02070002 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
1�' 3°1°p" NG DOWN RD FOUR SEASONS ROOFING PERMIT n070002
Vt_APRTN ELENA 645 HORNING ST APPLIc°bl`I'IVIAIT002
PHONE: (4 08) 278-0330 SANITARY NO. CONTROL NO.
O O ARCHITECT(ENGINCER: BUILDING PERMIT INFO
w F BLDG ELECT PLUMB MECH
a
y Z LICENSED CONTRACTOR'S DECLARATION
:v z P H I hereby affirm that 1 am licensed under provisions or Chapter 9(commencing REROOF tion
L:aixith Section )of Divi' nl of to Bu(incss and oressinns Cala andm license
:mE7 is in lull for an t3q J( - JAN e3 1 2003
I rep a V Liccnu C . f Lic.ppp Z
1 LL C Q D:ne CNITECT'SDg[vLA cAecnOrd� —
1 understand my plans shall M1e woad YY
i3<= BUILDING
i d=C Licensed Profeasinnal
o OWNER-BUILDER DECLARATION
1 hereby.plum thus turn exempt from the Cmina,lor's License Law lar the
C?0 following remora.(Section 7031.5,Business.nd Professions Cale:Any city or menty $8000
SS,,FF wit cl q Permit to constract.alter.improve,demolish.or repair any structure
PH.".t,rs..t,Isa marguima ulta.pidicam far such pe.it file a signed stmemem
tat h< 1 cn W punuant the mpro ons f tit t tog s Ltecnse Law Chpter
Valuation smacwithSection
7 fD 1oRlh sess.nd ProfessorsCodc)
or that i,exempt therefrocmand 0e basis for the allegednempnAny vimlanom
ofsectitns rayanyarhcaarapemnSay«es rotarpucantmaamtpA.Ity
m[ern more than fvehundrtd Jollnrs(55007. APN NMRIV Occupancy T
ype
°Las nwaernnbc ronorm loxes with woes as lh,irsolecom tion, 307 - INSULATION
Par remr > g pens.
will do the work,And Professions
emtdnrc is not ctor's d en a Law fnr snot(Secy''a, TE
-
owner of
ntrd Pry,Who
Code:The roves therm License Law does not apply'o an IrnnCC (Ions
owner of prnpeny,N'ho huiltls or improve.thereon,and who does such work himself 6 0 2 — ROOFXUUF PL A5� )VA
or through his own employ=&.provided that such improvements are not intended or 603 - ROOF BATTENS
offered for sale.IL however,the building or itpmvement is sold within one yew or
completion,thenwnermtilder will h.vanahuNmofpmvingthat bedid.mWild or ,
604 - ROOF IN-PROGRESS '
improve for p.,swa of sale.).
❑hes ownernhhe p(Sm.7 am exclusively Practisions licc:)The mranorsto
construct to project(.pd,m.0cl Business tea cityr who
Caor 1oO The yes thereon,License Low docsnotr.suc tornownercelf thpmpetmwho buildssed pursuant
athto the
and who Grommets for.such pmjens.with..wnwnor(q licensed pursuant to the. _.. . ....... ... . . ... .... .. .... . . _ .:_...._-.._.._._.... _
Contranors License L.w. '-
❑I.m exempt under Sec: B as PC for mid reason
_ Owner 'Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
S ❑ 1 have and will maintain a Certificate of Conant to self-insure tot Worker's
slate? Compensation, as provided for by Scction 3700 of the Labor Coce, for the
Performance of the work for which this permit is issued.
111 have and will maintain Worker's Compensation Inso6m,as required by Section
37W of the Labor Cada for the performance of the work for which this permit is
. is d My W ker's ComPpypsai n Insurance�Gat/m)er.nd Pal cy numbber eCrtc �/
Ca m, a, tl YM't f�1.'nI cyRD11]N�I)� /IO�VL q •y., t l ;: � 1 t �� ,i s f,_',� �,., I Y; tit, _ - a .` .' _ .. .. .
"CERTIFICATION PEXEM FROMW R ERS"
,COMPLNSATION INSURANCE .• ,. .., .... ____._.,_.,_._._.__.,_._..._.....__...__._.-.__...._._..__._____....—_._......-_._.._..____.__._.___..._ ...__. ._..
(This sw on rad not be,rnmpleted if the permit is for one hundred dollars
(SIAUI or less.) „
.. .- , .. .. .. . ..._n_.
' I centify that i p nL:nce the work for wit' h tit' permit s'iss ed,1 1
shall nemploy any Person in any manner so as to become sables to the Workegi - • ' -
Comn on laws of Califomin.Data
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
neninse subjca m the Worker's Contpensahon provisions bf the lator Code,you man
CO
lonhwith romply with such provisions or Nis permr shall be deemed revoked.
aZ __ ' •CONSTRUCTION LENDING AGENCY - - - - -
'� 1 hereby oRrra that there is a construction lending agehry for the performance
Qof the work for which this:permit is issued(Sec.3097,Civ.v.Cb)_
Lenders Name .. ..: ,. ., _i.. ..._ ... ...-. .._ . . _.. .. .
7 z finder's Address
t..) C) .I certify Nat I have mad this application and state that the above information is
4r E" cored.1 agree to comply wit all city and county ordinances and state laws relaling
D V to building coustmetion,and hereby amhOHZC representatives M thidcity to enter upon
�s y the alurvementianed property fur Inspection purposes.
Fs Rs (We)agree to save;indemnify and keep hamdcsithe City of Cupeninoagainn
V1 liabilities,judgments,cases anal expenses which may in my way sectio,against said '
U'Z City in consequence ofthe granting ofthis permit. "
"t APPLICANT NDE DS AND WILL COMPLY WITH ALL NO DINT
5u ce cul. IONS. _Q Z Issued by: r Date
JV
i naturcof Applican/ omractor' " ' "Dae Re-roofs
HA] RDOUS MATERIALS DISCLOSURE "
Will the applifmt or fuwre Wilding occurred store a handle Aeimdous material Type of Roof _.._,_., . . .......
as defined by the Cupertino Municipal Code,Chapter 912,and the Health and Safety - _ '
Codc Section 2571ha1 �- , ,!," I'. •.�a t•,; s'; : .t•
. . °Y �� All roofs shall-be Inspected prior to any roofing material being.installed.
B Rate indicarm or future Wilding Arout use equipment or devices which If a roof is installed without first obtainingan inspection; I agree to remove
con,h ab amt tasdarned bythe BayArea AirQualityManagement P g
Di tr[t^ all new material for inspection._ Applicant understands and will comply with
all non-poi is ree r- egulations.` ,
1 base rc d to haaardo s materials requirements under CNapter 695 of the (/�--
Cal ram a Health&Safety Cod Sections 25505 25533 and 25514 1 understand that
Jde be Id gal s o ilyM1 t rot tit t n yup 'bltyt n tify th< /\
roc
[apart art me req mints en mdn home,Prar to iaanmro of.Cera re e f
oaeuPapo 7�G`
Signaturi of Applicant Date
weer oraatn data agent -- ate All roof coverings to be Class "B" or better
OFFICE
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTiNO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Names✓ b-P ?''�- (b 1-4t4-
Address 02 $ `� I1 �c�/r✓
Reroofing Company Nam: f C-v.r Sea m le19eco (—ti
Applicants Signature: / Date: o -2-
Joe Antonucci
ZJoeAntonucci
(Chief Building Official)
6/25/01