03060108 r CITY OF CUPERTINO `%
BUILDING DIVISION PERMIT CONTRACTOR INFOR AT- ''�.
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO 03060108
a OWNER'SNAME: 645 HORNING ST �RMTT'Ygn6/2003
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECTrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O O
to I Wmby affirm Out I am licensed under provisions of Chapter 9(commencing Job Description
with secure 7IXg0 ofDividon 3 of tW Butlmv and Profes'nyS Code.and my license is
full forte
an
of
)t3z Do. clg(, — Ud.a �-1 ori% REROOF
F• Dam Cmvanwr F�l idµ-• R.��e®
qq ARCHITECTS DECLARATION
d I undersand my plans shall W used as public remrda
Licensed ihumsuan.l JUL 0 3 2003
3 OWNER-BUILDER DECLARATION
F I hereby affirm that I am exempt from the Contractor's License Law for IW
CO following reason.(Section 7031.5,Business and PmfendaaCc&:Any City Ofcounty B LDfNG
$_of which requires a Permit to csut ,alter.improve.demn ,or repair'my suucmm BUILDING
°zyCottonton.Cottonton. luh
Her to its issuance.aBu require tW applicant for such permit to fdeasi6ned Rncrom,
i cthatWis licensed purwant lathe provisimu.1'OcComforer',Lienselaw(Chapter 9 Sq. Ft.Floor Area 4Ygtygion
y (commencing with Section 7000)of Division 3 aftW Business and Professions Cndo)or
y $ Nat he Is exempt Nemfrom and the basis for the alleged caempdon.Any violation of
Secdon 7031.5 by arty,applicant for a permit subjects the applicant to a civil penalty of 3 APN Mffikr 0 0 Occas
on,morethan five hundred dollen(S5(KB. Occupancy Type
❑1,u Dana of the property,m my employcu with wage u their mlc compemdon,
willdo the work and thmuctum ism,intended or offered formle(Sec.7040,BusinessJ U
—
and Professions Cade:The Commerce's
License Law don not apply a an Dana of 3 0 7 — INSULATI'vN d Inspections
property who Willem improvestheresm.mdwh.ciesu uchworkhimsellor through his
mvo employ=.previdmd tonsuch Improvements ase not intended ora@red for sale.If, 601 — ROOF TEAR OFF
howeme.the building or improvement is sold within one year of cempledon,the owrer-
builder will have the burden of proving that W did rat Wild or improve for purpom of 602 - ROOF PLYWOOD NAIL
ale')' 603 - ROOF BATTENS
I,as owner of dm property,am eaelmively contrasting with licensed eonusemrs to
coewct the Project(Sec.7040,Business and Pmfeusioes Code:)The Cameramen.U. 604 — ROOF IN—PROGRESS
ceroe taw doe not apply to an owner of property who Wilds or improves thmon,and
who contracts for such projects with a cmlmeter(s)licensed pursuant a the Contractors
License Law.
❑I am exempt under See. ,B&PC for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
L have and will maintain a CeniOom of Coaem to self imum fee woskersCooper.
atian,as provided fm by Sendon 3700 of the tabm Code.for tW parfomance Of the
work fm which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Cade.for the perfmmancc of die work for which this Nmil u issued.
My Wmkcr Com( nu' hlnsunn¢Cx',,and Polity nf�ussm��k�,
Cartier. ixan Z'p Policy No.:Yy^'�'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(thissecdon need not W cmntleted if IW permit is forme hundred dollars(SIM)
or less.)
1 eenify that in the Performance of the work for which this Permit is issued 1 shall not
Laws O C3 tenon in;Any mmppecr��ppuu ly�ogome subject to the Workers'Compensation
Laws Of Calif Damm_ f. /
Applicantaa{ ta=p
NOTICE TO APPLICANT:If,afmmaking this Certificate of Exemption,you should
Wcome subject In the WoM1er's Compensation provisions of the Labor Code.you most
z forthwith comply with such provisions or this Permit shell W doomed revoked.
z CONSTRUCTION LENDING AGENCY
I homey alum our Nem us conswcdnn lending agency or tW perfomame of
the were for which this permit is issued(Sen.3097.Ci,C.)
1Lenders Iodine
z Lender's Address
:.9 O I certify that I hale read this ipplicadon and some Nu the aWve infommon is
toren.I agree to comply with all city and county ordinances and stem laws misting to
�U building construction,and hereby mododm mpmsenWives of this city to Crum,upon on
ahovm-mentioned nt,c costs
for inspectume.which may
a
G (We)agree to save,indemnify and temp hairless the City of Cupcnim against
Z in
eunce of the castsaMof tisPewhich maythany waystemagniml said City
;)z in consequence of the grantin6 of Nu pemiL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
sLgone OfApphcantrconu w Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W ill tW appliam or future Wilding ex cupmt firm or handle haudous mamdal
azdeftnmd by Ne Cupertino Municipal Code.Chapter 9.12.and the Health and safety
ode,Section 25532(e)?
1�.q. ❑Yes at NA All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mare Wilding Occupant use equipment or dcvda which -If a roof is installed without first obtaining an inspection,I agree to remove
i.
mit¢a?ardnus air contaminants az Jcfincd by the Bay Arca Air Quality Management all new materials for inspection.
o ❑Ycs •ala
1 have mad Ne haardmsmamnals requimmenu under Cname,6.95 of the Califor-
a,',(l/N'r&�,fy��s'.afety Cock,Sccdoa 25505,25533 and 25534.Imecrmnd thsifthe Wilding
q(LgCnLly haw IpnanL Nat it u my rap mibilily a nodly the occupant of the
cn hie Q c met Prior to issuance Ofa Certihum of Dec urrmey
g Inl�b�l) Signature of Applicant Date
owner or.amorrcd.6ent All roof coverings to be Class"B" or better
ICommunity Development Department
Building Division
i
- j City of Cupertino
10300 Torre Avenue
CITY Of ti Telephone: (408)777-3228
Fax: (408)777-3333
UPE,_,_,INO
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: 1�1u�ts
job Site Address: "7 — / uJ J0
Roofing Company Name: _ J/ i O✓_S Up .
hA 's Signature: Date:eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
0RERO.OF o j o
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: /
Building Address:
Owner's N AYA Phone#:
Contractor: Pho e#: 02�� 038 License#:
�✓- s e�5n��5 151 dl
Contact: Phone#:
6 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles *i Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ( L1Wood Shingles
EA Other(Specify) Ce-cc kzyoC- ❑ 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 E�r Commercial ❑
Fire Zone: Yes ❑ No J2�1 Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Project-. 00,D _ Type of Construction: Occupancy group:
Qty. if
A lic e Fee ID Fee Description Fee Group
MBUSLIC
RMFEE BldgPermit Fees BUILDING
ERGY Ener BUILDING
ISMICRE Seismic Fee Res BUILDING
ISMICOM Seismic Commercial BUILDING
ANCHK Plan Check Fee BUILDING
Business License BUILDING
z 2,10