02070092 CITY OF CUPERTINO
BUILDING DIVISIONCONTRACTO.R`DWORMATION• 'i
PERMIT �'; Ir e , .,:
BUILDING ADDRESS: PERMITN .
22921 LONG DOWN RD FOUR SEASONS ROOFING 82070092
_`96M WILLIAM N AND JOAN K 645 HORNING ST APPLICAIOW.T //%'$2002
r !HONE: (408) 278-0330 SANITARYUNO. CONTROL NO.
Q o ARCHITECTENGINEER: BUILDING PERMIT INTO
s w P BLDG ELECT PLUMB MECH
a 1_1 C=1 L.7 I I
i LICENSED CONTRACTOR'S DECLARATION Job Description
,Z!2, Ihe.byafrnnthnlamlicensed order prositimlChapter 9(commencing REROOF
_Cu wiN Sccian9000)e(Divisioe3 of the Business and Pmfessives Code.engmy license
m g is in full i.e.nQeffecq�j C 2 1�1t /j� L�
3 U Data Class _ LiatrContractor-J t=9NA
a O ARCHITECT'S DECLARATI
: < I undemm�d my,Plops shall M used as public records 3 12003
JANp O Licensed Professional
OWNER.BUILDER DECLAR
ATION
1 hereby,(fere on 1 ore emmp from the Conon,Co e:Any city
Low for N< e ' p�
y
530 ohc greesen.(ermitto03LS.Businessrntlave.deionsh,ormnycitysmacory B�/ILDI G BOOO
F e equircs a permit m construct,oltee improve.demolish,or rtpen any suu<wm Int
z fNl m
II o which r
- 'o to issuance,also rtq rtwM1e pplicom for permiuo NeecTgmd uammrnt
Nat he u l ixhsetl pis sed sed the pro l ions of the Convecmra luttnse few(Chopter9 q r1c ]p N1cc�� -- — _ ..__ .__.._u
(commencing.with Section 7")Of Division 3 of the Business and Pmfessions Code) ! (.:'s Valuation
or Thal he is eiein 1 theiefioiri and the bass for the olle ed esem ren.An 1
P 8 P Any
of an,arm/07 t ,t any dreddollfor opemut wbjmsshe applicam sou civil pcnairy" t
arimkinara men Bve nnnarm dollars(ssoo) 309�PN AhtiIE i.i,•::r :. Occupancy Type
❑1,di owner of she d the s,or to employees with wages fe ed f sole compemmion,
307 - INSULATION
will"do"-the Prof and the is not intended ocice eeLaw does not apply t 14 n _
Trome,of property Who
Code:The Contractors,and w Law s;a not apply m an Ion$ '� '1' 4'-d 1
owner of property
Ow Who Wilds or improves Merton,and who does such work himself 6 02 - ROOF PL
of Nro{M1 ti n employees provided That suchimprovementissoe not intendedyear or
b(fe d'f r lE I(howevo-,the Winding orimprovement is sold withinone yea 'of ""'"" "" 6 0 3ROOF"—BATTENS' .- ..,:•
"complet on,the owner-builder will have the burden of proving that he did not build or '
improve for purpose. le.).
604 - ROOF IN-PROGRESS
c - 0 L
- - _ Owner of the peeuYam reclusively rwsinncontractors m
amrixt he (Sec ]Iii,Business and Profusions Catlof no Cmilemr'a +. r
F,.
License Lowdoes no
apply m an owner ffi.o a my who Wilde sed pmu,.... ..he
i' ..mM.who.commne.fLawch.projects wiN.e conwctar(q IicensW-pumuem mahe. __......__... .... ......_.....____..
^;' `. Cenwnori Lironu Law. .-:, ,._.
❑lemeecrept under Sec."" _ _ ,_BRPCfor this rtesaa . .- .•.. .i�•IIP.^.
_. ._
Owner"" Dore "
'WORKER'S COMPENSATION DECLARATION
1 her,"affirm under Penalty of perjury one of the following dederesioes:-'
d ❑ I hive and will'maimein a Cenificam of Consent io'self-Town for Wor
Compensation.as-provided-for by Section 37W of the Labor Code. for the
Performance of toe work for which this permit is issued. '
❑1 bars war will malnuih Workw'i Coad nimioo Insumme,•ei rigoirtd by Section
3700 Vrk for'which Thu Perri
u
Cesaer �O,.n,e carrier war bcY number we. ..
