03050074 CITY OF CUPERTINO �r '""�7'`�4y.*'Q� nri ``���7`�f�7-yxy�°,�y���'` '
BUILDING DIVISION PRET-R)
MIT jeCONTsR�iC1UR T1V^-"- M '�,
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITN003050074
OWNER'S NAME: 645 HORNING ST P�''"'n7l6/2003
CKINN HRrT0R ET AT,
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECUENOINEER: BUOAINO PERMIT INFO
BLDG ELECT PLUMB MMECH
306 LICENSHD CONTRACTORS DECLARATION Job Description
hereby efllren fast l am licensed under provisions of Chapter 9(commencing
With Section 7000efDivldon S of the Enue.emd Professlom Cnde,and my near.k �'LIAC 9p ��v®
m rota teres and erten O REROOF Ya��@O�$•. G
�'� unmaCl Ix.g .
!211
Dak�11ECI91DECLA TION JUN 0 9 2003
I understood 5 Liconad Professional
p�shall he used u public record.
OWNER-BUILDER DECLARATION BUILDING
m 1 hereby afflm Chet I am ssempt from the Commctor's License Law for the BUILDING
�A
p O following nature.(Section W131.5,Business and Dofessimst Cade:Any city at county
$ which-quires•pmmit m eonsroet,alter.improv,demoluh,m-pair say ammurt
�^ prior to its lapance,elm-quires the applicant forsuch permit to File asigned statement
< thathelallcented punuantOtiwpmvlslomnnthc ConuOkr'sLlmnu LAw(Chapkr9 Sq.Ft.Floor Area $4)blgtion
(commencingwhh Section7000)nr Division7ofthe Desi m snd ProfculmuCnde)or
$ that W I.attempt numerous and Use basis for the alleged eaemptlm.Any Woladon of
not mom 7N 1.5 an 11bvn hundred a permit subjuat the applicant to a cMi penalty of 3�APNMIlIber 0 0 Occupancy Type
❑1,to owner arthe property,or my employcu with wages as their Ole compertasdon,
w(Ildothewurk,•MthesmcturttamtinkndedaraRemdrmsak(Sa.70aa,Budma. 3Ub -
and Peofeaslow Code:The Contraction'.Liana law data not apply to an owner of 3 0 7 — I NSULAT quiz d Inspections
property w ho builds or im prove.therein,end who donnmh wink bimself or through his
ON
own employee,provided thaumh lmprowmenb we not Intended orartersd forsals.if, 601 — ROOF TEAR OFF
ba war.the building or Improvement is Old wiWn ane Kar of completion.Ne owser-
bulker will have the buNO of prodng dust he did not build or improv for purpose of 602 - ROOF PLYWOOD NAIL
41n.). 603 - ROOF BATTENS
❑1.as water of tied property,am=elusively contracting with flamed comate-to
construct the project(see.704a.Burmese and Prorealana Cade:)The Contractor'.U. 604 - ROOF IN-PROGRESS
most law does not apply in an owner of property vvho build.or Improv thereon,and
who contracts for Inch projects with a eitrunwm(s)licensed personal o ft Camrsetofs
License law.
❑InmuemptunderSec ,B&PCfmthismason
OwnerDate
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of perjury ane of W following decla-tions:
I haw and will maintain•CeNOcak of Conant k alM1tmure fm WorteM1Comperl-
7cm`
lon,u provided for by Section 7700 of the labor Code,for the performance of the
Work for which this permit Is issued.
n Mw Od will mainWn Wmkefs Compewtion huunmu,u required by Section
00 of the labor Cede.fm the performance of tite work fm which this permit Is luted.
NwrIJ,C)nm udanl cannaaNmOdmicyriu!bre�IzNer. 7StiM I"s f F folic'.....—✓'"�- 'z�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thk omilon teed not ba com plated If the permit Is future hundred dolirm(S 100)
1 certily that in the pmfomaaa of the work fm which this permit is issued.I shall am
employ any pawn in any manner an at in becomt subject to the Workers'Compenaalion
Lave of California.Deck
Applicant
NOTICE TO APPLICAND If,after making this Certificate of Eaemption,you should
become Object In the Worker's Compensation provision,of the labor Code,you mus
rJ O forthwith comply with such provisions or this permit shell be deemed mwked.
Z.~N.. CONSTRUCTION LENDING AGENCY
[-� Ihereby Alam dos there Is.ronatro[tion lendingagenry for the performance of
the work for which this permit Is Issued(Sec.3097,Civ.C.)
Q Lender's Name
7 z Lemler'sAddmas
U Q I ctNfy that I haw read thisapplication and sok that the above Information Is
is, coma.I.gra to comply with AI City and county ordinances and ink laws-leling to
0 building construction.and hemby authasia repmxntativas or this city to cnler upon ft
W alma-mentioned property fee Inspection Pugwses.
G (We)agree It now,Indemnify and kxp hgmleu the City of Cupertino against
y nabilitiu,judgement,coast and expense,which may In any way acme.gains,aid City
$4A In consequence of the granting of this Permit.
Fi APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplinHAZAR O Oak
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant m future building e,Chapter
9.1 or MMIC Health a material
u dented by the Cupertino Municipal Cede.Chapter 9.R,and rite Netlth and Safety
Cade.Sashes 25573(a)7
Yes All roofs shall be inspected prior to any roofing material being installed.
❑ No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hevandom air comaminanta u donned by the Bay Area Air Quality Management all new materials for inspection.
tI ll
❑Yes O� No
I how mW Lh.ba mdmsmskdalsmquimmcntaundorChapkrb.95 ofthe Cannon
nla Hm1db&SActyCnde,Secdom 3 .335yyand 21531.1 undenknd thatif the building
dem n y haw a knot e u my rmPomibility k notify the occupant of the
rtgA wnehmus on in.ofacomflcakafOee Signature of Applicant Date
Owner %ttharirad• t � U All roof coverings to be Class"B"or better
I Community Development Department
Building Division
fil City of Cupertino
10300 Torre Avenue
4CITY OF Telephone: (408)777-3228
UPEkTINO 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-roofing.
Homeowner's Name:
Job Site Address: 02 17 CA,C[C-0-4-
Roofing
e ERoofing Company Name: I �U�s Sc 4Su�5 �cJ
A plicant's Signature: Date: 6l
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
CITY OF CUPERTINO
IO, REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# I Date: 16 O
Building Address:
3f�1 Cf:CV_e+ t-1-
Owner's Name: nn �/ I / J Phone #;
Contractor: honvh License#:
1 o rSe So.c Q 7g-�'3 3 t.()Zi 06/
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
\ ❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ay Asphalt Shingles
Cl Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) C ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
Cl To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 'E'
Job Description:
Residential 13-- Commercial ❑
Fire Zone:' Yes ❑ No n� Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projec Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID 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
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