04080018 a CITY OF CUPEM INO
Rfu,LDiNo DIVISION PIiRM7T `CONT[UA -TOR INFO I AT4O,N:
.c 1.s.'vvle nY "- WV
r
EU I I.D ING ADD RIMS: PERMIT NO.
FOUR SEASONS ROOFING 04080018
OWE1'SOW N �3 PERMIT ISSUE DATE
SANITARY AteOL NO,
ARCHMIE-CTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MrcH
AID 1=1 A
Lop LICENSEDCONTRACfOR'S DECLARATIONIA U
tt
❑ 1 hereby affirm Nat I am licensed under pmviaions or Chzpmr 9(commencing lob De rj�t¢R
xW with Section T"l)of Division]of the Business and Professions Code,and mylicense is uu
m cora core'amt er eel. q 47/Z�
Daen C1 . �_(_6a REROOF SEP � 2004
ZFW Dad CanlWe,r
ARCHITECTS DECLARATION
1 undcrs:mJ my plans shall he uuJ as puhlic mcnNs
;LLD o� Licensed Pmfcssiooal
oIL
OWNER-BUDER DECLARATION
i W
p I o.bxemm
y affirm that I am ept from We CnmoLms Liccnu Law his the UDLDDNC�
�i 00
following ren
o.v .(Section 7131.5,Business and Pmfessiuns Cade:Any city ar county
S..
m which requires a permit to CnnseucL slop improve,demalish,or repair any structure
aa—r^ poor um its issuance,alsu requires the applicamfor such permit In file a slgMd statement
te a Wm he is licensed danuentIn he Provisions of the Contractor'sLicense Law(Chapter9 Sq. Ft. Floor Area Valua[ on
arc FC (cram mending with Section]INM))of Division]of the Business and Professions Code)or
y
that he is exempt Wemfrnm and the basis for the alleged exemption.Any violation of
Section 707 L5 by any applicant for a permit subjects the applicant to a civil penally of 3 tj PdpI�1Y}�Il7er0 0 Occupancy Type
not more Wan five hundred dollars(6500). r
❑ I,mowner of the property,or my emplayces with wages az Weir sole compensation,
will do line work,and We atmemre is not intended or offered for sale(Sec.]rld4,Buldread Required Inspections
and Pmfessiuns Code:The Coneanors License Law does no,apply to an C er of q p
pmpenywhobuilds orimprovesWereon,and who dossuch work himselfordha his
tun emplayces,provided that such improvements are not intcnd,d arolered assets.If,
however,the building or improvement is sold within one year of completion,We owner
builder will have We burden of proving that he did not build or improve far purpose of
isle.).
❑ 1,as owner of We property,am exclusively contracting with licensed connotation to
nsm¢I the Pmjecl(Sec.70",Business and Professions Code:)The Canmicam's Li.
conic law Joel not apply In in owner of property who maids or improves Wsmon,and
Who coneacts for such projects soon a ContnemHs)licensed pursuant m We Comranors
so aw.
sum exempt under Sec. .B&P C for this season
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury mm of the following declarations:
I have and will maintain a Certificate of Consent m adDinsum for Worker's Cnmpen-
sminn,az provided for by Section 3700 of the tabor Cods,for the pcnormancc of the
work far which Was permit is issued.
I have and will maintain Worker's Compensation Insufan d,az inquired by Section
"I.,f We Labor Code,far We perfmmamce of the work far which this perm,is lamed.
My Wrkers Compensation Insurance sarrier and Policy number aa:
Cartier. P.Iiey No.: _
CERTIFICATE OF EKEMPr1ON FROM WORKERS'
COMPENSATION INSURANCE
(This sminn need not be completed if Ifr P.rtn'n is forme hundred dollars(6100)
less.)
I certify Nat in the performance of the work for which this permit is issued,1 shall not
employ any Noma in any man rr ,rr8apome subject 1.WC WorYcri Cnmpensatian
Laws of California.Qa¢ Y
Applicam I
NOTICE TO API{rl NT: a to making this Ccnilcom of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J Z foMwilh comply with such pmvisiom or this permit shall be deemed revoked.
ZO CONSTRUC`1 ON LENDING AG ENCY
I here by affirm than here is a construction In nding agency for the performance of
a We work far which this permit is issued(Sec.7097,Civ.C.)
U.1 Q Lenders Name
Lender's Addrus
az
U O I certify Wet I have read this aPpi.lias and smote that We above information is
F correct.I agree no comply with all city and county oNlromees and state laws rdating to
OU building construction,and hereby authorize representatives of his city to color uponex
W
above. )amd property far inspection dumases.
(We)
gy (Wc)agrees,seam,indemnify and keep hay in an W City accrue
Cupertino against
Fro Iiabilitieq=nc mchegra¢ind expcnsesmit. may in any wayaccrue against sail City
U z In consequence of the granting of this permit.
'-+ APPLICANr UNDERSTANDS AND WILL COMPLY W1TIi AI-L N N POINT Issued by: Date
SOUS ERP UL ONS.
y/�G �/ Re-roofs /
S#,WdIrrearApplicandUCortmear Dain
HAZARDOUS MATERIALS OISCLO RE Type of Roof
Will We applicant or future building(.,.pantwore or handle hasad to,maensl
as defined by The Cupertino Municipal Code,Chapter,9.12,and the Health and Subtly
Code.Section 25572(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the apolicant or future building occupant uu equipment or devies which If a roof is installed without first obtaining an inspection, I agree to remove
nit hamrdaus air contaminants az donned ray the Buy Arca Air Quality Management all new materials for inspection.
mist S
❑Yes /<N A
I have read We hmsdaus materials mquimmenes under Chapter 6.95 of We Callfor O
V§�Pr
255(19.25ynand3557d.1aarm rWdifdxhuilJing
alit ii my responvihilitnudty tM u'n(rtois,a.ae,or.Cenm ar PanCy. Sig turcofApplicant Date
�C/
Own ru au Wrired(fent All roof coverings to be Class"B" Or better
oDam
Community Development
Cupertino
Torre Avenue
P
� Cupertino CA 95014
_-: Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTIN® TD
JOB ADDRESS: // PERMIT #
1e)0'2 7 h4.tt �/ `v�-� 0
OWNER'S NAME: PHONE # z '7S -0 3s�
GENERAL CONTRACTOR: Se-�..y F?a�>;i� FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
66 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 -� Seas�tis 7 7 1 0
Septic Tank
Sheet Metal
Sheet Rock
Tile
oC
Owner/Contractor Signature Date
Community Development Department
Building Division
9
aEkT
City of Cupertino
10300 Torre Avenue
CITY OF 777Telephone: (408) 777-3228
CUP �N 0 Fax: (408) -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 V4" 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: D-e- `s"L O ec,�s
Job Site Address: 00 7 )—ci t,,2
Roofing Company Name:
A plicant's Signature: ate: 2��y .
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 02 o a k'
REROOF
UPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
67O 77
Owner's Name: Phone #:
Contractor: � Phone #: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
rX Other(Specify) CF��,xa3 ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
rw f"
Residential E;� 1 Commercial
Fire Zone: Yes ❑ No Zl--- Confirmed with Planning Det. if
there are anrestrictions: IJ
Cost of Project: Type of Construction: Occupancy group::
Qty. if
A li ab 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