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03060055 CITY OF CUPERTINO BUILDING DIVISION PERMIT (CONTRACTOR INFORMAa�ION BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO D3060055 OWNER'S NAME: 645 HORNING ST PERMIT L�IgAj u6/2003 1F ANZA OAKS HOA NE: (408) 278-0330 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARATION Job Description uC 1 botchy affirm Nat 1rumoredo er rumored under provisions of Chapter 9(commencing ��W wiNSecdon7atq) fDivislon3of theBWoessuW Pmfessisr Code.WmYlicerucis n in full forts and cttm.. q jaon License Class ` '� r Lk.X REROOF F 0 rkl ;A. E 0 t: Dao: fa , Contractor pp ARCHITECTS DECLARATION W 1 undcmaml my Plans shall W used u Public mcmds gar Lireosed Professional JUL Q 3 2003 OWNER-BUILDER DECLARATION F 1 bunny union that I am ucmpt from the Contmaors License Law for the BUILDING OO o following ma71 nn.(Section 31.5,Business and Pmfessions Cale:Any city or county C S fs which mquims a permit to construct,alter.improve,demolish.Or modur any structure y prior to its issuance,aim rcquims the applicant forsueh Permit to Glc a signed statement s?4o` that he is licensed pursuant in the provisions ofthcContrmm'aLicense Law(Chapter 9 Sq. Ft. Floor Area $4Y5l0?fion at- (commencing with section 7000)of Division 3 of rhe Business and Prefeassions Code)or y $ that M is exempt themfmm and the busis for the alleged eaemption My violation of SeNon 7031.5 by my applicant for a permit mbjew tha applicant to.civil penalty of 3�PI4 BiAa not more than five hundred dollar(5500). Iyer 0 0 Occupancy Type 1,a owner of the property or my employon with wages as their sole compenutlon, mildotheworkandthesmoselurnis oatinlermded OreRemd for Wc(Sa.70a4,Bud"•• - ria and Pmfeviom Cede,The Conuxtors License Lw does ret apply to.n owner of 3 O 7 - I NS ULAT l ONd Inspections property who Wildsor imp cam thereon,and whodoessuch work himself or through his Own employers,provided that such improvements are not intended aofferW forule.If. 6O1 - ROOF TEAR OFF however,the building or improvement is mid within one year of compledon,Ne owner- tuihler.) will hoe the burden of proving that M did not land or improve for purpose of 6 0 2 — ROOF PLYWOOD NAIL sok . ❑1,as Owner of the pmputy,am emlusively contracting with licensed contractors to 603 - ROOF BATTENS construct the pmject(Sac.70a4.Business and Poefcamms Code:)no Contractor's Li. 604 - ROOF IN-PROGRESS cmas Law does not apply to an owner Of property who builds or improves thereon,and who contracts for such poopm with a contrmmr(s)Iicansed pursuant to the Contractors License Law, ❑I am attempt undo Sec ,B A P C for this msmn Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Pena ty of perjury one of the following declamt oro: I have and will maintain a Certificate efC.nsent to mlGinsum for WmWsCompcn- mden,as provided for by Seedon 37W of the Labor Code,for the performance of the work for which this permit is issued. Iff 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for that performmce Of the wrk for which this Permit is issued. My WOrke1e Co`� section I arm¢onto and Policy number am: Cartier. ^'ff-r Poliq No.: 04%0- CERTIFICATE OF EKEMPI'ION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if tic Permit is fortune hundred dolim($100) or loss) I certify that in the performance of the work for which Nis permit is issued,l shall ria employ any person in my manner an,as In become subject in she Workeri Compensation ".of ci lifomia.Data Applicant NOTICE TO APPLICANT.If,after making this Ccrdbealc of Emontion,you should become subjW to the Workers Comp rdemor n Provisions Of tM U,,Code,you must ,z forthwith comply with such Provisions or this Permit shall W deemed revoked. zr O CONSTRUCTION LENDING AGENCY I hereby afffrn that there is I construction lending agency for the Performance of Y the.,it for which Nis permit is issued(Sec.3097,Ci,C.) 1l Lenders None 1 Lenders Add. Z J C) I certify that 1 have mad this application and sum a..she above information is S. comet.1 agree to comply with 91 city and county ordinances and mule laws odmag to Wilding commucdon,and hereby mthim m rep ase nudvrs of this city to cntor upon Use H aabove-mcnwnrA property for inspection purromes. (We)agrte to save,indemnify and keep harmless Ne City of Cupertino against C4 liabilities,judgments,costa andettpcnsrs which mpgin my my•crnse.gaiost said City J Z in consequence of the granting of this Permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date SOURCE REGULATIONS. Re-roofs &gnuurt of AppbcanUContranor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ars future building occupant atom or handle haru bous material as defmncd by the Correction Municipal Code.Chapter 9.13,and the Health and Safety cede.Smtion 255324)7 All roofs shall be inspected prior to an roofing material beim C]Y. �fe P P Y g g installed. Will thea leant Or future Wilding Occupant use, If a roof is installed without first obtaining an inspection,I agree to remove PP 8 p cyuipmem or dcvim which g it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. LMIL1 ❑Ya UINu I have mal the harardtusmm:rials mquimmcnts under ChapterA sin he Califon ria Health&SafctyCodc,Scctiut.shat it i 2my nerpd 355k.l W nodland thO lcupant of the Q , docs not u��r,AAy��mmntly hove a n 4 that itis my rraptmihilily m nnul'y the acupant of the a re'.4c anffwhich el prior to issuance ora CcrtiGcale of act Signature Of Ap (Cant Dale dd,,.11YYl! 10� Owner or authomsd ager bad All roof coverings to be Class "B"or better Community Development Department Building Division a City of Cupertino 10300 Torre Avenue ] � CITY OF Telephone: (408)777-3228 C V P E D'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 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: ex-K5 1+ U job Site Address: Z O I `I j r ✓ DG Roofing Company Name: C A plicarit's Signature: Date:�U3 Greg eel Building Official Revised 1/30/03 CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 3 Date: D Building Address: Owner's Name: Phone#s �c 5 -X �-'� �rvl Contractor: Phone#: License#: �� r—ov-, Se�9ws (�:�0 .�1 a�4- ��3� Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ✓ P Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) C 42"A ❑ 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: f Job Description: I 06� r�:54:Aj llt--` tP! 36L u 4(+ � � �� SeyV ti Residential Commercial ❑ Fire Zone: Yes ❑ No E— Confirmed with Planning Dept. if there are any res LJ Cost of Proj t: Type of e6mtru tion: Occupancy gro Qty. if A li a e 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