03060056 Ir CITY OF CUPERTINO 1^+ ""� "• �% '>✓'� � °"�=
BUILDING DIVISION PERMIT \CONTRAC7TaRINFORMATION
BUI LOING ADDRESS: FOUR SEASONS ROOFING PERMIT NO,03060056
OWNER'S NAME: 645 HORNING ST PERMIT ISSUEgAA6/2003
(408) 278-0330
NE: SANITARY NO. / ` CONTROL NO.
ARCHITECDENGINEER: BUIIDING PERMRINFO
BLDG EIRCT PLUMB MECH
0
uoo LICENSED CONTRACTOR'S DECLARATION
ZF!� 1 bertby affirm that I and Ecenmd under provisions of Chapter 9(commencing Job Descrip A
n<iwith Sutton 70710)of Division 3 of dw Business and Professions Code.and my license u 8�1,g�
„ in fullfortcandc ccL OTS REROOF
Diatom JUL 0 3 2003
CI
t Date `°" ac°r
ARCHITECTS DECLARATION
U 1 understated my plans shall W used as public mends
oG LeensdPmfessinn.I BUILDING
5 OWNER-BUILDER DECLARATION
y 1 reason.rthy.(Gens Nat 11. exempt fmm Ne Conlon Co LiAny c law for tW
❑o whiiwingnes.Peution Tfl3LEBusiussand Pmfeuiuns Code:Any city ocounty
nscus.
which requires a permit tot muuueL eller,lmpmw,deermit t file
mash anyed uttemem
_Z i prior m its ceased p also n te,the the applicant for such permit m Glc a signed shmmcnl
E�0 the Wincing wit pursuant toth)of Division
of the Comracand enmisonC Code)
Sq.Ft. Floor Area $4✓®I5�jion
a that he I,
Section7") Dasisf3r(tWegeBusiness and Professions Crdo)of
egg that o u"••opt thertfmm and far
basis for the cts ba, exemption.Any violation of
Seton.Wo 3 five
hundred
applicant(or a permit subjttts the applieanuo a civil penally of
not mom Nan fiw wmme d°vara(org). 3 9213$IpbpeT 0 0 Occupancy Type
❑i,u owner of Ne property,or my employees with wages u Noir wle compensation,
willdetheworkand thesuuctumisnotinteM doroRercdfofsak(Su.7DM,Busies"•
and PrefeWons Code:The Contractors License Law docs not apply to an owner of — Re uired Inspections
property who Wildswireproves thereon,andwW dousub work himmlfm through his 307 - INSULATION
awn employees,provided Nal such improvements art not inudcd Or offered formal If. BOJ. — ROOF TEAR OFF
however.the Wilding or improvement is mid within on year of completion.Ne owncr-
bullderwiBhavetWWmenofprovingNathedidnotWildorimprova for purpose,of 602 — ROOF PLYWOOD NAIL
sats.).
01.u..,of the propcny,am exclusively co.tosee g with licensed conuxtors to 603 — ROOF BATTENS
..=.I the pmjcn(See 7W.Business and Professions Code:)The Conuaetor's U. 604 — ROOF IN-PROGRESS
cense law does not apply w an owner of property who Wilds or improws themon,and
who contracts for such pmjcm with a co erector(a)licensed pursuant to the Contractors
License law.
❑I sac exempt under Sec. .B&P C fu Nis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby afBmt under pointy of perjury one of the following declaration
1 have and will maintain•Cutin®u°f Cmuent be self-insure fu WorkNS Compen- _
union,as provided for by Section 37M of the ISWr Code,for the performance of the
wok for which this permit is issued
�l have arta will meinuin Wallace,Compensation lemmas,a,rel by Section
3700 of Ne Ia Wr CO ..dfor Ne performance of Ne wart for which this permit is issued
My Warkeh C,[op�fcn�{Won In eapfriu and Policy nuVm�ber art�.i1
Cartier. "—'s-ac4✓ ^I Policy No.: s L0(::'�yOU
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thismetiorn need not W completed if the permit ufurose hundred dollan(SIBB)
or loss)
I certify thnt in the performance of the it for which this permit b issued.I shall our
employs ny haemo yryt^to p Lure subject m the Work,Cmnpevatimt
Lawsof Cel'f Dd Wit.
Applicam --
NOTICE TO ASPLICANT.If,after making this Cenificate of Exemption,you should
become subject to the Workers Compensation provisions of the labor Code,you most
7O foMwiN comply with such provisions or Nis Permit shall W deemed revoked.Zh CONSTRUCTION LENDING AGENCY
I hereby affirm that then is a construction lending agency for the performance of
1.'
the work for which this permit is issued(Sec.3097,Civ.C.)
ALemko's Name
z Lenders Address
J Q I comfy,that I have read Nis application and sats that tho show information is
iL P correct.I agree to comply with all city and county oNina"ces and auto laws relating to
0U building construction.and hereby mthmice mpremnutives of this city to enter upon the
�Lw above-mentioned property for inspection purposes.
r 6. (We)agree to taw.ind expenses
and tech harmless du City of Capon.against
Z Iia bililOquengmcnhe losts ggindof this Permit. may in any way ucrue gamest said City
U z in eortsequmc of the granting of Nis permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOURCE REGULATIONS.
Re-roofs
Date Stgnuurc of AppbcanUCantracmr Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
he a
S4(oel
Will tpplicant reform building occvp tar riorc or WrWlc lowArdous mamdsi
as defined by the Cupmioo Municipal Code.Chapter 9.13,and the Health and Safety
Code.S6ta zs3z(.I7
yns5d1h° All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ormwre building occupant use cquipme Iordevices which If a roof is installed without first obtaining an inspection,I agree to remove
it havatdnns air conuminants u defined by Ne Bay Area Air Quality Management all new materials for Inspection.
7❑
Yes 04.
I have mad Or hvammsmaterials requimmcnts under Chapter 6.95 of the Califar
natHeraNSecCS2Zs
does roOt c haw a ten mm
f
sihityMuluoectofc 6161
�
m wuissnof•Certfcte1 /bw
603 Signature of Applicant Date
ountt°r artM1orized stent °,te All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CCITY OF Telephone: (408)777-3228
L U P E kT] � 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: !� e r��l 2 0 t S 14- U A
job Site Address:
Roofing Company Name: o-tS koo � t �u C
A plicarit s Signature: Date:�U3
Greg eel
Building Official
Revised 1/30/03
CITY OF CUPERTIN0 3
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# ,3 � ) _ 3 S U I Date:
�o O'
Building Address:
Owner's Name: Phone#:
SaK Lente
Contractor: Phone#: License#:
fay. Seg-S�"^s (����,�1 a-)4- vJ3�� F�alo�3
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) C 42 V4 kwy�_ ❑ 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: ff
Job Description: c
I r r D� >= .5 �• �y 14i—t &61-r _30(_ 6
Residential Commercial ❑
Fire Zone: Yes ❑ No ® Confirmed with Plannin De t. if
there are an restric s:
Cost of Pr!w +� Type of Construction: cc cy group:
-� t2e-rv��
Qty. if
A li 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