06040175 CITY OF CUPERTINO '�" ' - " '"`" -
bU1LDING)DIVISTON' PERMIT 4� '1ZAG!'nRI,m`U)KM �'If11�I
a$,Y^E;zxtisx hx «• ''". � >FNaz nk-�§',�.t
BUILDING ADDRESS: FOUR SEASONS ROOFING PMovil ND.06040172
10102 FIRWOOD DR
OWNER'S NAME: PERMIT IEEUEDATE -
DE ANZA OAKS HOA 502 HORNING ST 2 0
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACT'OR'S DECLARATION 706 Description
1 hereby mint Nan I am[immune under provisions of Chapter 9(commenting S wide Section 7Mo)of seOivWonlefdaBusinessandPrefessbnsCods,andmylkenaca
m full term and 0) TEAR OFF SHAKES . INSTALL 1/211 CDX AND GAF GRAND
SO
3@g Lice La.
�' w 3 —Gnmmr A SEQUOIA SHINGLES 50 YEAR CLASS A
DaR=�
ARCHITECT'S DE LLATION fn�
A l understand my plasmas dealt he used u public records � �r
1 ted Licensed Professional
9r`EB
sO3 OWNER-BUILDER DECLARATION
f I hereby
elRttn that 1 am exempt from the Comm mos License Low for the
p a following mason.(Section 705 1.5,Business And Professions Cade:My city or county
119 which Milm ul s permit us COMAHWI,alms.improve,demolish,or repair,ray Outcome logs
13� prior in it issuance,alw requires the applicant farsuch permit ro file a signed saammt Ft.Floor Area - Valuatiy�500
C Nmu
helalicensedpursuanttodesprovislooftheContractor'sBermelaw(ChaparY9 Sq.B (emnmencing with Section 7000)of Division 3 of the Business and Nofesslotn Code)or
that he is uempt thezefrom And On bub he the alleged euunpdom My vioWl'mt of
Section 7031.5byany applieant for apermltsubject the applianua Advil pcnslty ofppNN mber ccupancy Type
Act come Nur Ove hundred dolam(S300). 3423335 . 0 b
0 1,As owner of Int property,or my employees wide wage As dmir said compensation,
will do like well.And the seuoure a not Intended m onerra far SAM(Sec.7044.Boniness Re Required Inspections
BM—
And Professions Code:The Commute,License Law don Am apply an an owner of 9 P
pmpcny who bu0dsarhoproves Nelson.andwhadeessuch work him undf or through his
Own cmployeu•provided that such improvements rum Ant inrendW moRrsed fersala U.
however,to building or Improvement is sold widdn am you of completion,the owner-
Indian will have to b adeo of proving that he did rot build m improve for purpose of
sale.).
❑1,u Owner of to property.Am conclusively eommemi,with Bmnvd mnuatom b
conswm the pmjen(See.7044,Business and Profnsimu Code:)The Cmbm.Ter's U.
cense law den out Apply in an owner of progeny who builds or Improve thereon,and
who contract fm such project with A mntmetr(0 licensed purwant a this ConuMofa
License Law.
❑IunuAmptunder See .B&PCfmthioasau
Owner Dab
WORKERS COMPENSATION DECLARATION
40 1 hereby affirm under penalty Of perjury arc of site following decAmdoom
❑1 haft and will maintain,Cenibnt ofCouem an salf-insure for WorkcYs Camper.
Older.u provided Ter by Section 37M of dee labor Code.for dee performanuc of Ibc
work for which this permit is issued.
0 1 haw and will malnWn Worker's Cmnpensidon Insur .As required by Section
3700 of the labor CAM,fm the fictionalize of Ne work fmwhich this permit is issued.
