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04080019 CI'T'Y OF CUPRTINO E BUILDING In ISION PERMIT CQNTRACI.QR INTORMATION 3„ BU ILDING ADDRESS: PERM rN0. FOUR SEASONS ROOFING 04080019 •OWNER'S NAME: PERMIT ISSUE DATE NE: I SANITARY OL NO. ARCHITLCTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ups LICENSED CONTRACTOR'S DECLARATION �r O O U C I hcrchy affirm that I am licensed under provisions of Chapter 9(commencing JOb D U wim section 9lV�Il)l of nividon 3 of On Bnsineasand Professions Code,and my riaemois V I� in fll furca 7 c I 3'q? uceun:r clasr Y` Lie.. `� o - REROOF ZFp Dam— /- Cuntraztor SEP ��// ARCHITECTS DECLARA IOy 2004 'Sy�< 1_u_ndcr;tend my plans anal[M usnl m public rtcdrds iit. Y/ r�� p p OG Licensed Prom,hereby iontl RM II��I D�(� ❑� <5 OWNER-BUILDER DECLARATION O U IL17 II\\\\\lfl f I Acrehy alarm Nm I am exempt from the Cnmmclofs License Law for the I❑1 00 following reason.(Section 1031.5,Business and Ptnfcssions Code:Any city nr county K m� which requires a Penna to consumer,alley,improve,demolish,or repair any suucmo poor o its isamnce aim)requires Onapplicanl for such permit to rile a signed slalcmcnl done ishoodcd PursumOffic pmvisinnsnfNc Comracmr's License Law(Chapmr'3 Sq.Ft. Floor Area Valuator be (commenciagwith Section 1000)of Division 3 oflhe Businessand Professions Com)or i Ihm he is exempt Reminded and the basis for the alleged exemption.Any viOlarion of Section 7031.5 by any applicant for a pem,it subjects the applicant to a civil Penaltyof3 4ttVA�j*r0 0 Occupancy Type not mnrt than five hundred dollars($50(E. , 01,asowner of the propeny,or my employceS with wagesaz their saleeompeamo n, will do me work.and the stricture is not intended croffemd for sale(Sec.1094,Business Required Inspections andmfoss Pinns Code:The CoatnLicence Law LiceLaw does not apply to in owner of q p propeny who builds or improves thereon,and who does such work himself or through his own employes,provided that such Iaproends are not intended or offered for me.IL however,the building or improvement is sold within one year of completion,On owner builder will have the Eandmi of moving Incl he did not Wild or improve for pmpoa of salt,.). ❑1,as owner of the pfopeny,am exclusively contracting wile licensed communist or comm ct the project(Sec.11U,I,Business and Professions Code:)The Conmemr's U. Ise Law does not apply to an owner of property who Wilds or improves Immon,and. who contracts for such projects with a cormsetor(s)licensed pursuant 0 the Chromatid's License law, I inn evempl under Sec. ,B&P C fm leis reason Owner Dam WORKER'S COMPENSATION DECI-ARATION 1 hereby atom under penalty of perjury One of dm following declarations: 1 have and will maintain a Ceni rime of Consent o xl N insure for Workcri Compcm cation,as provided for by Section 3100 of the labor Code,for the Performance of the work for which this pecten is issued, ❑1 have and will maintain Workers Compensation Insurance,as required by Section 310.1 of the Labor Come,for the performance of the work for which this permit is issued. My Workcl Compensmmn Insurance carrier and Policy num Tart: Cartier. I Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissenion need nmbxc rddmcd ifthe permitisforane hundmd dollars(SI0(B IrIQ 1 coni fy that in the pm Bindmee of the work for which this Pcrmil is issued,1 sha11 not emptoyany rsohmanym an become subjauo the Workers Compensation Laws of CaL Applicants ` NOTIC TO AP ANT:if,after making this Certificate of Exemption,you should bccnme lite t to the Worker's Compcnsntion provisions of the Labor Code,you must .J O foM t ply with such provisions or this permit abut[be meemed mvnked. Z CONSTRUCTION LENDING AGENCY f~ I hcrchy affirm that Baiei1a commotion lending agency(move petfunnansaf L'4 > the work for which this permit is issued(See.3191,Civ.C.) WQ Lendcr's Name 70 Lender's Address U Q 1 certify Thal I have read Ibis application and state that the above information is W P correct.I agree In comply with all city and county ordinances and state laws rclming to 0U building Cmeameim,and hereby autnorire represcnmtivesaflhis city menterupe the d ahave.mcntioned property for impvNon purposes. (Wt,)agree to save,indemnify and keep haonless the City of Cupertino against F'y liabilides,judgments,costs and eapenses which may in any way seems against mid city I-) Z to consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RV6ULAT10NS. SlnamNpPlinacmr Re-roofs ,AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(Muni building e,Chapter or handle HnIth anmaterial u dcfincm by the Cupeninn Municipal Code,ChaPmr 9.12,and the Health and Safety Cade.Sc❑c Von 25532(x)? /QX� All roofs shall be inspected prior to any roofing material being installed. Will the applicim fduwre building occupant use equipment or devices which If a roof is Installed without first obtaining an Inspection,I agree to remove mit ha>arti air contaminants as defined by the Bay Arca Air Quality Monagcmcm all new materials for inspection. n? ❑Vcs uf�Nu I have mad me hvarmmads materials mqu imnuou under Chapter 6.95 of the Cali No 70,nc�:�ffdrilcd a Healm&Safety Code,Section,25505.25533 and 25534.1 understand Nal if Oc building G C oel not wmmff,hxv tenant,that it is my responsibility m nattily the aeuPam of the quirements whir out be mel prior an issuance of a Cerdfwlc o y S (ore of Applicant Date �.3f G` All roof coverings to be Class "B" or better agcm Dam Community Development f 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 Fax(408) 777-3333 UPEkTIN® Building Department JOB ADDRESS: 100,? 7 f—q ,��//S � ]PERMIT 0# OWNER'S NAME: R2 c PHONE # ? 0 33 Q GENERAL CONTRACTOR: ,S'/2 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: 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 r-k Z o S Septic Tank Sheet Metal Sheet Rock Tile ® Z, Z3-1 �l Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino ' 10300 Torre Avenue CO-110 Telephone: (408)777-3228 C U n E kT I N O Fax: (408) 777-3333 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 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: / pnJ Z, job Site Address: / DOS �a a //S Roofing Company Name: — S A plicant's Signature: ate: y . C.1/451n1DCXt Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF zP U 8 l CHINO PERMIT APPLICATION FORM APN # 9 Z 0 Z Date: y O Building Address: Owner's.Name: Phone#: Po V tivO 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 Other(Specify) ❑ 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: Residential �- Commercial ❑ Fire Zone: Yes ❑ No Zl� Confirmed with Planning Dept. if there are an restrictions: ❑ Cost of Prbject: Type of Construction: Occupancy group: Qty. if, A lic/ab e J 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 z6 -2-- f (�'S, 7