05100030 CITY OF CUPERTINO -77777777777777777777, �`t" '
BUILDING DIVISION PERMIT '5CONTRACTOR,�INFORMATION ,
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO.05100030
OWNER'S NAME: PERMIT ISSUE DATE
RAYMOND SHANNQN 502 HORNING ST
N
SANITARY NO. CONTROL TROL NO.
408) 278-0330
ARCHIECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
w❑ Inertbyaffirm Nadlamlicensedunder prov'tionofChapter Y(mmmencing Job Description p
�z with Section 7") (Division 3 of NC Business and Professions Code,and my license is f� Q
j� in mB carte sena r c REROOF--T�O COMP . , INSTALL '0 ��
ca Liccnm Class o- - Lk.n �O
^=w Date 6- o Convector C•
ARCHITECTS DECLARATION Q s. ,a.
orI undcrsunJ my puns shall o cold u public rtcnrds C •a g�A( gy
spy Licensed Pmfnsionel
1005
OWNER-BUILDER DECLARATION
af 1 hereby arfirm Nal I am cacmpt from the Conlraaor's License Law for the
ca 0 fallowing mason.(Section 7031.5,Business and Professions Code:Any city or county 0 �n�
i$ which requires a permit m construct.alter,improve,dcma[L h,or repair any structure ;� D'7 V.O
bprior w its issuance.also hogmhcz the applicant for such permit file a signed statement
that he is licensed pureuinto Ne provisions of the Contmcmr's License lsw(Chapter 9 Sq.Ft.Floor Area V81UattOtl_�
Y1- (commencing with Seldom 7000)of Division 3 of the Business and Professions CNe)or
i $
Our he is cacmpt dominant and that basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 0 0 Occupancy Type
not mom On five hundred dollars MOD).
❑1.as owner of the pmpcny,or my cmplayeu with wages u their sok comperom o r
will do the work,and the structure is not intended or offered for ale(Sm.7044,Business
and Profession Case The Contractor's License Law dao trot apply in an owner of Required Inspections
property who builds orimpraves thereon,and whodocs such work himself Or through his
own cmployeas,provided that such improvements are not intended or offered forsda.If.
hcwevcn the building or improvement is slid within one year of completion,the owner-
builder will have the burden of proving that he did not build or imprave for purpose of
Calc.).
❑h as Owner of the progeny,am exclusively contracting with licensed conuacbrs to
construct the project(Sec.7044,Business and Professions Code:)Thk Contractors Li-
cense Law dues not apply to an owner of propcny who builds or improves themon,and
who contracts for such pmjecu with a emavvewr(s)licensd pursuant m the Commences
Lim.Law.
❑1 am aempt under Sec. B&P C for this rtsson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby a(fvm under Penalty of pedury one of the following declination:
I have and will maintain a Cenlficmm of Consent o self-insure for Worker's Compen-
sation,as provided for by Section 37W of the labor Code,for the performance of the
work for which this permit is ismad.
have and will maintain Workers Compensation Insurance,as required by Section
37011 of the labor Code for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Camcr.le\MCf1 C/wn rPaH� Policy No.: til y-� ali-IY(l
CERTIFICATE OF EXEMPTION FROM WORKERS'
AS{Url+rW COMPENSATION INSURANCE
(Thiamctinn need not ocmnpleted Htbe permit is fmomc hundred dollars(ging)
or less.)
1 ccnify Our in Ne performance of the work for which this Permit is issued,I shall not
employ any Noma in any manner an as to become subject o the Workcri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicak Of Exemption,you should
become subject to Ne Worker's Compensation previsions of the Labor Code,you muse
.JZ forthwith comply with such provision or tris Permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that then is a construction lending agency for the perfurmanee of
Nc work fur which this permit is issued(Sec.3097,Civ.C.)
IT] Q Lender's Name
DZ Lenders Add.
