04080189 CITY OF CUPERTINO �"
BUILDING DIVISION PERMIT .xCONTRACTOR TNEORMATIOW'
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NU 04080189
OWNER'S NAME: PERMIT ISSUE DATE
ONE:DE SANITARY O. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo
LICENSED CONTRdunderSDEConsofCON RNA tlO 2D
1 Wrchy affirm that I em CONTRACTOR'S
under provisions of DECLARATION
9(commencing 'IJr Illl V� IL'S LIS—'
Zto ha with SOLIH17Wl)of Division 3 club,Businessand Professions Code,and my license is
'pvni in full force and,/fpps. x1R2tOY REROOF
j�'Z LicensLrClaaz V3 l Lic.p�
Z�p Date RM22Ay Com,actor (�[D �J� 1'
a ARCHITECTS DECLAI TION SEP '--^' �oOq
I understand my plans shell be cud as mbli records
�nU
;ao: Licensed Pmfcssional O Il 11 11 D 1� (1
S OWNER-BUILDER DECLARATION U III IIS II\\VI
1 hereby affirm too I am exempt from the Conlmnnr's License Law for the
u
X p O following reason.(Section IIonstr ,.altar,
and improve,
de o li Cole:Any tiny or county
K m which its requires a pmmit means(hie a@a improve demnnit t m repair any structure
Ono
y'm grimwirs�ensed passe myo the thovisio of forsucthe Cohpermitmcense Law(ned Chapter
that he is licensed pursuant to the of Diviouof the Commerce's License Law(Chopmr9 Sq.Ft,Floor Area Valuation
k F m that he is exem with Section 70nd ch Division 3 the
the Busalleged
exempt and on.Any vi lumenCode)of
y�� loot he is exempt therefrom and tM basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3412192011)er00 Occupancy Type
.or more Nan Eve hundred dollars(5500).
❑I,u nwner of the pmpeny,or my employees with wages m iheirselc compenudon,
will do the work,and the strucmm is notimended or offered forsale(Sec.7044,Business
and Professions Cod,:The Comment's License law does not apply in an owner of Required Inspections
progeny who builds or improves thereon,and who does such work himself or through his
own employers,provided that such improvements an,not intended oroRered formic.If,
however,Ne building or improvement is held within one year of complexion,toe owner
builder will have the burden of proving Nat he did not Wild or improve for purpou of
sale J.
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70M,Business and Professions Code:)The Comeacters Li
cense law does not apply to an owner of property who builds or improves domain,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby Orion tinder Penalty of perjury ane of the following declarations:
I haus and will maintain aCcnificam of Consent to xlf insure for Workcr'sCompen-
arti on,as provided for by Section 3000 of the learn Code,for the performance-of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3](10 of the Labor Code,far the perfmmance of Ore w—p r which this Permit is issued.
My Wmkpmr�'aCompensation InmMnw tarsiercid"FZ, cram:
[ (Zaa.4E AL. L ilicy No,:W L ArOl WIO I MCI
CERTIFICATE OF MEMPTION FROM WORKERS'
V COMPENSATION INSURANCE
(This section need not he Completed if the pmmit is fbrone hundred dollars(EIBB)
nr less.)
I certify Nat in he performance of the work for which this permit is issued,I shot l not
employ any person in any manner so az to become subject to the Workers'Compensation
Laws of California.Doc
Applicam
NOTICE TO APPLICANT:If,after mining this Certificate of Exemption,you should
become subject in the Worker's Compensation provisions of Ne Labor Code,you must
Z forthwith comply with such provisions Or this permit shall be,deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
rte-. I hereby affirm that there is a comsuuminn lending agency for Ne performance of
LlC > the work far which this pemot is issued(Site.3097,Civ.C.)
W A Lender's Name
Z Lenders Addeba
C)Q I certify that 1 have read Nis city
and coon and state that Ne shove nomination tme(ing is /
W U bandit.1 agree m comply with all city and county ordinances and slate laws relating a
pU shavenmentioned construction,and herebyoinspection prpose& tativesof Niscity to enter upon the
W
shave (We)ii ctl progave for inspection keep s
(Wit)ogrce to save,indemnify and keep yinhumble.the City secure
Cupertino against
UZ
liabilities,enc memsecoals and of this expenses which may in any way eccmc againstsold City /ff`
(„)z in consequence of the granting of this permit.
APP �CppaNNaaaf111''''t������UNDF NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCE!RU_ IONSI
��3 o't
gaamm o�pPh<an m ter Dow Re-roofs
H DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building occupant store or handle haexrdous material
az defined by the Cupenine Municipal Code.Chapter 9.12,and the Health and Safety
ode.Section 25532601 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �Na
Will the applicant or future building uttmprem use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conaminams u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes No
I have mad the Initiations materials rcquircmcros undar Chapter6.95 of the Califor-
res Health&SafetyCode,Scctions25505,25533 and 25534.1 undersand thaifNe building
dxa not call ave a t t,that it is my responsibility m notify the w:cugant of the \ D D
Nqu' mcnmw c mu metpdorwissumccofa Cmdficamuf Occupancy. I.i :nature Of Applica t Date
g�
Ow r�K "A roof coverings to be Class 'B" or better
ur awneized agcn Data
Community Development
10300 Torre Avenue
;4� w
^� Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEDT
k, IN®
Building Department
JOB ADDRESS: PERMIT#
O`d0 O
t s � 8 t89
OWNER'S NAME: 6a ' o PHONE # og o
GENERAL CONTRACTOR: w FAX #
I am not using any subcontractors:_ cj� g•a 3 .p�
Signatur Date
Please check applicable subcontractors and com Tete 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
Ask Tile
- � a3 oy
Owner/Confractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) T77-3333
UPEITTINO
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: RaNFc Cns.
Job Site Address: R\,.A
J t
Roofing Company Name: o
AlicanYs Signature: Date: 8•aa•Oy
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
aR1 ,
CITY OF CUPERTINO
REROOF
OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3ti2`12012 $ - a3 • o4
Building Address:
10I16 LaMp1i9l,+er S9. Bled .
Owner's Name: Phone#:
C2>a%Aes SOAK — DE Ati ,n OAILS q0A (oos) z"t8-o330
Contractor: Phone#: License#:
SeAsoNs (40%) a 1-d -038o y -►2108
Contact: Phone#: Cupertino Business License#:
aa.LoS GP,-&AV C-S o8 0-0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles p7 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
!» Other(Specify) Ce,.,,y,.*o e ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
/�-pn Exn
emova (sri floor � rI �H Vk" oL A l Ar l,_Avc &H,N(;Lzs
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are an restrictions: Ll
Cost of Project: Type of Construction: Occupancy group:
Coo 0a� 2eAooP �esioEr .-rig -_
Qty. if
Appli4ble 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
z � 7 7