03060058 CITY OF CUPERTINO
to BUILDING DIVISION
PERMIT �COPI'ri2ACT,OR�INN' RMATI(�N`
�.. 'Sai:w'x
BUILAINO ADDRESS: FOUR SEASONS ROOFING PERMIT"o 03060058
0201 PL1RWQQ9 QR OWNER'S NAME: 645 HORNING ST �"`ff`I�`��}�6/2003
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARC HITECUENGINEER: BUILDING PERMIT INFO
O ELECT PLO MECH
O
30o LICENSED CONIRALT¢¢¢¢'S DECLARATION
I he .mno thal 1 sec licensed unlJfr provil ostor Chapter 9(mmmemus Job Description
4 ala Secure ). husim31 me BuYrhaganI ProfeWons Code lmy license I. —T
In mem denecy. l �� W REROOF 71
j'g Lican �') Ue.g
C Data
Cori
ARCHITECTS DEWARATION
,I,SI 1 on& my plans dold be uacd a.pullto mcmd.
k Licensed Professional
gm OWNER-BUILDERexamptDE he comiION
I Mrehy einem mat 1 1. eumpt from he f..ionro o License ty for the J
cc 0 following muse.(Section 703 LS,BNimu and[koreuions Code:AnY tilt v county
S$ which mqulms a permit W con L alter,Improve,dcmnl W,ar.Pair my.uuclum
-zi prior to its issuance.also requires tho.pplicanl forauch Permit to rite a signed[ulement
E c "hciallmnsedpurnantmmcproviaioNofthcCanuacmrSlueticlaw(Ch.plv9 Sq.F[. Floor Area $�®Ig*ion
arts$ (cmanummg with Sztion7003)of Divulon3afine Bualneu.nd Profasaioru Code)or
3.. did he is exempt memfrom and me bub for the alli exemption.My violation of
Section 7031.5 by any applicant For a permit objects the applicant to a civil penalty of 3 APN 1500&r 0 0 Occupancy Type
not mom man 0w hundred dollars(5300).
0 I,u owner of the property,many employees with wagesas decir sole compenudon,
will do the work and thnmucu.is not intended proffered fonaia(Sm.7044,Businaa JUb - u dins actions
and Professions Cade:The Convector's Liswe Law dans not apply m an owner of jR�eeq j�p� p
property who bullds orimproves hmeon.and whodoessech work himselforduough his 307 - INSULAT�VN
ownemployeses,provided that such improvements art mat mlended aroEeaed for W&If. 601 - ROOF TEAR OFF
however.the Wilding or impmwment is sold within am Year of completion.the owrw-
WllderwiBbawtiebuNenofproNngWthe,didnmbuildmimprovefmpuryosear 602 - ROOF PLYWOOD NAIL
ate')' 603 - ROOF BATTENS
coiumer ohm wojjM If the SS".i0044 Bu�inles and PPraortcWom CadiMscocnu.n�u 604 - ROOF IN-PROGRESS
ruse law does mol apply an an owner of property who holds or improve marten,and.
who centra for such projects with a coninact .)Ilavnd pursuant to the Comrmror.
Licevn law.
0 1.03 aaempt under See. .B!P C far this recon
Owner Data
13771WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pchaty of perjury ore of the following hcleradons:
I low end will nommuin.Certificate of Cement an saf-insure fm Workers Chi
0
on,u provided for by Section 3700 of he labor Code.for the part...of the
rk for which oris permit b issued.
I have end will maintain Warkera Component Ivur.nm,u required by Secdon
of the labor Code,fur me performance of me work fns which miss permit la leaned.
`WorkereKo�re ,�l / -0 —'[-t'`K7 r-G PoII/ CERrIFlCATEOFEXEM FROM WORKERS'
COMPENSATION INSURANCE
(Thr rection need notbecomplemd If the pi is Intone h m1md dollen($100)
or li
I unify mat in the Mfornarce of the work for which thin Permit is larval,I shall not
employ any person in any matter an u m become subject m the Ni Compervemon
Laws of Caiifomie.Data
Applicants
NOTICE TO APPLICANT.If.after making this Cenlncam of Earmption,you should
bamme subject an the Workers Comxmdon provisions of the Luor Code,you most
Z forthwith comply with ash provisions or this permit shall be deemed k.d.
Z O CONSTRUCTION LENDING AGENCY
Ihe.byetrvm that have is a couuueion lending agency for he performance of
+1 he work far which this Permit is timed(Sec.301 Civ.C.)
Y Q Lendcrss Nama
=z Landerress
Landers Add
J O 1 eenify that 1 haw rend his application and rete that me show informadun Is
i coreeL I agree.comply with all city and County ordinums and sum laws relating as
building construction.said bemby.umodm represenutive of this city.enter upon the
W abovmmentioned properly far inspection purposes.
(We).gem an cave,indemnify and keep hamilw he City of Cupmtino against G3
r DI IIabllitia,judgments,eosts and eapeNu which may in any way acarus against and CIL S
i
U APPLIq a UNDEf be R
anon of this permlt.
APPLIC UNDER SAND WILL COMPLY WI NON-POINT Issued by: Date
SOUR E E ULA CQ�
Re-roofs
igen inn of Appli onv.cmr Oak
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wit rep applicant or future Wilding ascapamt stem or handle huudou materiel
Is delinad by the Capitation,Municipal Cade.Chapter 9.12.and the HNIh and Safety
We.Settle.2.9532(il7 All roofs shall be inspected prior to any roofing material being installed.
DYca No
Will dte applicant or four.building oecopera me equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
I,hourdnns sit conumiNnu u de0ned by the Bay Ams Air Quality Management all new materials for inspection.
isvictT X
AwllehocandoIrcmcnts under ChaPter6.95ofheCalifonnu de,Sc7 and 255J4.IderstsMthuifmc Wildinglouw a sercapovlhil recti da m[u ant ofthereqummnt, uuur ram ySignature of Applicant Date
OwrcroramW red.gcra Dam All roof coverings to be Class "B"or better
i
RT Community Development Department
Building Division
rC. City of Cupertino
" e` 10300 Tone Avenue
� I CITY OF Telephone: (408)777-3228
C V P E'kT I N Fax: (408)777333
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: ZL.KS t� U <}
Dd O� —. ✓ �J d��
Job Site Address:
Roofing Company Name: r—60,' s 0_4 o-,s Vzoo
A pIcan's Signature: Date:—V6163)
IAJ�IJ�OC�o
Greg eel
Building Official
Revised 1/30/03
CITY OF CUPERTINO �3 0 -�
REROOF
+ CUPEkTINO PERMIT APPLICATION FORM
APN# 3 `f a- -3-9 - 03< Date:
bo
Building Address:
Owner's Name: . nn 11 Phone#:
cSwc.&'1S0d1 Wdn `t (C
Contractor. Phone#: License#:
�ov�- SeaSc�s 1 _q- -*v?
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) CQ"`'t ❑ 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:
Lt
Cs
I r_,✓• D� �� �S f �� l�o- tPl 30(- 6 elf G-� � 5 "teti
Residential Commercial ❑
Fire Zone: Yes ❑ No ®- Confirmed with Pl t. if
there are anres ons: ' '
Cost of Proj Type o 0 on: Occupancy grou :
Qty. if
A li 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
97. x°