U C) I certify,that 1 have read this application and sok that On above information is
14. F contract 1 agree a comply with all city and county¢Win..,and sum laws.]arm,m
pU building construction,and hereby authorize mpmsenutives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
LL (We)agree to tam,indemnify and keep harmless the City of Cupertino¢$¢lest
„F„ h liabilides.Judgmcnu.costa sena eapcnsu which ntayin anyway¢ant�agitmstaild City
t)Z in consequence of the granting of this Permit.
r. APPLICANT UN STAN SAND L OMPLY WITH ALL NON-POINT Issued by: Date /0 —�,o
SOURCE RE TIO
/o`7-e Re-roofs f (K
Signazpplicahu cto, Dak
HAZ D S MATERIALS DISCLOSURE Type of Roof
Will rho applicam tumbulIding Occupant store or handle ouNous material
u defined by the Cupenina Municipal Code.Chapter 9.12,and the Health and Safety
Calc.section 25532(¢)?
Yes All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant Or f' uwmuWildingxcupant usccyuipmendor Jcvier�wMeh If a roof is installed without first obtaining an inspection,I agree to remove
nit ha,mmus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
isvict?
❑Yes �u
1 have mad the hazardous materials acquirements under Chapter 6.95 of the Calirm-
niaHealth&Safcty Cade,Seldom 25505.25533 and 25534.1 undersand then ifft Wilding �� /O -�-Q�
does rat currently have a teaan t is my ruponinility w notify the occupend Of dk
anho a int rteSignatureofApplicant Date
10-7�e� All roof coverings to be Class"B"or better
OAF or su,horiaed age Dam
Community Development
* 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
// 3g � e� f, �o6d� �v - as/ oao3o
OWNER'S NAME: V1,61A PHONE # 0e- z -7,? -
GENERAL CONTRACTO : e eaS/a/�s/��r o FAX # Z.7g;- 03
I am not using any subcontractors: 1616 ,5,.
Signature Date
Please check applicable subcontractors and complete the following information
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
�F. City of Cupertino
+ 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
TIN 0 Fax: (408)777-3333
U P ER.
Building Department
Subject: Re-roofing policy for the City of Cupertino
17—' --Prior to permit issuance,you must agree to comply with 1997 UBC Standards
grid 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.
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.
z i,� }5.r- If plywood is installed`,a plywood nail inspection is
,S 6. . Any roofing which is applied without first obtaining an inspection,
will'iequire the removal'of all hew matehal'down to the sheathing, -
,J 'so a proper City,inspection ca ,be pei'forrriedi' -'" =1":;
n -
F.7_, l; NOTE:' If you call for.a"plywood nail-inspection and the job_is,not ready,
;,you will be.charged'a re-inspection fee of$17618;r+The re-inspecfion fee must
,n 'be paid before another inspection can be scheduled. .IMPORTANT: .
1. Flat roofs.must have a minimum of 1/a," 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: 141y N,o r „i+/noh -
' . . Job Site Address:
Roofing Company Name: �O✓r S�4 Svc S "�1�� '
Applicant's Signature: / Date:'�G�
. ' Greg Casteel
Building Official
Revised 71/2/04 -
• .. .• :'.o. Printed on Recycled Paper - - "
CITY OF CUPERTINO
CE` REROOF
�CA'XIINO PERMIT APPLICATION FORM
APN # Date:
O SY 1010s-
Building Address:
1139,
Yf n o /g V•
Owner's Name: Phone#:
Coytractor: Phone#: ___, -License #: _
Contact: Phone #: Cupertino Business License#:
A-Ce s Z'7 !?-0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
-; Asphalt Shingles %r Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
' ❑ - Other(Specify) ❑ 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: Z:.[ oG psi Ffo cn t n5 �q.l l
i 6A F,; yo j
L Residential ::�_ Commercial ❑ t_•+•+ •__•
Fire Zone: ,. Yes ❑ .-.No __._ Confirmed with Planning Dept. if
there are any restrictions: LJ -
�. Cost of Project: i Type of Construction: Occupancy group:
Qty. if
Applicable Fee lD 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
ZG .�. �