C� 1, •.
issuedM WCERTIFICATION OF EXEMPTION 0M W""17S.0
ate r r Ne Performa c e(Ne wo
fk
Y Y q..�l'�1T 11�
c No r t"
. Y e d 'l.. t
WORKERS.
` - ITh,canton pled not be nom lead if NSURANCE or' '
COMPENSATION I -d,. ... ...._____ .__ __...__.............._...._.._.._.._._._._....
W doss... r completed the permit is for one hundred dollen
($1007 or(esti '
Iea this. of _..—....,_.._ .........w._- ...._- _..1..........-...._.-......_
Ts vl s lo in the perform,m of the work far which this Permit is issued,l
hell ena.employ Laws
f rwn re any madncr,w m m bedome svbJett m the,Workeri '
Compe anon Wws of California Data
itr
•becoICE TOAPPLICANT-If Compenking N C niOcue h Esempbon.you should
z Qbecome subject to the WorkeYaCompersobon pmvtdoiu of the IaWr Code,you must
forthwith complj'witti such provision or this permit shell be Thalamus revoked.
-
a 1 hereby'R N t N r Is o consmaon le d ng agency f the perfo ono. T r
W fNe wokfa;hch tors permins s"d(See J097 CT C)
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U .......
.
Z _
, r
-0 1 endy shot I he a ed N s applicet on d mote shu the above informaban is
Tess[~' carte!(.1 agree w comply wish ail city 0hd county ordinances ontl sum(ewe ter
upon�.f,)', mWilding ronswmion.mtl ficrttiy auNotiie rtprcseniauvu of chis airy so corer upon
[g] NeeWvomemidnW property,(or inspersion Puryous.
y-� f We)agree m wve,indemriify.and keep hertnlcas the Ciiy of Cupertino ejainst
rr"Vl Habil t ee,judgmems,cam e d expenses wh eh req m any wry acme against aid
V Z! ChY m conseghenee of N gra t ng of Nis Peron t -
APPLICAN�T�'' )ER5TAND5AIDWRLCOMPLYNTTHALLNONPOINT"c Issued!Y: Date
souk yyg�no "
SiPelcHAZAmwto -' ..Darr,' . Re-roofs
coe�ftSeen..� iss3ai.i a MunicipalUS MCode(Chapter
12 andE 11
the Health nes s imal Tape of Roof: _._ •--
Will the app(c ant or burden Wild ng Occupant Rare or handle haaanloos ma
byP Safety
.. .. ... .�'.. 1It1G -
❑Ys- +^ o r l-1 p t ' �i•.= r ` _ ?' { ''r'E P)r�:. '' 1.` :s: u.
t *; ' All.roofs shall.be inspected prior-to any roofing material.being installed... ...............
n
Will do,a pplicion,or
llNeepplcantor set acquitsdingts,, quip mardal!ceewhich If a roof is installed without first obtainm an'ins ecnon, I 'agree to(iemove
emit haurtl i a conumm s es defined by the Bay Atea Au Qudity Management g p
District f _
h area T. ❑Nn all new materials for inspection. Applicant understands and will comply with
i rt , all non-point ice iegulahons . --..-._
1 Neve rend the safety
Co ui materiels 503,2 533 an 255 4,1 understand
97 of the �g 7
California lyHeelto k Safety Code Sections 33305 t itis and]3334 1 and uund Net
(uta Wlldugda urtently haeuenenl Nanus my rupom btpty To notify the
a' Ni
q
f ' menu whmh must be met prior to aluenn ifa Certificate of '
oRmpe ��6 Z + ignatur_of Applicant Date
Ow_ No dogcm '1S t Dn5All roof coverings to be Class B or'better
TI:v .
n p, -OFFICE--
- --- — . _.. .
Building Division
10300 Tom Avenue
Cupertino,CA 95014.3255
` Telephone: (408)777-3228
CI Fax: (408)777-3333
CUPERTiNO
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 YV 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 policy policon reroofing and will comply with this policy.
Homeowners Name: �- 1 02
Address:
Reroofing Company Name: Y,- S�S6 ✓tS O F!'
Applicants Signature: Date: 7-/6 -�
Joe Antonucci �~
(Chief Building Official)
60101