03060109 • CITY OF CUPERTINO - zic»1 11sew 1'1 ' ' "* '
BUILDING DIVISION PERMIT �€C$ONTRACTORTNFORMATION, ;
BUIWINGADDRESS: FOUR SEASONS ROOFING PERMITN0.03060109
1
OWNEWSNAME: - 645 HORNING ST PEwM S"69A7Tl16/2003
F, ANZA OAK T40A
NE' (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRd underSDECL/s of chap Job Description
F U ION
I ion 7 ))Item that I an limned under provisions of Chapter 9(commencing. is P
n� with Section 7axq of Division 3 of oro Business and Professions Cock.and my license is
N in full force and effect,,3 )x0� F U Ip B rq Ig C
;y: Lkeo 't REROOF If ®@}dN�i bs�m
ak- Date 6 Conlracter
ARCHITECTS DECLARATION
u I understand my plana sten be used as public mebrds J U L 0 3 2003
s G G Licensed Professional
OWNER-BUILDER DECLARATION
iE 1 berehy affirm that 1 am exempt from the Canuecmrs License law for the BUILDING
0 o following mann.(Section 703 IS,Business and Professions Cmc:Any city or county
3$� which inquire a Permit to construct,it mr.improve,demonh.Or repair any .tum
prior to its issuance.also require the applicant forsueb permit m file a signed sutemem
Eg that hoislicensed purmenuoNcprovisions ofdoContracmr'sLicense aw(chapter 9 Sq.Ft.Floor Area $4Yttggion
aF (commencing with Section 700M of Division 3 of the Business and Professions Cade)or
y F 3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant N a civil penalty of 3 APS M�IBer 0 0 Occupancy Type
not mom man five hundred dollars(M). P Y YP
I,as owner of the pmperty,or my employes with wage as their sole mmpemation,
will do the work.and the structure is not intended or offered for sale(Sec.7044,Business gn�f�yg�
and Profectiam Cock:The Conuaetoh Limine m j�e
law it=not apply an owner of 307 - I NSULAT Ren
VN d Inspections
progeny he Wildsorimproves thereon,andwho detention work Mmselfor Mouth his
own employma,provided that such improvements are nmintenled or)@red for tile.It, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner-
Wilder will have the burden of pmving Wt to did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
"le')' 603 - ROOF BATTENS
0 1,as owner of the property,em"elusively contracting with licensed convectors N
convect the pmjen(Sec.70".Business and Prefessiom Cade:)The Conuactm's U. 604 — ROOF IN-PROGRESS
moue law deco nos apply to an owner of propoty who Wilds or improves themon,and
who contracts for much projects with a eomeaetor(s)licensed pursuant N dIe Contractors
License Law.
[]lamcxailumblerSx. ,B&PCfmthisreuon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following derclan0ov:
1 have and will maintain a Certi0ate ofCons ms to self-iuum for Woromes Compen-
sation,u provided for by Section 37M of the labor Code,for me pend m Bance of 0th
work for which this permit is issued.
1 Mw and will didi um Werkefs Compensation luvm e,u required by Section
700of Ne Inbar Code,far me perfm omm of the work for which this permit is issued.
My Workcf Com uea, Ir ursnm artier end Policy bar art:
g1pl (A
Gorier. S �•� Policy No.: a�wL
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihusection recd not becrun ted iftW permit is Imbue hundrrddollars(SIM)
or Mss.)
I mnify that in me performance of the work for which this Permit is issued,l shall not
employanypersto anym SS0.0.—RV mewbjmttotWWarkeni Cmnpennam
Lapses CalifetmAppll�ti"
Laws f
NOTICE TO APPLICANT:IL after making this Certi0cate of Exemption,you should
become subject in dm Workeri Compensation provisions of the labor Code,you muss
=O foMm
with comply with such provisions or this permit shall be deeed revoked.
Z CONS'TRUCT'ION LENDING AGENCY
1 thereby arm that Nem is a mnsuucdon lending agency for M performance of
Yi Ne work for which this permit is issued(Scc.3097,Civ.C.)
yA Lender'Name
Z lender's Add.
J 0 1 codify that 1 have mad this appliadon and nam that the above information is
1 f' correct.l agree to comply with all city and county ONinarmes and sink laws mining to
7O Wilding construction,roend fherebyeecdo. rtgr"antigen of Nu city wenmrupon use
W shove-mentioned property far iexp a ses pis ch may
0. (We)agree to save,indemnify and keep harmless Ne City of Cupertino against
j Z Iiaemoes,judgments.hecoarsand expenses which they in any way urnm against said City
m consequence Of the granting of this Permit,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Sgmibrc fAppI..VConuactor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building nempam stem or handle haeNuus material
u defined by Ne Cupenian Municipal Cush.Chapter 9.12,and the,Health and Safety
od,oris zs532U)7 e1Na All roofs shall be inspected prior to any roofing material being installed.
Will rc applicant or future Wilding Occupant use equipment If a roof is installed without first obtaining an inspection,I agree to remove
it hmadow air eanuminams u de0ned b 0m Ba Area Asir ant or Manna which g P
r r Quality Management all rte serials for i s ection.
iuria? J
❑Yca Ip Nu
1 have mad M W-dinusmamrials mquimmenu undcrChapteri,95 oldie Califon \�
ria Hcalth cry Code.SceNIay25505,25533 and 25534 Iumcbmid Nat if Ne Wilding -
it=not c rte ly have (Nat itis my mipomibiliry m nettil'y oro mcopant of on,
mquimc mtaw ichor Emir to issuance ofa Ccoifmam of Q�cuT/i
//// o Signature of pp icant ate
ownerareamorivca.ant D,m All roof coverings to be Class "B"or better
r Community Development Department
fff r Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E IST I N O
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 Y4 " 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: A-,Zc, C3c-,t( S
job Site Address: 10 -3
(' Qr
Roofing Company Name: J 0-603 F l
1P'A , ant's Signature: Date: I
CilJK1R1DCX1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO v3 v
REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: C
LA) 09
Owner's Name: l•,n� � tC� Phone#:
Contractor: Ph ne#: License#: O
RL) V esus
Contact: ,/\ Phone#: a—Y1�v33� Cupertino Business License#:
t(� Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles &vAsphatt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
g>eOther(Specify) e� '� ❑ 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: I .p / //��L ( ryr� Vol
(/, C
P I l�'��� v \J �\U � t `( Vr/Y.+1✓Py C/( "fit
Residential Commercial ❑
Fire Zone: Yes ❑ N Confirmed with Planning Dept. if
there are an restriction LJ
Cost r tType of Co c o Occupancy group:
Qty. i
Appli a 1 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
# 2Z��3