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04080021 CITY OF CUPERTINO i1NTRACTCTR TNk'fJRMATION ;�;. BUILDING DIVISION PERMIT Cs,' T BUILDING ADDRESS: PERMIT NO. FOUR SEASONS ROOFING 04080021 OW NFR'S NAME: PERMIT ISSUE DATE ONE: G ST SANITARY W& 2 QftOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH rI �+oa LICENSED CONTRACTOR'S DECLARATION Job De Crl Iy ,,per I hereby affirm lbs I am licensed under,provisions of Chapin 9(enmmencing <Yw with Section TWO) f Division 3 ofthe Businessand Professions Cnde,and my hear c is us in mu forceandeff t. Z(O REROOF i�= LiadaeClass 3 s Liek SEP TL 2004 so Dale - Contractor ^_od m ARCHITECTS DECLARATI N ?wV dProfe un yplans shall he area as pathic lemma D rs ,��LD��� Ii Licensed Professional U S OWNER-BUILDER DECLARATION 1 hereby affirm[hat I am exempt from the Contractor's License Law far the o o fimlawing armor.(Sections 7031.5,Business and Profir ado,Code:Any any or county K m which squires a permit nt amaidde,. her,improve,dcmnlieh,nr repair any epunurc m�'^ pito to its issuance,also requires[he applicant for such permit to rile a signed statement that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuator alf-$ (commenei ng with Section 7")of Division 3 of the Business and Prufesslmu CSWe)us that he is exempt Ihcmfmm and the basis for the alleged exemption.Any=df Section 1031.3 by any applicant for a permit subjects the applicant to a civil penally of 3[J�i'JI}pt3eip p Occupancy Type not more than Bvc hundred dollars(SSW). ❑h as owner or the property,or my employees with wages as their mole compensation, will do the work,and the swcture is not intended or offered for sale(See.1044,Business and Professions Coda.The entraaor's License Law dors nal apply to an uwnef of Required Inspections property who builds or improves[hereon,and who does such work himselr or through his awn emplayces,provided that such impmvemenu one at intended.,.Rend for sale.If. however,the building or improvement is sold within one year of completion,the awner- wilder will have the burden of proving that he did not Wild or improve far purpose of sale.), 1,as owner of the property,am exclusively contracting with licensed conuacma to contract the project(Sea.7W,Business and Professions Code:)The Contractor's Li. came Law does not apply to an owner of property who builds or improves demand,and. who contracts for such projects with a contractor(s)licensed pursuant o dee Cantract0 i ��4case Law. TFT lam exempt under Sec. ,B&P C for this rcunn 0w.nor Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the following declarations: I have and will maintain a Ccmificme of Consent to self-intim for Workers Compere satian,as provided for by Section 31W of the Labor Cute,her the performance of he work for which this permit is issued. ❑1 have and will maintain Worker's Compensa[imr Insurance,as acquired by Section 37W of the l-shor Code,for the performance of the work for which this permit is issued. My Worker's Cmalson tdnn Insurance carrier tad Policy member art:- Correct Pall,No.: CERTIFICATE OF EKEM"ION FROM WORKERS' COMPENSATION INSURANCE phis section need not M completed if the Irrmit is forane hundred dollars(518(1) last.) 1 certify that in the performanee of the work far which this permit is issued,l shall not employ any person in any man&5srtp3}o hacpinc subject to the Workers'Compensalim Lawsof Califmin Da[c `,c f� °° Applicant �i"� NOTICE APPL A Lmakingthis Ccninof Exemption,youehnu become ca m Com Cana dbc Worker's Compensation provisionssof of the Iahnr CnJc,you must ,J z foNr comply with such provisions nr Nis permit shall be JccmcJ revtkcJ. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a consouction lending agency rm the performance of IYi the work fur which this pcnn'it is issued(Sea307.Civ.C.) W Q Lender's Name a Lender's Address V 0 1 certify thal 1 have mad this application and auto that the above information is W F mtrect.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authanic representatives ofois city broader upon the W above-mentioned propetty,for inspection purposes. t1 (We)agree to save,indemnify and keep harmless the City of Cupertino against Hfn Iiabilidra,judgmcna,emu anaexpenscs which may in anyway accrue a,dawseid City U,Z in consequence of the granting of this permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH A L N N-POINT Issued by: SOUR C OLA IONS. �S Signature of Applicam/Conlmcier D� Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as dcftocd by the Cupertino Municipal Code,Chapter 9.12,and the Hcalm and Safety Code Section 25532(0)1 All roofs shall be inspected prior to any roofing material being installed. ❑Yea Nu Will the applicant or (Imre building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havamous air contain as defirdd by the Bay Arca Air Quality Menagcm w all new materials for inspection. istrict? 5 I]Ycs I have read dhc haaaN smaterialsrcquiremcnuunJcr Chapter 695of the Califor- HcalthrW Safc[yCWc,Sections 255(15,25533 anJ25534.1 unJcamnd thmifthc building !� /r does sol caneml ave a Ienan Na[it is my respmmm1lity[o nndly he arupam of the rcgaifmr9e nmaal mpnortnisamanaaracmmrp,m� ya�JncyC(. na re of Applicant Date owner ar a mndr.ce agnnl All roof coverings to be Class "B"or better Community Development ate, 10300 Torre Avenue A: Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 UPERTiN® 113-lllA.71ldin Department t JOB ADDRESS: 16 ( 6-7 #��� lrs, ti PERMITGYM 9- ©O 2 OWNER'S NAME: Sw , cf/i,- IPHONE # 27? -0330 GENERAL CONTRACTOR: ��� SCk5a s Gt FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 a✓� SP, s �n��-� Z/G S� Septic Tank Sheet Metal Sheet Rock Alk Tile Owner/Contractor Signature Date Community Development Department Building Division ' City of Cupertino 10300 Tone Avenue 110 Telephone: (408)777-3228 C U^EkTI 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 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. Homeowner's Name: \ ) '{� tA-,,)-Z A .5 Job Site Address: l O C0 -7 Roofing Company Name: — S A plicant's Signature: ate:�2�1 y \A�OCX7 Greg teel Building Official Revised 1/30/03 Ptinled on Recycled Paper CITY OF CUPERTINO REROOF v ° o Z ' $CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: -r Owner's Name: Phone #s (ct/-j Contractor: � Phone #: License#: 0�1r� �z�-�-��••S /t ar; " 'Z 7�—c�33 C� 7Z /0� Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles per_Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles X 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 Confirmed with Planning Dept. if there are an restrictions: E5 Cost of Prbject: Type of Construction: Occupancy group:: Qty. if^ A ica le 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