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04070144 CITY OF CUPERTINO ^°"'"'� ' ^*� BUILDING DIVISION PI✓RMIT = CONTRACTOWINFORMATION vin,. BUILDING ADDRESS: ALL SEASONS ROOFING SERVIC 9" "'04070144 ,10151 .9 DR, ANZA RT,vn OWNER'S NAME: PERMIT ISSUE DATE AMBINDER MONTE IMF ONE: SANITARY NO. CONTROL NO. 408 971-4455 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION Job DOSCTIpI100 I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing iWm❑ with Section 7000)of Division 3 of the Business and Professions Cod and my license is m❑ n jtj? m rate force mderre t. ]J/ 09% REROOF W/NEW BUILT-UP ROOF �QU4`Jf � ® License�r Lk.N n F p Date -/� -(J ` Contractor WWy ARCHITECTS DECLARATION oar Iundcs d ansa hall be used as public records AUG 152004 JyU x.0 Licensed clarnnal 3 OWNER-BUILDER DECLARATION BUILDING ING M 1 hereby affirm Net I am exempt from ft Car nnofs Liecme Law for the II IIA��pait^ x00 following reason.fSeedun 703 1.5,Business and PrOkasium Codve:Any city or county . m which requires a permit to construct,alter,improve,demolish,or repair any suumum �Z6prior to its issuance.alms requires the applicant for such permit to File a signed statement that he is licensed pursuamm,he provisions of to Connor m 's Lies.Law(Chapter 9 Sq. Ft. Floor Area Valuation �F$ (commenring with Section 70M)of Division 3 of tM Business and Professions Code)or i - Nn he u exempt Beteftom and the hers for to alleged exemption.Any violaum of Section 7031.5 by any appllemt for a permit subjects she applicant to a civil penalty of 3 5'3)NgAWr$er0 0 Occupancy Type not more than Eve hundred dollars MOB. ❑1.as owner of she property,m my employees with wages u their sale compensation, will do the work and theawcmm is not intended m.ffi and for sok star.7W.Business and Profession Cade:The Conuacmr's Li..law arcs trot apply m an dam r of Required Inspections radiator who builds orimproves thereon,and who Jousuch work himselfortough his own employ=,provided Nat such improvements ere not intended moRered foreale.If, howeveo Ne building or improvement is sold within one year of eumpletion.Ne owner Wilder will have the burden of moving Nat he did not build or impmw fro pugrose of sale.). ❑1,as owner of the property,am uelumvely convecting wit licensed convacmrs to construct the pmjcn(Sec.7W.Business and Professions Code:)The Conuacor's Li me Law dues not apply to in owner of property who builds or improves Lemon,and who contracts for such pmjcm wish a contractor(s)licensed pursuant to the Commctoi s License law. ❑1 em exempt under Sec. B k P C for this mason owar, Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury ore of the following dectimmom: ' I have and will mainuin a Cenifcae of Consent to mit-msum for Worker'sCompcn- sation.as pmvidcd for by Section 37M of me labor Code,for the porrormma a(tire work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,u required by Section 3700 of the labor Code,for tc Wiformance of the work for which this permit is issued. My WalareaCmmau apeon lnsurznce comer and Policy number are: Cartier. (5-A�. Policy No.: 017 5�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu sevum need not Wcomplowd if the permit is for one hundred dollars(SIM) or Icss.) 1 ccmfy that in me performance or me work for which this permit is issued,1 shall not employ any parson in any mortician as to become subjccua me Workers'Compcmation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should become subject in the Worker's Compensation provisions of to Labor Code,you mum Z foMwith comply wit such provisions or this permit shall M deemed reeked. ZO CONSTRUCTION LENDING AGENCY j-.(Z' Ibrichy affirm mu inert is a construction lending agency for ate performance of D:> be work fur which ms permit is issued(Sec.309?,Civ.C.) W Q Lenders Name =z Lender's Address U Q 1 certify that I have read this application and sue mat me above information is Ii F coma I agree to comply wish all city and county ordinances and sum laws relating to OU building mnswction,and hereby autoris repmseornives of this city to enter open the W almvcmemmned properly for inspection purposes. We)agree m save,indemnify and keep harmless @c City of Cupertino against F'N liabilities,judgmenu.cosu and expenses which may in any way accrue against said City U Z in rmsequcnecof te'nstingof this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATI NS. �39uy 7`ZDow Re-roofs Sid tourc Of ApplicaHAZARDOr Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will she Mapplicantmfubuildingoccupantmwcar handle h anmateriel ' u defined by the Cupennn Municipal cipal Codc.Chapter 9.13,and the HHahncalsh and Safety Codc.Sc❑c 9"10.25532(a)?25532(x)? No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building mcupam was equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit w7aximas air contaminants as defncd by me Bay Area Air Quality Management all new materials for inspection. 7_�ffl isvict? ❑Yes Ire1 have mol tohaganus mamrials requirements under Clomer 6.95 or the Califao-u Health&SawlyCode,Sections 35505.25533 and 35534.1 undersand Jw iftc Wildingoes nm currently hoe a wro nt.mat it u my esponsihility m ratify ow oecupam of We yviEc cin priorto issuance ofa Certificate of �cy.v Slgn [Ute Of plicant Date E ,e y All roof coverings to be Class "B"or better .� Community Development _ 10300 Torre Avenue aI Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # !o%si 070 r 4LA OWNER'SNAME: 1'/1ic(j1j PHONE #6-5L? c/-8S'OD GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 'W/LL Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing ✓ oofing � Septic Tank Sheet Metal Sheet Rock Tile �Z3 �r/C(Vhtractor Signature Date Community Development,Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 IST I N O Fax: (408) 777-3333 C O P E 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: / f!lreU3 l�'(iC_�,ao o lob Site Address: �(�/J`r//� S . t/2 AEIZ� 810d Roofing Company Name: / r �4✓��/t/� ��ny" ( 7 A p'Cant's Signature: 75�r Date: GregTteel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN#3 S 1001!S 0 0 (s Date:�_n ^� Building Address: �J YVW-Cu Y VIA 1: C. Owner's Name: Phone #s 101 S ( (,o5o `tay Bsc�� Contractor: Phone#: j( License #: cS?A6O l 'C ,S Contact: Phone#: Cupertino Business License#: 3 ca-go — 014(00 Type of Roof Covering: Existi�tBpos g: Pro ed: ra' uilt-Up Roof Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ 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: d, &Jet3 S l Icy Biu+� Residential ❑ J Commercial Q Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: IJ Cost of Project: Type of Construction: Occupancy group: 15, V V0Applfc9 . i is ble 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 Z 2