03050120 CITY OF CUPERTINO ". ...
BUILDING DIVISION PERMIT 6CCONTRACTOR, IN 'Q,VMATION
BUILDING ADDRESS: PERMIT NO.
FOUR SEASONS ROOFING 03050120
I
99AMPeNG
PERMIT ISSUE DATE
645 HORNING ST 05/27/2003.
IrE SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECrIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION JbDescri tion
�J M
1 rehy affirm IMI I am oP licensed under provisions of Chapter 9(commencing
aZj with Sutton 7000)ofEM,un Softhe Business and Professions Code,and my license le
-<ro,� in fu ll force and cifu, p¢j
pqZ LlcenecClae Lic.x L4 —^`// REROOF
F- Dam W Co"rut
ARCHTfELTS DECLARATION I�O t\Il,�a D B
1 understand rey plans Mall be used u public records Ir B vfB raw IRS'
tWU
s ts Licensed Pmfeuianel p
G OWNER-BUILDER DECLARATION - JUN O S 2003
s� I naso .(See on 1am 1. .Bumps from We contractorsstCoLicense taw for IM
00 following moon Permian Bement Business and Profession Cade:Any oily or county
5$ which requires a permit re cothe titer.Mprosu dsm enit t or r a sir ed structure
-Zf.^ thiormiu iumna,else
uanttrequires hlM,pions for t�Mpermino Eleasiaw(Chamem
G
that staged pursuantto00)of Diriom of Nc ConusloossaLafunion Chepttt9 Sq.Ft.Floor Area 1sUalt�Ot{t
�$
(commencing Gu lumen
ethiourfoun And the
Divis;for the
the eg einexe and Pm An I Cede)or $4000
Net io t 31.5 b any applicant ore end Ne node for be atmgur essmptico.Any viottien of
Section than ny hurtreddllfm a permit subjects Bre applicant to•civil penally ofOccupancy EYP
not mart Nen rave hundred aon.n Pssrok
34APMu�aper00e
❑I,As owner offt property,Or my employcn with wages As their sole compensation,
will do the work and thestrursu n Is notin andea oruffemd fouls(Su.70th,Business
end Profuclont Com:The Convenor,Ucene Law Coes not apply to an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who does such work himself or through his 307 - INSULATION
own employees,provided that such Improvements are not intended or offered for sale.If.
however,the building or Improvement is sold within one year of completion.the owner. 601 - ROOF TEAR OFF
builder will have tbe burden of proving Nal he did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
O 1,as owner of the property,am uclusinly contracting with licensed contractors to y 603 - ROOF BATTENS
convect the project ISA.7044,Business and Pmfessimu Cane:)The Convector's Li. / 604 — ROOF IN-PROGRESS
more law does not pply to an mvner of property who builds or improves themon,and,
who contract for uch projects with a cowator(U licensed pursuant to Out Contractor,
License Lew,
❑1 am exempt under Su. .B Ar P C Ire this mason
Own r
Data
WORKER'S COMPENSATION DECLARATION
1 bertby affirm under pe rmy of perjury one of the following declarations:
I he.end will meinuin a CeNRn a orconsent loulf-0uure forworke"Compen.
urian,As provided for by Section 37M of the labor Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compeaedon Insurance,As required by Smu n
W of Nc labor Code,for tito performance of the work for which this permit It Issued,
My Workd'eI Cum "Ali.Insurance artier and Policy number am:
Carrier: VeLJV', rul(S PolicyNo,: QWColLca"y(
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mrisso.d.toad or he complevA time permit it forum,hundred dollars($100)
nr lace)
I certify titer in the performenu of Ne wart for which this permll is Wood.I shall not
employ Amy 1m mo,tN.i m�Maomgtufje1l10 Nc workeKCompcnudon
Lava -O `7LCl Gam_
Appli
NOTICE
E
NOTICETO APo flee MIL after making Nu Cellons Of of "bar on,you Mould
became subject y it Wohera Comp Or this proud mai of Nc labor Cock,you mut
0 forthwith comply with such provisions or this permit MJI M domed revntrd.
zy CONSTRUCTION LENDING AGENCY
(-� Iherebyafrvm that then iteromvuctimn lendingagenry for Ne performence of
C> Ne work for which this permit ie Wood(Sm.3M.Civ.C.)
dQ Lender',Nater
D z Lemaers Address
U 0 I certify that I have mad this Application and sum that the short information It
D.E� COMM I agree to comply with ell city and county ordinances and sure laws misting to
0 U building construction,and hereby authorise representatives of this city to enter upon tM
4s7 above-mentioned Property for inprction Purposes.
(We)agree to save,indemnify and kap hermleu the City of Cupertino against
pQ'q liabilities.judgments,cods end expenses which may In any way aurum against said City
U 7 in consequence of Ne granting of this permit.
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Sigmurt of AppliesDan,HAZA
HAZARDOUS MATERIALS DISCLOSURE mhaRE. Type Of ROOF
will Ne applicant ert or future Wilding asuput tore or and MUNoes d Sterid
As defined by tie Cupertino Municipal Code.Chapter 9.13.and Ne Health and Satcry
Code,Section 25532A)? All roofs shall be inspected prior to any roofing material being installed.
Oyu C�lw
Will t applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
soh hs'ardrm air cora moot u defined by ftBey Arca Air Quality Muegenteel all neZma als for inspection.
District?
O Yes n
l he. ad Ne haurdmusmamrmIsrequimment undcrChapmr6.95 ofthe Califnr- C
meFmel afctyccac,Suti g5505.25533end35534.1undcrund thallfUrc be ing {J ��
rima res c ntly hove a Nat It t my repo"ibilily m nntily the ucupmt of Ne
tcyulm n eh mu nortoissuuaofaCcniOamofOccu r Signature ofApplicant Date
�� . aj/-IL U_a'
Owner or authori Agent Dam All roof coverings to be Class oBn or better
Community Development Department
Building Division
U City of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408)777-3228
4UPEkTINO 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.
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 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 then above stated policy on re-roofing.
Homeowner's Name: S e til et
Job Site Address: oZ lJ��J}tri roK d 01-0 4
Roofing Company Name:
A phcant's Signature: Date:
• Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
RE ROO F
UPEkTINO PERMIT APPLICATION FORM'
APN # ct Z D Date: 1 03
Building Address:
Owner's Name: Phoge#l:
Contractor: Phone #: License #:
FOv1^ S �SSu1 I COd�i t a. "�33U
Contac
�0t, ICJ Phone#: Cupertino Business License#:
a �(na33d
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O Built-Up roof
❑ Asphalt Shingles & Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
.& Other(Specify) Ce-t cZ)VO ❑ Other(Specify)
Number of existing coverings_� ❑ Provide I.C.B.O. Report#
59 To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
I fir/ D
Residential Jj6 Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restriction
Cost P e t: <� Type of Const o Occupancy group:
Qty. if
Ap;risk 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
41- 1
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