My Wa s Compenuticn baunme artier rob Polley number Am:
Garle� 4mliry ROM 2yZu4
CERTIFl COMP EXTIONIMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(This setakin need Aetbeeornpleted Uthe perm,a(mane hundred de0ms(5100) f
or leu)
1 modify that In the perfamanm of hat walk rat which Nis Permit a issued.I shall Aot
employ any person In my ma mcrm As At become subject in the Wehen'L'nmpanaden
Laws of Califomia.Dot
Applicant
NOTICE TO APPLICANT.If,afar making Na CeniOam of Exemption,you should
become"him in da Worker's Compensation provisions of dee labor Code,you mesa
.,O fmdewiN comply wide such provisions or this permit shall he domed revoked.
z'` CONSTRUCTION LENDING AGENCY
[r I hereby alnmt that there Is a construction leading Agency for the pe-kne a of
Cf the work for which Na permit is issum(See.3177.Cl,.C)
W 0 Lender's Name
7 z leaden Addaas
U O i certify dust I have rend We application end sub Nu Ne above information Is
u,k� cotmi.1 AIrca in comply with all city and contrary aNlnuxear and sub laws relating M
0U building construction,and hereby Authorize npresenutives of Ois city to enter upon me
W above-mentioned property for inspection pury nes
(We)agree to ave,indemnify and keep h mpleu Ne City of Cupertinogain"
v-t(AA Imbilides,judgments,eosu and upemes which may in say wyacomc egalMLIA, Ctry
U wZ in<oucquenec of the{rating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RFA
--Lind Re-roofs
signuureaf i tfConumnm Dna
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Ap911.1 Or f inure building oceupatmom m handle huaNau maaral
u dented by uses Cuperum Municipal Code.Chapter 9.13.and the Nunn and Safety
41 code.Section)5532(4°. All roofs shall be inspected prior to any roofing material being installed.
E3 Y. No
Will the applicant or future building occupam use equipment Or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasaNnu air conuminanu u deftmd by the Bay Area Air Quality Management all new materials for inspection.
Didn't?
❑sin u
I have mW the huudests mSbrimsminummenuumkr ,Chapar 6.95of the Califor.
niAHUIO&SafetyCndq Swdms23305.25533And25534.lwdcr dNmlfda building
does not currently haw,anonL Nm It is my responsibility b notify to occupant of the
reyaire nienm mwtaAmaI Gerir�a,�ar`aypaT.� Signature of Applicant Date
owner o tame rad bent ,�,�+ M 1 DA; I All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
J' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEI,TINO
Building Department
JOB ADDRESS: PERMIT#
to 0 Y0/7S
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: "Z
Signature Date
Please check applicable subcontractors an complete the followin information
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/Contractor Signature Date
CITY OF CUPERTINO
am 6 of 6 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34233032 . 00
DATE ISSUED. . . . . . . : 04/27/2006
RECEIPT # • . . . . . . . . : 34163
REFERENCE ID # . . . : 06040175
SITE ADDRESS . . . . . : 10120 FIRWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DE ANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : LOS ALTOS HILLS CA, CA 94022
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 .36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 761 . 76 005516
TOTAL RECEIPT 761 . 76
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: � I-Y�,Zc, cy_j t ' •�• +1
Job Site Address: 101 2J�:)
Roofing Company Name:nS n
Applicant's SignaDate:�Zo c
• Greg Casteel
Building Official
Revised 11/2/04
I -OUN n« 5
CITY OF CUPERTINO
• - REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
0(o
Building Address:101 In ,
0
Owner's Name: 1' O Phone#: -0�3�
�c.�C i
Contractor: ��77 License M
v SQ'tSonS '1 0517 / Z F
Contact: Cupertino Busine L ense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 311�—Asphalt SJtingles
M— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) __ ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
A To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description: of(- �£ 5 f tNs� .`�� t C-6y , 0^51 (�A Ginn $uorr
O c,
Resitdential ®._ Commercial ❑
Fire Zone: Yes ❑ Nom Confirmed with Planning Dqt. if
there are nnv restrictions: u
Cost of Project: oo Type of Construction: Occupancy group:
S Soo — 2e - (Loo F`sem -7
Qty. if
RFee ID Fee Description Fee Group
PERMFEE Bld Permit Fees BUILDING
ENERGY Ener BUILDING
SEISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDING
PLANCHK Plan Check Fee BUILDING
USLIC Business License BUILDING
•