _. ...._ �...-.. .._..
0 it hCERTIFIIt
CATIONOFEXEMI'HUNFROMWORKERS, _ +_ l,' ( t 't..ri t.'lx3 +j<il't�Ja� Oma,% -„
, COMPENSATION INSURANCE'' a -
. . _— _ _ ._._..._... ._....--------------------
s Iinali u'c,i6bnhd mttie completed if the fannt is for he hundred dollors.
ISI00)orless.l
Person in an Ix i
r 1 c n f th t m rh< rtormo cc of th< rk for which this , i.ved:1
II t tion y y pe y manner o a r Neto h min the Work
C ""' `
ompensa,on Lews of Californiaf Duro
.NOTICE.- _ rP _._.. ...... . _
NOTICETOAPPLICAN,1vu,ohermakini phis C..ina, fth Labor hil,yoshould as, i„" - L.
tiecbmifir co<im the Worker's C6ions or tion pr,,hit hall she meas Chile,you mut I
Z O f : --,.comply with such provisions or
permit shall be deemed mvoketl.
a "' I 7 CONSTRUCTION LENDING AGENCY ,. -
thereby
off th r th n lium o 1 d gag my f r,he performance _ ._ s. v;
(h kfor wbuh,h p u 1 ed(S .30)7 Civ Cl
pW; "Lc d ra Name... - .-._v ..,._,.. .i ties -.- _ _.._ .. .. ......_ .._ ...... ._ ..__.
Led .Adds. , � _ .. �
I rely thv I M d tti aPPll t d.t t sh uhe aM,ve of mutant,
w.F c , I g ,1 c PIY th II uY P J< 1Y d' n . and smm las I i g
D.V dre above
bo g , no anJh by amh rcprese tav fth" -ry, nuns upon
ober aha i ed propenyl specs puryo e;
[r til es 1right
6 n s de'oily a d keep harms th C ty f C pen nn r st
V1 I t Ilucs.judg nem co m d experts h ch y n a) yy «Iter cera t said
r
V 7�
City
consequen o f th g i ng ohhix perm t
iAPPLICdNTU ER NDS A\D WILL COMPLY WITH ALL hON�POINT ISsned by: Dale
3 SOUR. YS i a
S g a nmb ppn<aa c RDO r: . .. .,�;L , D le" Re-roofs
i HAZARDOUS MATERIALS DISCLOSURE
+
Willmethe Co t future bpal hdr.Chan,same" o Handle haaardHealth s Safe,,ial Type Of Roof -.._ .......
e def d by IhaCupcn o Municipal I C,de Chapter 9.12. W theHealth and Safe,,
ry '
,Code,oYa25532(a) Y � ' I Vii d Ii f' rF . t ., .v' + 1 rWad9'+ l+
�6y + , : -All roofs shall be inspected pnor.to,any rooffngmaterial.being.installed.. . _
• Wil she applicant r futurebuilding oc upam equipment devices which I If a roof is installed''with'out first obtaining ,in ihspectil:Hi, hagree:to remove
em r h d us air c w I t def 1 by the Bay Area All Qu liry Management'
D all new materi is for inspection.,_Applicant understands_ and will comply with. .
all non-poin ource regulations ..,n u• `
i A r adah h r riot materials equ m ts. d Chapter 695 fBi I
Calf a He l,li'&S f ty CW 5 t u s 25505 25533 und 25514.I rartharsouraffiniC
IN��Fp d n6 E«sn cu Ily h - amt ,rho tnmv rtsponvbd rym In ft'sec _
ocof rhe rt h ch must be me,pfliu o sone fa Cenificem ofy' f'°� Si tat re of.A bean[ _ _ Date
r g pp
r' 'Dvion.raymrroadirge r Date All roof coverings to be Class "B"or better
rr
Building Division
` } 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF 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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:: ��� /� / C) cJ f
Address:
Reroofing Company Name:
Applicants Signature:
. Joe Antonucci
(Chief Building Official)
6/13/00