04080076 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO ryRACT R'-INFO,RMATIO
N.,j"k,
BU ILDINGADDRESS: FOUR SEASONS ROOFING PERMIT No.04080076
OWNER'S NAME: PERMITIS51JEDATE
ONE:
SANITARY 0 TROL NO,
ARCHITELTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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i o O LICENSED CONTRACTOR'S DECLARATION `pk' ff
P I hereby affirm that 1 am licensed under provisions of Chapter 9 prommencing Jo IDv'Sariptd n
zw with Sccdm7000)of Divi' Sof NC Boamessand Pmfcssinns Codc,md my license is
in full farce and cfe�dt��'Jn l o �b REROOF �`�� 22-
A
$ p
j�? License Cl s .7 1 Lic.p 6d�
F•❑ Dam c..,.c:tbr _
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ARCHITECTS DECIARATI D ��
'i2� I unders and my plans shall be used as public records
yU
moH Licensed Professional
OWNER-BUILDER DECLARATION
a8 1 hereby of firm that I am exempt from the Contractor's License Law for the
00 following reason.(Section II31.5.Bus mess and Professions Cade:Any city or county
k m which requires a permit to consumer,alter,Improve,demalish,nr repair any immune
w—m fiber ba its iscurrec.alsu requires the applicant forsuch permit to rile aligned sommnnt
that he is licensed pursuant to the provisions of the Contractor'sLicense Law(Carrion 9 Sq.Ft. Floor Area Valuation
aFG (commencing with Section 7000)of Divisian3 of the Business and Professions Code)or
i that he is exempt thcrefmm and are basis for the alleged exemption.Any violation of
Section 703 1.5 by any applicant for a permit subjecu the applicant to a civil penalty of 34N2NnOl'4eF00 Occupancy Type
not marc than rive hundred dollars(SSW).
r
0 I,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the .,arm is not intended or offered far sale(See.7W,Business Required Inspections
and Paudessions Code:The Central License Law does not apply m e an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such impmvememms are not intended or offered for sale.if,
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the propeny,am exclusively contracting with licensed contractors to
oonsbvn the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
me Law does not apply to an owner of foppery,who builds or improves thereon,and
who contracts for such projects with x c'onuaclor(s)licensed pursuant to the Cor nbrou's
License Law,
C1 1 am exempt under Sec. ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declariuns:
1 have and will maintain a Ceniricmc of Consenuo self-insum for Workers Coo per-
ration,as provided for by Section 30W of the Labor Code.for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as Remains!by Section
37W of We Labor Code,for the performance of the work for which Nis permit is issued.
My Worker's Compensation Insurance caoien and Policynymbm
Cartier Me4,V...�C X Policy shm:�J CSV
CERTIFICA FE "ION FROM WORKERS'
COMPENSATION INSURANCE
(Thai section need not hecomplemd if the permit is forome hundred dnllals(Shap
less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner sr,as to became so bjecuo the WOrkefi Compenardi n
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject to the Worker's Coope border,provisions of the LJhor Code,you most
.J Q forthwith comply with Inch provisions or this learn hot)he formed revna.d.
z CON STRUCTON LENDING AGENCY
[-. .N. I hereby from that there is a construction lending agency for the performance of
LYi > the work for which this permit is issued(Sec.30)7,Civ.C.)
V] Q Lender's Name
6i
az Lender's Address
U 0 I codify that 1 have read thirty and c un y ordinances state @m the shove information is
W F worn, agreemcomply with all cityand countytboortrade City
Cute laws relating e
0U abovengcotioned iomand hereby ambonprposesrnutivex of Nis citymenter upon the
,r fJ.l above.men
(We)
agree
I.orlysave for inspection purposes.
G (Wc)agree m save,indemnify and keep harmless the City accrue
against
against
Iiabilities.judgments,costs and expenses which may in any way accrue agaimt mid City
U in consequence of the granting of this permit.
^ APPLICA UNDE TANDS AND WILL COMPLY WITH l9�LL NOjj��''-POINT Issued by: Date
SOyQrIE :GUL ONS. l "0 y
$'i/gnatmdcof Applicant/Contractor 6/ YDow / Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forme building occupant store or handle haardous material
gdefined by the Cupertino Municipal Code,Chapter 9.12,and the Hcalth and Safety
d o.
Sec lion 255321x)? All roofs shall be inspected prior to any roofing material being installed.
Ycs
Will the applicant or future building occnpam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit h...arms in came has formed by the Bay Arca Air Quality Management all new 71e, Is for inspection.
70.acr
istrict?
OVes ON.
t
Ih&Se et me c,Scceusmam05,25gvimme5534.irdcmm6atifthc Calding t/ �iSO
for
ix,Health&Safety Coeammdons 255JlanJZ55J4.lundersund thmlf the building (J/\ (�'
xs not curtently have a tenant Willis itimy responsiM1iliq m nosily the acupant of Ne
requirement;which must bC mel poor to issuance of a CenlGcam of Cempancy. I t re of Applicant ate
or air lhariaed agent Date All roof coverings to be Class"I or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEDTIN®
Building Department
JOB ADDRESS: .f6/j� [ q, Q/�9�gvl Sez PERMIT #
Q b K6O
OWNER'S NAME: IPHONE # 7 '7W -C>3?-6
GENERAL CONTRACTOR: F 3 2. , 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
Septic Tank 10
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)=-3333
CUPEI�TINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Staridards
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: °¢'" Z'^" Oak S
Job Site Address:
Roofing Company Name: S "—
A plicant's Signature: ate:
-o
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
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CITY OF CUPERTINO D
acoREROOF
CUERINO PERMIT APPLICATION FORM
APN # Date:
7
3 ?. (4 0 3i P
Building Address: I0
1
37 G / �
Owner's.Names Pho #: a
Contractor: Phone#: License#:
Contac • Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >911.Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
ae Other(Specify) L.jt�•'t�c.tx�.� ❑ 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:
✓/'!off - �r t.GY�+L[itx�>' .( /Il fH
Residential Zj , Commercial ❑
Fire Zone: Yes ❑ No 2 `� Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group::/
cX� Dula �--Zi DCz✓1'"�!-'�
Qty, if�'
A Lica 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