03090166 CITY OF CUPEWFINO "• % �' �
BUILDING DIVISION PI✓RMIT CONTRAC�'T ,R INFORMATION R
BDILPINGADDRESS: ALL SEASONS ROOFING SERVIC EMIT"°.03090166
OWNER'S NAME: 2640 PACER LN PERMIT ISSUE DATE
SANITARY N0. CONTROL NO.
i' 4089724455
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MF,CH
1 6 LICENSED CONTRACTOR'S DECLARATION O O O O
w K 1 hereby affirm that 1 am littnAd under provisions of Chapter 9(commencing Job Description
?2w with Section 7IXgquf DivisianJof NC Busin¢saM PmfcQ Coale.And my license is �B�® qs rp irB®
a�N inefcll(.me And a // ®�QL"Y1■�1iE
,q? Li aA Clava 9 Lied 7 REROOF
cp,0 Date —� Cuntmctor,lCam
3f',y
ARCHITECrS DECLARATION NOV 2' 4 2003
2 hiU 1 understand my plans shell W used as Muhlie records
CinLiccmcJ Professional �'���
I OWNER-BUILDER DECLARATION
s f 1 hereby affirm that 1 am exempt(rum the Contractors License Law for the
O O following hamen.(Section 713 I.S.Business and Professions Calc:Any city or county
e m which requires a permit m construct,alter,improve,demolish,or repair any structure
YZi
Prior it)its issuance.also requires the applicant for such permit to file a signed statement
a< that he islimmiedPursua LtoftprovisionsoftheContnnuraLimnselaw(Chapter9 Sq. Ft. Floor Area Valuation
rt—O (cnmmeneing with Section 7000of Division 3 of the Business ad Professions Code)or
Q that he is exempt thetefmm and She basis for the alleged exemption.Any violation of 356028012 . 00
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mere man r hundred dull...($5W). P Y YP
O 1,as owner of the ymperty,or my employees with wages AS their Ale compensation,
will do the work.and the swmute is not intended or onered(or sale(Sec.7014.Business 3 05 _
and Professions Code:The Contractor's License law does not apply to an owner of F' Required Inspections
pmpeny who builds or improves Wercon,and who does such work himself.,through his 307 - INSULATION
own employees,prodded that such lmprovemenu are net intended or offered for Sale.If. 6O1 — ROOF TEAR OFF
however,me building or improvement is sold within one year of completion.the ownter-
build).er ,will have the burden of Moving That he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sem. 603 - ROOF BATTENS
C L m owner of Project
popery,,Business exclusively contracting wire licensed convenors to
censtact doesre n tapply oan owner of
Py who nsds OF
proContrerem,U. 604 — ROOF IN—PROGRESS
cox Law cts f not apply to an.wnar of Propery who seilea.,ant to the thereon,and,
who se Lace for such Projects with a contranor(s)licensed pursuant to the Contractor's
License law.
1 am exempt under Sec. ,B&P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby Nm, under penally of perjury one of the following declarations:
11.w anti will maintain a Ccnifica a of Consent to self-insure for Workers Compcm
sation,as provided for by Section 3700 of the L AWT Code,for the PiP ormanee of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the Performance of the work for which this permit is issued.
My Workers C�oo/pe/pRe��ad//oqq''Intunn�rcarticr and Poliy number am:
cameo e'�/ll/C-TR= Policy No.:
CERTIFICATEOFEXEMPUONFROMWORK S'
COMPENSATION INSURANCE
(Gon Aaiam need not W e.mpleted if Ila,permit is(or one hundred dollars(Slpn
,r less.)
1 cenify that in the performance of the work for which this Permit is issued.I shall net
emPl.y any Paraxon in any manner A as to become Subject o the WorkersCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Centric..of Exemption.you should
�s
became subject to the Worker Compensation provisions of the Labor Code,you moat
.J2 forthwi to comply with Such pravxAmns Or thin perm l t shall W deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
r+ (hereby affirm that there is a construction lending agency for Performance of
a z the wish for which this pernil is issm¢d(Six.3097,Civ.C.) �.
f7 Lendct's Name
z Lcndcr's Address
U Q 1 certify that 1 have read this application and state Nu the above information is
Fcorrect.1 agree to comply with all city and county ordinances and suite laws mining to
U building construction,and hereby authome rePresemauves of this city to enter upon the
"how-mentioned d popc costs
for ad exp uses whichama ( e
gy (We)agree m save,indemnify and keep harmless the City of Cupertino against
incoitiequinco f the
uang of this cwhich they in any way accmc against said City
U z in costseyuenec of me graining of this permit.
`^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
rWill
,"Z/
' z Re-roofs
ppucanvCmamcor ata
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
e applicant ser future building occupant store or handle havmduus material
AS the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
1ss3a(a)a `` All roofs shall be inspected prior to any roofing material being installed.
NO
ea licant or future buildin «ca ant use a ui If a roof is installed without first obtainin an ins ection, I agree to remove
PP g p y pmcm or dcvi¢s whicM1 g Ps air contaminants as defraud by the Bay Area Air Quality Management all new materials for inspection.
❑Yea �Nu
N
I have mad the llmanusmaterials requirements under Chapter 6.95 of the Cali for
nim Health&Safety Cade,Sectors ny)5.25533 and 1!SX l understand that ifthe Wilding
dots not curenlly have a tenAl,that it u my resproomi uy to Fury ate an cumeof the y
myuimmom -h mel AcerufcueofGec. ay natur Applicant ate
9z r
iter or aur .ed agent ZD.tc All roof coverings to be Class "B" or better
Building Division
10300 Tone Avenue
i Cupertino,CA 95014-3255
Telephone: (408) n7-3228
C 0 Pax: (408)Tn-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of Yd"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: CL-WA 4-55 /1�i�itav prrrc
Address: �07
Reroofing Compa4y Name: I I h eaj.-✓? s izyn-D
Applicants Signature: Date: 9 Z
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO 03
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# J Date:
e' V 9 � � a
Building Address.
r r
Own e 's Name: / Phone#:
5 n q q 410,Lr -,2,?,
-
Contractor: License#:
Contact: )
Phone#:
Applicant/Contra or.
.:Ell 08 - V77
Buil ' g Permit Info:
Elect Plumb Mech
ob escription: "T� c
Residential: R Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
7/Op G
Architect/Enginee . Valuation:
Type of Constru 'on: Occupar.cy Group: "
� oo�
QtY• .
Fee ID Fee Description Fee Grou
BPERMFEE BldgPermit Fees BUII IDNG
BENERGY Energy BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG