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04080075 CITY OP COPER'1'INO `- yr BUILDING DIVISION PERMIT CONTRAC IORINTORMATION , nuaowc Arnnecss: FOUR SEASONS ROOFING PERMIT No.04080075 OWNER'S NAME: PERMITISSUEDATE ONE: SANITARY 9*01,NO. ARCHITECT/feNGiNEER: BUILDING MR PERINFO RLDG ELECT' PLUMB MECH (� 0 0 LICENSED CON'TRACTOR'S DECLARATION LOO W p 1 hercM1y affirm Nm 1 am licensed under pravisium of Chapter 9(cnmmcneing P„L.LL., D _?w wa/��ith Ecction]I%N17 of Divii Sof the RusinessanJ Professions Code,and myliccnu:is UL_I in fall force and efrut.nREROOF j B�? License Class `�J� Lic.N - Z'~❑ Date � Coreme A —HTCTS DECLARATION SEP 2004 5 < i understand my plans shall W used as public records QMOL�D� ;oG Licensed Professional i g OWNER-BUILDER DECLARATION O eZ booby affirm that 1 ore exempt from the Contractors :License Law fur the p o whnwi ng mason.Section 7031.3,Business and improve de em Code:Any color munty ,�, which myucs a issuance.als.m construct,alcor,ire far Such demolish,fi repair any.pmmure Fie pat heissensedprsuamgo o,ithe provision of for Contractor's Gene,oned aw(Chremcm that meacing wit pursuant of Division 3 NC Conuiness nd Proclaw(C Code) Sq. Ft. Floor Area ValUallO❑ w�$ (cat he xemptb Section 7")ofDivision]of the he alleged exemption. Any vi Cation of 5 thin he is exempt tacmfmm allot the aura for be alleged caemhad to Any violation of sr�n,n�wss Semon dom by any red della for a panni,suajecm the applicana,o a civil penalty of 3�alad W V ibeir0 0 Occupancy Type not more man foe hundred sonars($sm). P Y , 1,as owner of the property,or my employees with wages as heir sole compensation, will do Ne work and the structure is not intended or offered for sale(See.7144,Business and Pr fessiona CW,:The Contractor's Li..Law docs nna apply,p as owner of Required Inspections property who builds or improves thereon,and who doea such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, Imw w'.the building nr improvement is Sold within ane yam of cnmploo n,the owner builder will have the burden of proving that he did not Wild or improve for purpose of Sale). El 1,as owner of the property,am aclusively contracting with licensed convectors to convect the project(Sec.7844.Business and Profession Code:)The Contractor's Li. rte Law dope not apply to an owner of property who Wilds or improve themon,and who contracts for such projects with a cnntnemr(a)licensed pursuant o the Contractor's Licence Law. - 0 we escmpt under See. ,B@PC far this moon Owner Dam ghWORKER'S COMPENSATION DECLARATION 1 hemby aRm,under penally of perjury arc of the following dedua,inns: J 1 have and will moimain a Cedincas of Ctnson,to self-inure for Worker's Compere cation,u pmvided for by Section 3700 of me labor Code,for the perhounacc of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,u squired by Section 700 of the Labor Coda,for the performance of the work for which this permit is issued. My Worker's Compensation Inswnce carrier and Policy numlicr am: 3� carver: Monvf�w-T A can c Ppney Na r Q rQ/0 O 60 CERTIFICATE T PTIONFROMWOOMRS' COMPENSATION INSURANCE (This section need not W ewadided if Ina permit is(crude hundred kind.(SHO) r less.) I certify mat in the performance of the work for which this Permit is issued,I shall not employ any person in any manner se,u to become subject to the Workeri CumIx namion Laws of California.Date Applicant NOTICE TO APPLICANT:If,aper making this Ccniacae of Esemindon,you should become subject to the Worker's Compensation provisions of the labor Code,you most �Z forthwith comply with such provisions or this Permit shall W doomed revoked. 'ZO CONSTRUCTION LENDING AGENCY r_ Ihereby affirm that there is a construction lending agency for the performance of C 7 Or work fur which this permia is issund(Sec.309].Civ.C.) VitQJz Lcndcls Name 6. lender's Addres U O 1 ceNry that I have read minty and coup and stem ccs and above information is 0 U building 1 agree ct comply with all oily and county oxtives of and slam laws relining e �U building consuctlproolyhandy amhorimrtpmsemmivnof Nixcity mcnmrupon the ahovo-mcmidgme prep out for inspection purposes. H G (We)agree,o save,indemnify and keep harmless the City of Cupertino against h liabilities,judgmentse grarsing exleakes fewbich they in anyway acerae against said City UZ in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCECULATIg7�!S // G y Re-roofs Signa,We pplicint/Contractio Date, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future,building occupant store or handle h wri mmerial u declined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safely Code. —Ye ESSI]la)? All roofs shall be inspected prior to any roofing material beinginstalled. Ye ❑Will the applicant,t future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove nit hmaul air cantaminan az donned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑Nu I have mad one havNnus materials requiremcnu under Chapter 6.95 of Or Califor not Hcal,hfk Safety Cock.Sccdon255f15,35533.d25534.1undcrsundmatifdtc building docs no, cuecmly have a boxm,Nm it is my responsibility it,nodly the nccupam of the requirements which must be met pdonn issuance of a Cmincam of Occupancy. Slgnaiulei A-Kpplicant Date Owncroramm.ri..adagent Dale All roof coverings to be Class "R"or better Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTIN® Building Department JOB ADDRESS: PERMIT# / 0/2 7 �, n, / 1 1 er S e ©g d C) 75•— OWNER'S NAME: Co AA4 e c e,&-_ PHONE # t 7?"— 0 3 g GENERAL CONTRACTOR: 'F5'{L. FAX # I am not using any subcontractors: 8le IG Signature Date Please check applicable subcontractors and complete the following information: 10 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 S a Septic Tank Sheet Metal Sheet Rock Tile C , e--- Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue *CIOF Telephone: (408)777-3228 C��_ I�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. Ask 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: Job Site Address: /0/ 21 ? Roofing Company Name: _ S A plicantes Signature: ate:_er o f� Cil/r61ND�X1 ` Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO u X76 REROOF OF CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: 0 7 1IJ � �� (31 LI4 Owner's.Name Phone #: (i^nle— S�—Roi� os z 7g -0336 Contractor: Phone #: License#: 7 7 —v 3 3 U 72 16!F5 Cont t 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 09. � Other(Specify) CZ:3 ua A-x-+ ❑ 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 Policy: Job Description: Residential Z, Commercial Fire Zone' Yes ❑ No [Z] � Confirmed with Planning De t. if there are any restrictions: IJ Cost of Project: Type of Construction: Occupancy group: Qty. if Applia/41e_ 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 � V 7