04080020 I CITY OF CUPERTINO ��p.
BUILDING DIVISION PERMIT �C,ONTRACT.OR INFORM, T.
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT r+o04080020
• OWNER'S NAME: FERMITISSUBDATE
NE: SANrrARY OL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
uGG LICENSED CONTRACTOR'S DECLARATION Job Descri tion
1 hereby af01m Nat I am licenud under prmisions of Chapter 9(commencing p
opwith Se ion70nO)nf Division3ofthenusinmand Pr culuns Coda,andmylkenu is f
In full to do cm r/
Lie e1.a — S Lk,Al 7 uBG RERO F
Y Date Centocor
RCHITECTS DP—.61I.
nd
Y 1 ucralan�mY Plana shall he mud u public /
3u, Licensed Prolessioml
OWNER-BUILDER DECLARATION
F I hereby affirm Nat I am exempt from the Cotwoner's Licenu Law for the
00 fallowing mason.(Section 7101.3,Business and professions Code:Any city or county
M$ which uquimh a permit to eovtmet.alter,improve,demnish,m mpair any
v,i�^ Pdmwitsissusme,rlmmquiru lM applicant far Communes
mRkso Law(charter
stammenl
that he isInvestedwith
to do,provisions of theeBuacmfs Lhcnxlsw(C Code)or Sq.F[. Floor Area j/ Valua[on
wz❑O (commencing Seeionsand or OnDivialon3 of TheBusinessessand
on.m vi CMe)old of
Not he b sump(Imerefrom and Ne basis for the alleged exemption.My violation of iy
Section 7031.3 by any applicant for a petmll subjects the applicant to a civil penalty of 3 4AP4Ut0 qr0 0 - ` .Occupancy Type
an five
not mom Nhundred delta.(ISM). � '
r
❑1,ssowner a!Ne propmy,or myemployeeswithwageu.1c(roteeom.11u.i on,
will do lhewonal ands: swcturt ts not s Laces re Law dosed act apply to an orwinm Required Inspections
prerand ertywhProfessiom Code:The ve;themon.Licence Law uch or apply to an multi is q p
own em whobulids i impious thereon.sodwho dmssnchworkhicompound
thmuge tib
ownemployees,provides pr such impuumenuin not year
of cmofferctl formlethe ow.Ir,
huilder the building or improvement bsold withinoarWeldo!comoveforNeowner-
builder will hats Ne burden of proving Nn he did not build or improve for purpose of
sale J.
❑1,as owner of Ne property-am exclusively eonmacting with licensed eonuaebn to
comment the project(Sec.704x,Business and Pmfmiam Cade)The Camnctor's Li-
mme Law docs not apply to an owner of property who builds or improve,demon,and
who contracts for such projects with a contractor(s)licensed reasons in Nm Contrumr's
LI u Law.
am exempt under Sec .B&P C for this lesson
Owner Doe
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ore of the following decla.tlo ur
I haw and will maintain a Ccnlfrme of Cement to ui4lmum for Weil er'sCompen.
.tion,ss provided far by Section 37M of the Labor Code,for the Performance of the
work for which Nis permit is issued.
❑1 hats and will maintain Worker's Compensation Insurance.u rtquimd by Section
37M of the Iobm Code,far the performance of the work for which Nis permit is issued.
My wmke a Compensation Insurance canner and Policy numbe,art:
Cartier.
Policy
No.:
CERTIFICATE OF EXEMPnON FROM WORKE�
COMPENSATION INSURANCE
V'I(Theisceflon nced not uncompleted if the permit is fmonehundred dollars(SIM)
less)
I certify that in Ne performance of the.,it for which thio permit k bound.I shall not
employ any person in any manner ss�hodme su ju110 the W(idelf CompemNon
Laws of Celifar .Dam
Applicant
NOTICE ANI" ,1RLTmgking this Cenificau of Exemption,you should
become subject in the Workerr's Compensation provisions of the Labor Code.you most
.,0 forthwith comply with such pmvisiom or this prowl hall un dcemed rooked.
„'Z.iy. CONSTRUCTION LENDING AGENCY
(-+ lunmby affirm that there its comtmatinn knding agency for the Performance of
Ix
On work for which Nis permit is issued(Sec.3097.Civ.C.)
W Q lender's Now.
]z lender's Addusa
U Q I«nify that 1 haw read this applicoion and state tha(Nm above Inrorrouhm is
H. f+ comm I More m comply withall city and county on inanms and sone law totaling to
DU Wilding construction.and hereby suNarice mpuxmai.es of this city in enter upon the
W ahove-mendured property for inspection purpose,
(We)ague to save,indemnify ad keep harems the City of Cupertino against
jy TaA
liabilities.judgments,costs and expenses which may in any way ncttuc against mid City
(„)'Z in consequence of the grunting of this perms(.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE OULATIONS.
yRe-roofs
Signaw of pplicandConmcrorate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupm,store or handle hatcardous material
o confined by Ne Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code.Section 35533(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant ruwu building occupant won equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
it haysrdous air contaminants u darned by the Bay Arta Air Quality Management all new materials for inspection.
tastier? /
❑Yes
I have lead On hatardateirmrrials mquircmenu underCMper R95 often Califon.
nuHush&reelyyK.d.wnm4e 3303,35533and33334.1undc.yft=up Wilding
does nal curtemly mots a¢nanl Nat it u my uspomihililY b notify dr amupanl of de \-
mquimmenhwhi m Ibcmclpdarus issuance ofaGaudreauof pane SignatureGfApplicant Date
Owner od.n grant aim All roof coverings to be Class"B" or better
Community Development
` 4✓ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
/Doe? 7 / 4e,r p4e�2o
OWNER'S NAME: G Ee, � PHONE #
GENERAL CONTRACTOR �-;fes S o<se s /� 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
4i"..
t
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Cl Telephone: (408)777-3228
CUPEI�TINO 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 specificatiorty 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 1A " 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: // ZMA mJe-s' /,�/p//t
job Site Address: [JPJ 22
9
Roofing Company Name: �-
A plicant's Signature: ate: 2�1 y
Greg eel
Building Official
Revised 1/30/03
Pdnted on Reoyded Paper
CITY OF CUPERTINO
REROOF �{ u ���
�CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
3 y
Building Addles:
[DD 7 2,? !- 1,S 411,
Owner's.Name: Phone#:
Contractor: � Phone#: License#:
Oma/✓ -x�..�S Z 7 —c�33U �Z /0
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Q Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Ce Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Pf Have Read, Understand and Will Comply With Cu rtino's Tear Off Policy:
Job Description:
.yfo.-cam 'r-1c,
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. i
A li a e 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
2-
� ��` 76