04080136 CITY OF CUPERTINO
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BUILDING Drvlslon PERMIT CTRACTnR NFORMATIQN.`
...
BUILDING ADDRESS: PERMITNO.
FOUR SEASONS ROOFING 04080136
OWNER'S NAME: P;ei1Q11T-RR SQ-TJ PERMIT ISSUE DATE
12
NE:
SANITARY 1:7OL NO.
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEED
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L O o LICENSED CONTRACTOR'S DECLARATION I b' 6rl
s u C 1 hereby affirm that 1 am luno)under pr iv ons of Chapter 9(commencing
e 1 11111ala k[U)
Zry Willis tion 700)of Divixion3oflhcnusinessan ofcssinns COda.and my license is
^tea infull for deffecl.
5�_ uanaCEfss a3`�{ Lia.x h��-toad REROOF g
z�� Date l �Cuntraetnr SEP%& 2004
qq ARCHITECTS DECLARA
1 understand my plans shall he used as public=s
off'Ca° oMLU
Licensed Professional //_
Cal
OWNER-BUILDER DECLARATION \\tea-Jj/
1 hereby affirm that 1 am exempt from the Contractor's License Law for rhe
O o following Carl(Section 7031.5,Business and Professions Code:Any city or county
K m( which noisome a permit to consnuct,alter,improve,demolish,or repair any structure
aa"w poor it)its issuance,also requires the applicant for such permit to fle a signed statement
-E?a that he is licensed pursuanuo the provisions of the Conlmemr's License law(Chapter 9 Sq.Ft.Floor Area Valuation
9Hm (commencing with Section 7000)of Division 3 of the B usiness and Professions Code)or
y Nat he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 703 1.5 by any applicant for a permit subjects the applicant to a civil penalty of 34V4T2-gp*er00 Occupancy Type
not more than Eve hundred dollars($51K).
❑1,m owner ofthe property,or my employees with wages as their sole compensation,
willd0 thework,andee he Comisnot,Liensoroffered for apply
1. aBusiness
and Professions Code:The wsIacwrs License law doh+our apply to an awncr is Required Inspections
property who builds Oded that eathereon,and who deessuchended w self ed formicthadought his
own employees,provided than such improvements are net intended proffered the owner.e. .
builder ,the building or improvement is said within one year of completion.he eof
builder will have the burden of proving that he did not buil)or improve for purpose of
salt.).
❑1.as owner of the property,am exclusively contracting with licensed contractors to
consumer the pmjen(Sec.7044,Business and Professions Code:)The Convector's Li
cense Law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
1 am exempt under See .B S,P C for this reason
Owner - Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of pe jury One Of the fallowing declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Compere
smion,as provided for by Section 37W of the labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the labor Code,for the performance Of the work forwhich this permit is issued.
My Workers Compensation insurance
escarrieraannd,Policy number art: ,.(� >..
CayRierr�rNnR Cm TPNT^Pdli'7 No.: iac:yQ Itjtl�all
CERTIFICATE OF EXEMPTION FROM WORKERS'
17 COMPENSATION INSURANCE
(This section need not bccomplemd Ethe permit is for one hundred dollars($100)
,,Aces.)
1 eeNfy that in the performance of the work for which his permit is issued,1 shall not
employ any Person in any manner an as to become subject n the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become&object,to the Worker's Compensation provisions of the Labor Code,you must
.,O forthwith comply with such provisions or this Permit shall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that here is a conswction lending agency for the performance of
R...,it for which this .it is issued(Sec.3097.Civ.C.)
W� Q Lender's Name
= z Lender's Address
V C I eenify that 1 have read this application and sum that the shout information is
V. H Comets.l agree to comply with all city and county ordinances and state laws relating to
CU building construction,and hereby submit.representatives of this city to enter upon the
r U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep hornless the City Of Cupertino against
wfA Iiabithiseem,judgments,cosls and expenses which may in any way seeagainst said City
U in consequence Of the granting Of this Permit.
APPLICANT UND'yRST NqS AND WILL COMPLY WITH ALL NON-POINT Issued by:9
Date
S URsB REI!KX�0
^t I t �—Ir-o-OL/ Re-roofs
SW..OApplicam/Cn actor Date
HA DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stow or handle havardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
ode,Suction 25532601 All roofs shall be inspected prior to an roofing material being installed.
❑Yea Na P P Y g g
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
If
huzmdaus air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
I have read the her Nous materials requirements under Chapter 6.95 of the Calton-
ins Has]eASafety Code.Sections 25505,8533 and 255311 undersandden ifthe building — „0f'
fres notcurtcnb vd atenangtha it respansihilitye notif ytheacupwt of ec �"'—"--
rcquire nts hmh ustM t onorssuanenfal.l. Carol Occupancy SI ature of Applicant ate
8 »-0
Owner or olibmi.,ceptor Data All roof coverings to be Class "B" o better
Community Development
LL p 10300 Torre Avenue
a,
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEDTIN®
'Building Department
JOB ADDRESS: ` PERMIT #
/ J / Nl LG.� pliy �7-zrScl. �l� 013ro
OWNER'S NAME: /Jul V r inic PHONE #
GENERAL CONTRACTOR: Fa S/e o,s`J or/.� FAX #
I am not using any subcontractors:
Signa 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 Sceasons 21 OB
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Si e Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
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) h1-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:
Job Site Address:
Roofing Company Name:
AA
ate: �f-/6- 0 /
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CITY Of
CUPEkTINO PERMIT APPLICATION FORM
APN # 3Li1zi4Z008 ate: b /6 2-00qBuilding Address: ff I
/ 01 (4 -1 J_A nn �1 " n'1 P(' �cL t/a C 91v
Owner's..Name: Ti rt 1 n i q Phone#: L-716 o
Contractor: � Phone #: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles " Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) ❑ Other(Specify)
NunnbeS of existing coverings ❑ Provide LC.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 ZJ_— Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni De t. if
there are any restrictio s:
Cost of Project: Type of Cd-n-R Cd-n- cn' Occupancy group:
if
XPplicade Fee ID Fee Description Fee Grow
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-67a �