03040032 CITY OF CUPERTINOr,sr
BUILDING DIVISION PERMIT CONTRMTQR INk�QRMr� 7ION
BUILDING ADDRESS: PERMIT NO.
22963 LONG DOWN RD FOUR SEASONS ROOFING 03040032
;;
OWNER'S NAME: PERMIT ISSUE DATE
COMMUNITY MANAGEMENT SERVIC 5645 HORNING ST 04/07/2003
E: SANITARY NO. CONTROL N0.
(408) 278-0330
ARCHLTEcTmNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
M LICENSED CONTRd under
SDECons of CON
�� 1 hereby Orion that 1 am IittnvA under provisions of Chapter 9(commencing Job Description
with Section 0(Ijl)of Dividon 3aNita UAinnsp9tlProfcasd Code,. my license is
in full forte a_effe. ,f� :
5'�g Licnsecl =Contra 7 REROOF
L Dau Conan
ARCNTfELTS OEC ATIONON p
Imtd andmyplans shell Musedul)ubisnomobt FII�IALED
o� licrnsed Pofesuonal
OWNER-BUILDER DECLARATION MAY 2 12003
�.� E 1 hominy afnrm that I em exempt from the Conmumes License Law for IM
O O following mason.(Section 703 1.5.Business and Professions Code:Any city or county
$ which requires a permit in construct.alter.Improve,demolkh,or repair any slNnum
S' prior N its issuance,elan rcqulmsthe applicant forsuch permit to file..lgnedtawment
£CLQ the,he is licensed premem to the provisions of the Common's License Law(Chapter 9 Sq.Ft. Floor Area M C3
y (commcndngwithSection70D0)pfDiWdon7nfthcBusinmandProfeuiomCnde)m $SOOT
that ha ls exempt therefrom and to basis for the alleged exemption.Any vmlaton of pt�f� t,�
Secdon 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of 3�'L4Ud�br 00 Occupancy Type
not more than five hundred dellen(1000).
❑t As owner of the property,or my employee,with wages u Weir sole compensation,
will do Wework,and the suuctum is not intended proffered for sale(See.7044,11usinns
And Pmfnd ms Code:The Consomme,Littnse Law does rot apply te an owner of 305 - FRAME Required Inspections
proper who builds orlmproves Wereon,and who doe,.mh work hlmselrwwmugh his 307 - INSULATION
own employees,provided Wel such Improvements an,not Intended confused ferule If.
however,the Wilding or improvement issold within one year ofeompledon.the owor, 601. — ROOF TEAR OFF
Wilder will have We burden of moving that he did.1 Wild or Improve for purpose of 602 - ROOF PLYWOOD NAIL
0 I,as owner of the property,am exclusively contracting with licensed convenors to 603 - ROOF BATTENS
construct the project(Sec,7010,Business and Profosaions Code:)`Gm Con odor's Li- 604 — ROOF IN-PROGRESS
cense Law don not pply to an owner of property who builds or Improv thereon.and
who contracts for such projects with a contactor(s)licensed pursuant in Lou Commences
LicenseLaw,
of Am exempt under Sm. .B&P C for this reamn
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby si lore under penalty of perjury one of the following declunims,
have and will msinsaln•Cenlfiute of Consent to self-insum for WoheesCompcn-
on,As,provided for by Section 3700 of the labor Code,in,the performance of de
wait for which his permit h inueQ
0 I have and will maintain Woawri Compensation Insurance,u requited by Section
3700 of the Labor Code,for the peRor imcc of the work for which this permit Is Issued.
My Worwes Compensation Insunna carrier and Policycy number am:
Cy. Policy No•¢t'•�� Ci gg OOd
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
Obloscer lon need not bcompleted if tae permit Joint.hundreddWhoo($1 W)
or loss)
I ccnify that in the performantt of the work for which this Permit ls issued.I shall not
employ any person in any manners As to become subject to the Worker'Compensation
Lawn of California.Dam
Applicant
NOTICE TO APPLICANP.If.after making Ibis Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of to Lahr Code,you most
.JZ forthwith comply with such provisions An this permit shall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
(—h . Ihereby affirm that there in construction lending agency for the performance of
14 7 the work for which this permit is Issued(Sec,3(197,Civ,C.)
W� Q Lender's Name
z Lendees Adders•
U O 1 certify that I haw reed this application and,uric that the above Information is
tg• torten.1 agree to comply with all city and county On inst m and Aute law mining to
OU building construction.and hereby mthodn representatives of this city to enter upon the
W .hove-mentimM property for inspersion purposes.
(We)ogee to saw.Indemnify and keep harmless the City of Cupertino against
h.•h liabilities,judgments,amts and expense,which may In any my cc=against aid City .y
U 7 In consequence of the Booting of this Permit. S
'7 APPLICANT UNDERSTANDL6SQ WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC R LA770N5. '�/
SI`t�o�llcnNCmdroCoN Dote Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcup fit atom or handle haurdou material
As defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 13531(a)7All roofs shall be inspected prior to any roofing material being installed.
l]Yes �t a
Will the applicant or future building occupant use equipment or dcvjm which If a roof is installed without first obtaining an inspection,I agree to remove
h havamous air connminents u donned by the Bay Area Air Quality Management all new materials for inspection.
Irier7
C]Yes
�No
Iis.
I haw mad the hazardous materials requirements under Chapter 6.95 of the Califm-
Health&Safety Code,Sections 25505,25533 and 75534,I undemmud that lite Wilding �not currently haw a tenant,that my mpoulMlity le notify the oeeupanl of the (�-'� •uirements which mum print arecof,certilicecor7ancy. Signature of Applicant -'� Date
O s All roof coverings to be Class "B"or better
ncr or authorized agent Dole
'r
,t
Community Development Department
�I Building Division
City of Cupertino
M.. - 10300 Torre Avenue
Telephone: (408)777-3228
CITY Of
Fax: (408)777-3333
L U P E ]N
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.
J 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: '41 D, / Z /!
Job Site Address: 9 2 Z I Z 0&4 do ey o-.. �-
Roofing Company Name:
A plicant s��Signature: l%' Date:
IWQS1hLD�X1
t
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
A •
CITY OF CUPERTINO o 3 0 o 0 3
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 0 Date:
Building Address:
�✓� 6 �O �t! �L 7- N6
Owner's Name: Phone #:
Contractor: hone#: License#:
o✓ �aa�s of 8n go
Contact: Wone#: Cupertino Business License#:
G S. oe- s n • ,� 3
Type of Roof overing:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,TdL Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ^ ,� / L3Wood Shingles
Other(Specify) ('LPi' [�l/ ❑ 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:
Residential [2� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Constru• ' Occupancy gro
Qty. if
Appl'c bye 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
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