04070170 CITY OF CUPERTINO
BUILDING DIVISION PERMIT co�rrRl�,cTOR INk'URNxAION
1 BUILDING ADDRESS: FOUR SEASONS ROOFING PEI`MIT" 74070170
10086 LAMPLIGHTER S
OWNER'S NAME: PERMITISUEDATE
DE ANZA OAK HOA 645 HORNING ST 07/27/2004
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHOEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
so, LICENSED CONfRACmR'SDECLARATION Job Description
WEF❑ 1 heathy affirm Nat I am limned under provisions of Chapter 9(commencing
WW aim Soma.7003)of Division 3 ofthe Ruetuv and Professions Code.iud my he...is
Jii�m m e. Sdart REROOF
y�z Licen Lk.p
z F,w Date U Cunhac
ARCHI CTS DECLARATION
e s 1sund my plana shall W cud m Public records /
J ld
3 in LiccnLicensedProfe
d Professional
3 Oat I son m nut from
DECLARATION
1 hereby.(Sinn Nat 1 1. esempes an tiro Cssurns Co License Law for the
O O following masa.(Section]1131.5,Business and P e,don l Code:Any city or manly
k � which mqui«s a permit to conamel,alar.impmve,dcmmlLsh,or«pair any swemre $8000
_i o prior m its issuance,also sequitur the applicant for such permitio file a signed statement -
BSCthathcisliccnxdPursoenlrotMprovisionsofdeConuactor'sLicenseaw(Chapter9 Sq.FL Floor Area Valuation
mom$ mommrnring with Section 7M)of Division 3 of the Business and Professions Code)or `G
i
don he h esempt thcmfrom and Ne basis for Ne alleged esempuon,Any violation of
Section]031.5 by airy applicant for a permit subjects the applicant a civil penalty of e IS- Occupancy Type
not mom Orion Eve hundred dollars(S Wt .
❑I.m ownu of the pmpeny,m my employcm with wag.m meir ole compcnsatiOm,
will do the work and the summa«is not intended aroRead farm,(Sec.7044,Business
and Professions Code:The Cuntncu is License Law does not apply to an anion,of Required I t1OD5
progeny who builds orim not Hereon,and who doessuch work himulf or Utmugh his
own emppoyus,provided that such improvemenp Ins ni tinended oroReud forsalm If,
hawevem Ne building or improvement is said within one Year of completion,Ne Owner-
builder will have da hurtle.of moving Net he did not Wild or improve for puryose of
sale.).
1,m owner of the property am exclusively contracting with licensed contractors to
construm the project(Sec.7044.Business and profession Code:)The Contractor's Li.
come law does not apply to am owner of progeny who Wiids or improves de«on,and
who contracts for such projects with a counse (s)licensed formal in the Commences
License Law.
❑1 am aemm under Sec. .B A P C on this reason -
Owner Dow
WORKER'S COMPENSATION DECLARATION
( I hereby affirm under Penalty of perjury am:of the following declarations:
I have and will maintain aCerdfieaeof Consent to self-imam for WorkcoSCQmpem-
,.firm,m provided for by Saturn 3700 of the labor Code,for the performance of dtc
I
ork for which this permit is issued.
❑1 bout and will maintain Worker's Compensation Insurance,as required by Section
37M of One,labor Code,for me perforsome of the work for which this Permit is issued.
My Workers Compensation Insurance aniir and Policy number are:
Cartier.fie sfJh+/i Policy No.:b IC 4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section outdoor W cion,mud if the permit is formic hundred dollars($100)
nr Icss.)
I certify that in me perromorm of the work for which this permit is issued,l shall nut
employ any Person in any marrom as to become subject to the Worked'Compensation
Laws of Calionam.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cmdreate of Exemption,you should
become Surma to me Worker's Compemnion provisions of me Labor Codc,you a=
,JZ foMwith comply with such provisions or this Permit ShallM deemed revoked. .
ZO CONSTRUCTION LENDING AGENCY
'Tr I hereby affirm that mem iso conswctinn lending agency fm me performance of
a 7 me work for which this permit is Wised(Sec.3097.Civ.C.)
W A lender's Name
IL Lender's Address
U O 1 certify that I have mad this applicmion and sum that the above infomuuu s is
U. F correct 1 agree to comply with all city and county ordinances and sure laws moving in
0U Wilding construction,and hereby aummire v:picunutivm of this city to enter upon me
r W above-mcmdoned pmleny for inspection purposes
(We)agree to ave,indemnify and keep harmicv me City of CaNnino against
liebilifica,judgmens.costs P' which may loan way we=against said City
U z in canscqucncc of th ti of mu a it.
APPLICANT U ERS( 5 ANO ILL COMPLY WITH ALL NON-POINT Issued by: at
7-� Re-roofs
Signe «Of
HAZARDOUS
ApplicaO au
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the a Cumnt n Sumo building e.Chapter
or hanand floc
h Health us and
,
as defined by mS Cupertino Municipal Code.Chapur 9.12,and the Health and Safe,y
,dftCwc,S❑mn 25532()]
Ye, NAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Smit havmdous air concomitants as defined by me Bay Arm Air Quality Management all new materials for inspection.
Distrito?
❑Yes
I have mail me commas materials mquirements under Chapur 6.95 or he Cali
ria Halm&Safety Code.Sections 5.13�3J and 25534.1uwcrsundmnifmc Wilding
does not commit hisL�M1at it k re es a s3 is,m may moccupant or occupaof On _
menu wMuh n pmrWSS cc Qfa CmufiaeD upanay Signa sof Applicant Date
zzc
ownm Qn aamQnzed ages Date ' All roof coverings to be Class "B" or better
.�. Community Development
` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: t/ ' �£( PHONE # 27Ss-(�T 33 o
GENERAL CONTRACTOR J syr S iso s a FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
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 G
Septic Tank
Sheet Metal
Sheet Rock
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone:
CITY OF Fax: (408) 777-3333
qUPEkTINO
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 1/4 " 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.
LS
Homeowner's Name: .7I/( rJ Pj 14 9:--,
t
job Site Address: L�t,(P IfV44—`—
Roofing Company Name: S e��^s /„
A plicant's Signature: / �i� Dater
ee
Greg tl
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF ° �AcOf
�I7
CUPERTINO PERMIT APPLICATION FORM
APN # i3 "—� Dater 2 O
Building Address:
Owner's Name: Phone #:
G-) e Cttwzt<t o c] Z7�-o330
Contractor: Phone #: License#:
Z7'? —'n) 7Z %DS
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering.-
Existing:
overing:Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 9C'_Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
g/ Other(Specify) 6't /•'+u,t.: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 Polic
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No 91--- Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construc Occupancy group:
cX� eel'
Qy-if
A�plijeablFee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING.
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING