03060059 ;BCUILDING
TY OF CUPERTINOs BUILDING DIVISION PERMITADDRESS: FOUR SEASONS ROOFING PERMIT NO.03060059
ER'S NAME: 645 HORNING ST PERMGT x
S'I5 7706/2003
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo� LICENSED CONTRACTOR'S DECLARATION O ! O
£u 1 I¢rtby grim Met I am liu999yypeeer pmvivons of Chapter 9(rommeming Job Description a'
with Section )of Division 3.f=POCU Profcasions Code,and my liceve is
in full forte cRcc ✓✓ 003
Lmense Lie.« 'REROOF - JUL 0 3 Z
^� ARCHITECTS RATION
q' ��'TandersunJ my plans shall M1c uudns public records BUILDING
5yU
g G� Len
icsed Professional
3 OWNER-BUILDER DECLARATION
m I hcraby affirm Nat I am exempt from On Contra or's License Lew for the
O O following meson.(Section 7831.5,Business and Professions Code:Any city or county
<$ which requites a Permit to construct.alter,improve,demolish,or repair any s metere
prior to its issuen¢.also oupdoca the applicant for such Permit to file a signed su¢mem
ESC Nat he is licensed pursuant to Ne provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $Y�"on
' (commencing with Section 7000)of Division 3 of Me Business and Professions Code)or
y 5$ that h is exempt therefrom and the passu for Me alleged caemption.My violation of
Section 7031.5 by tory applicant for a Permit subjects the epplicam to a civil penalty of( 3AffiN 81(Atlt$[ 0 0 Occupancy Type
cot more Nan five hundred 6.11s.s SSW).
❑1,or owns of Me Property.or my employes with wages ss Meir sole compensation,
will do Ncwotis and Me structure is not intended or offered for isle(Sas.7014,Business
and Professmns Code:The Conuactnrs License Lew does cot apply to en owner of - Re uired Inspections
property who buildsor improve demon,endwho doessuch work himselforthrough his 307 — INSULATION
awn cropmyues.provided datstehimpm.emenuere.or mounded moffemdforaele.If, 601 — ROOF TEAR OFF
however.de building or improvement is mid within one year of completion.Me owner-
buaderwithaveMewmenofprovingthatWdidnotwndorimproveforpurposeof 602 ROOF PLYWOOD NAIL
Ute.).
❑I,ss owmr of the pmpeny,am asemsively eonuaerng with licensed contractors to 603 — ROOF BATTENS
construct Me project(Sec.IDLs.Business and Professions Cade:)The Conuacmrs U. 604 - ROOF IN-PROGRESS
«Me law does not apply an an owner of ierapeny who builds or improv demon,and.
who contracts foraucli pmjccm with a coma uor(s)licensed prostate in the ConuactoYs
License law.
❑I an exempt under Sec. ,B&P C for this moon
Ovo Data
WORKER'S COMPENSATION DECLARATION
larm
1 hereby aunder penalty of perjury am of de following declarations:
1 have and will maintain a Comftcate ofCon u m in elf-insure far woroo sCanpcn-
amen,ss Provided for by Section 370F of de labor Code,fm de performance of the
wok for which this permit is issued.
❑1 have and will maintain Wokera Compensation loduro me.or equiredl by Section
37W cruise lapse Code,for to performance of the work for which this perotit is issued
My rYsrs capes ti on lnsuece carrier and Polity num,berr m�r,
�•
'ai •r. in�oIicy�_Y�/^_C0 3.0
CERIFIR TE FEKEMPr10NFROMWORKERS'
COMPENSATION INSURANCE
(Tbuuction need cot he completed Rtie pahaft is foram hwdrtd dollar(SI W)
or leu)
I comfy dor in Me perfsnmance of Ma wok for which this permit is issued,I Mall on
employ any pcimn in any mannerso u In berome subject to the Workers Compcnulium
Laws of Califomie.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Cetiftcam of Eaemption,you should
become subject to de Workers Campenudon provision,of mo labor Code,you mute
z foMwid comply with such pmvidrou Or FULL Permit Mall be,commnd mvoecd.
Z O CONSrRUC`nON LENDING AGENCY
1 hereby alum that dem is a eomwction lending agency for rhe performance of
x the work fur which the permit is issued(Sec.3(197,Co.C.)
37 A Lenders Name
z Lenders Address
;)Q 1 certify Mail 1 have read du application end cute Met the above bar mmadue is
'l. F corncL 1 agree M comply with ill city and county ordinances and sure laws mining in
^JU building construction,and hereby authome repmunutiv of this city to cnmr upon Me
� W move-mentioned property,for impaction purposes.
(Wee)agree to on.indemnify and keep harmless tk City of Cupcuino gipcost
JzEllz incoitie;judcafthcgmntingofpis tmrmhich may in anyway accost againstuid City
inconsegmdgmac Mi.gu8 shade rspermit.APPLICA L7
rr sOURCE GU DE1 AND WILL COMPLY WITH ALL NQjijP01NT Issued by: Date
Re-roofs
tig M01 Applman✓Contractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building attmpant Som ar handle huardous material
se defined by de Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
otic.Section 25532(a)?
Ye All roofs shall be inspected prior to any roofing material being installed.
r If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or fuwm building arupum vu equipment of deviate which g p
it hmardnns air commuranu as defined by the Bay Area Air Quality Management all new materials for Inspection.
uic4 �)
C]Yes cz No
the-mad MeL Licentious ammonia reyuimments under Chip.,6.95 of Me califs.
nu
Health&Sell L Code,Sections 7558 z5 533 and 25534.1 understood Mar if Me building
docs not cuncn y vee a umans t y muponvbilisy m nndl'y Me o tapant of Me
m irtmcn� 'ch un be t missuance ora Ccnificatgpf Occypanry.�
Signature o Apph cat Date
On�r ter audorncJ egcm D,m All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P S kT I N O 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 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: I✓ C' f 2i (�ac (�S U�
Job Site Address: 0
Roofing Company Name: ro0✓ S f'K S 0d,5 Fzoo l°i t 1�7u C
A plicariYs Signature: Date:
U�
Greg eel
Building Official
Revised 1/30/03
- _ _ P,Inlul nn Oan.rinM Oenni
CITY OF CUPERTINO
REROOF 6 Ste/
' CUPEkTINO PERMIT APPLICATION FORM J/
APN# 31.) _ 3 s - oa3 Date: 6 b o >
Building Address: 'g r
Owner's Name: Phone#s
Contractor: Phone#: License#:
r=ove Seg—Su^s pijor,t1 . t-F-).; log
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Ce`^'t %.wy�_ ❑ 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: I"
Job Description: k
I to.r v� :Si.-�y l/o—t PI 36(_ 6 )Cet- -
Residential -En- Commercial ❑
Fire Zone: Yes ❑ No ®— Confirmed with Plan ' _pt. if
there are an rest ' tions: L;I
Cost of PrV: Type o ruction: Occupancy gro
_tb �e—roo�
Qty. i
A li ab 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