03050048 CITY OF CUPERTINO
BUILDING DIVISION PERMIT Tr CONTRACTWINFORMATTON
F r
RUILDING ADD RES S: FOUR SEASONS ROOFING Pr'""03050048
23007 CRICKET
OWNER'S NAME: 645 HORNING ST "81SD712/2003
JTA JUDITH L
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ELDG ELECT PLUMB MECH
0 0 0 0
,10 p LICENSED CONTRACTOR'S DECLARATION M
2Jb Description
til I hcmaffirm No
by r
at 1 am licensed under previsions of Chapter 9(commencing
withS don70f10)of Division3ofdm Buuaaiand Professions Co ., mylicenwis
"may infnulnretanden w 3 Lm x 4T3,lou„a REROOF
i Licensenc
Z�— Dam Conumwr 5 1�U9�ff psqLE®
g ARCHITECT'S DECLARATIt
?W< 1 uMersund my plana shall he urAu public menrd
30� LfecnsedProfentio..I MAY 2 1 2003
OWNER-BUILDER DECLARATION
1 hcmby aff m that I am exempt from On Contractor's Licence Law for the
0 O following mamn.(Section 71D1.5,Business and Professions Calc:My city or county BUILDING
a which requires ir permit to cmuvucL alcor,impmw,dcmnlinh,or repair any.net..
,^2 prior in its issuance,ilea mimics ma applicant for such permit to file a signed statement
2E� That he is licensed pursuant to the provisions of the Contractor's Licence Law(Chapter 9 Sq.Ft. Floor Area $416iMtion
e (commenring with Section 70(K))of Division 3 of the Ban.and Professions Cadc)or
$ that he is emmpt thctcfirm and The hada for the alleged emmption.Any violation of
Sectlon 7031.5 by any applicmt for a permit aubjmIn the applicant in a civil penalty of 3 W4MOulfiSer0 0 Occupancy T
not moan five hundred doll..(55110). P y yPf'
re N
0 1,m own.of ffti property,m my empleym with wage ss theta mle compemadon,
will do the work,and the structure is not intended m.11.4(minde(Sce.7OM,Business 305 —
Inspections
and Profession,Critic:The Comrena's Lt..law don teat apply m an owner of 307 — I NS ULA'1'IOt� d
property who builds or improvee thereon,and who does such work himselforthmugh his
Own employees,providce that such imprommanu are sot intended croffasei for sak,If. 601 — ROOF TEAR OFF
however,the hailding or improvement is said within one Sear of completion,the owucr-
W ilder will have the harden of proving that M did am build at Improve fm purpose of 602 - ROOF PLYWOOD NAIL
sale 1.
- 603 - ROOF BATTENS
01.as owner of the property.a.exclusively contracting with licensed cormnamam 604 - ROOF IN-PROGRESS
construct the project(Sec.]Odd.Business and Professions Code:)The Conuacmr's Li-
am law does not apply to in Owner of progeny who build or improws thereon,and
who contracts for such projects with a camractor(s)licensed pursuant o fk Contracmh
License Law.
01 am exempt under See .B h P C for Nis ream.
0' Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pcood y of perjury one of the following drela.dons:
1 have and will maintain a Cenffiate of Consent to self-insure fm Wake'sCompen-
satian.as Provided far by Section 3700 of the labor Code.for the performance of the
work for which this permit is issued.
bio have and will maintain Worker's Compensation Insurance,as required by Section
3700 of Ne labor Code,for One performance of The wart for which thin permit is issued.
My Wcdcr`t6. eats,dmh 1psVau
...carrier and Policy number :
Grticr. '�-' f'�a ole Policy No.: PL(-C L'i't"I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred doll].($10(a
or lea)
I eenify that in the perfarm uce of the wok or w 'ch this permit in intend.l shall not
empmyaCa., in any mapgcuoazw�ypjeam me Worlrori Compensation
Iowaa lf D ty t l-t
Appliccant
NOTICE TO jest or Wort:If,after making Nis Cisions o of Exemption,you should
become subject w the Workers Compensation this previsions of d e char Coke,you mute
.,O foMwith comply with each provisions or this permit shall be deemed revoked. '
z'"" CONSTRUCTION LENDING AGENCY
I heroby affirm that there is a construction lending agency for one perfamance of
C the work for which this permit is issued(Sec.3097,Civ.C.)
6W. LendmS Name
= z I-andeea Addsa,s
U Q 1 cereify,that 1 haw read this application and sum that the&bow infomfatiun is
Fcancer.I agree m comply with all city and county ordinances and stain laws relating to
�U Wilding construction.and herebyruthodan mpssenutivn of this caymcnurupnn the
tlavcmendoned property for inspection purposes.
f6W. (WO agree to saw,indemnify and keep homeless the City of Cupertino against
(A liabilities,judgments.cons andespcnsa which may in any way accrue against said City Q
f> Z to consequence of the granting of this NMIL \�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplianUContracmr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hauardons material
as defined by the Cupertino Municipal Code.Chapter 9.12.and than Health and Safe
code.Sem zss3z(a)? Safety
All roofs shall be inspected prior to any roofing material being installed.
❑Yea A No
If a roof is installed without first obtaining an inspection,I
Will the applicant or town building Occupant use equipment at devices which �+ agree to remove P
mit hazardous air conuminams as&forted by the Bay Area Air Quality Management all new materials for inspection.
District? M
O Yes on
1 haw mrd dm hvardoes mamnals mi,uiromenes under Chapter 6.95 offhe Colifor-
msHcalm/ afmy Code,Sections SM5.15533 and 25534.I undersand and if the hi ilding y
does wt edd5ntly haw )F at it u my msporuibilitY m mdfy the.eta ant o du
mquimm nu hich Rt£ riorwissuartcc ofa CeNfcam of Occu m Y,it (1.S Signature of A icant Date
Owncror.otAOd; d d Dam V/h All roof coverings to be Class"B"or better
Community Development Department
t Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CUPEkT]CITY OFTelephone:
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 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-ro,pfing.
Homeowner's Name: '
Job Site Address:
Roofing Company Name:
Aplicanies Signature: Date: S/ O�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO b 3 ,�,
J REROOF
CIT OF
CUPEkTINO PERMIT APPLICATION FORM
APN# r Date:
Building Address:
a3Ce)-7 C/,' (4e4- W ((
Owner's Name: Phone#:
Contractor:L_ nn Pho #: U License#:
r (�tJr^S oti5 `�,aa yi. .�yc ate'-
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ® Asphalt Shingles
tL Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential ® Commercial ❑
Fire Zone: Yes ❑ No Confirmed lammng De t. if
�� there ar an restrictions:
Cost of P Type of Constmctio
Occu ancy gr p:
Qty. if
A h abl Fee ID Fee Description Fee Grou
BPERMFEE =Busi:ness
Fees4BUILDING
UILDING
BENERGYUILDING
BSEISMICRE ResUILDING
BSEISMICOMmmercialUILDING
BPLANCHKFee
BUSLICcenseUII DING
2&
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