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02070094 CITY OF CUPERTINO BUILDING DIVISION PERMIT `CO PERMIT BUILDING ADDRESS: PERMITN . 22991 LONG DOWN RD FOUR SEASONS ROOFING 82070094 WALKER SANDRA A 645 HORNING ST APPLICA`61s�19972002 PHONE: q (4 0 8) 2 7 8-0 3 3 0 SANITARY N0. CONTROL N0. {v 0 z ARCHITECTIENGINEER: BUILDING PERMIT INFO && BLDG ELECT PLUMB MECH �?i U C.I L '7 Li Z_S2= LICEN5ED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under EEm,sion,of Chapter 9(commencing REROOF P Iw1:1 with Section 7000)of Division 3oflhe11.6atssend Professions Code..nd my license I 'i A, � Lcense force end tlkSl, 'y/o P FIN AL O o h License Class ` Lic.N / IJ F 3 O Date Commmor LL O(r ARCHITECT'S DECLARATIGIN L r s ate o d my plans shall be used as Public records JAN 3 1.2003 ip O Licensed PmOu,wul OWNER-BUILDER DECLARATION A p� 1 hereby a?nn shat 11. aurin from the Commcmr',License law far the BUILDING C?< following reason.(Semon]031.3,Business and Professions Code:Any city or county us 8 0 0 0 F F C which requires a Permit A. re comtwes.Quer,in mve,demolish. file repair arty t.m.e t°J 3C$-prior ro iu iuusnn.efwrquirts the Ikantf«suchpenniuofienseLow(Cnemcm q - . .. ..... . _ dwth.issing aepmwiottoihe Purvis sof the the Busiam AndPelaw lChapter) n'• ',3d¢4�V,�IDIDcfQ@ara. ValUflllOn - - (commepcine,wit[t,$enion TfJ(�0)of Division 3 of the Business end Profcesians Code? - ..r.s• l h.l.i,5,',,,.% c.3 s.l a!,\.•i„':sat..,'• : at that he N ceempf theiefrdm and the basis for the alleged eRnnpsiofi.Any violation of Section 7031:5 by any applicant for a permit subjects the applicant roe civil penalty '!of not fimiclhen Ove hundred dollars(SSW). 30%PN AULME _. TQI'' Occupancy Type 01.a......frhe proprny.mmy,.pl.,,.with wages.,their sale compensation, 307 - INSULATION will clothe work;ono the strita. ie mi imeudea or-offered for.].'(Sm:7664;' q-_•, 'Business and Professions Code:The Contractor's License Law does not apply m 601 _an 6 0 2 - ROOF PLYW u QC[IO71S - owner of property Who builds or improves rherton,and who does such work himself .1.L or throw h his own employees.provided that such improvements an not intended or ;q. reale.If,Wweve the Wildmi r Improvemmr is sola within our year of ' 603--'`ROOF 'BATTENS '�'” - -'--' Rcred smmr�ova for to o%ner-Wider will have the burden of proving that hedid not Wild or 604 - ROOF IN-PROGRESS P PrP n n:mownerpmjcc p(SmrtYam eusiniss and mmnisions Wenud Contractor', - -�;U^J;'>".i -- _ - - License the does n (Sm.7044,Business and Pmfahons Code:)The ws t eaor's I` [;_ Liana Lew car mar apply m mj owner of property who Wilds or impmsua thto be +.;.. wrd.wctor. wcte.for wch Prof«u wim.a.contmctw(s)licensed pursuant to be .-__.__. ..._-_._.. ...,_._ _. _ ......_.,.. ,...-..r _r License Lmv. ❑tealexempt under Sec "..., " '"I B&P C for this reason �•.)l: ft Il�rll Owner r''Daie'' WORKER'S COMPENSATION DECLARATION 1 hereby affirm under pnnahy of i ecrury one Of the following declarations: - 7 ❑ 1 have and will'inunuin'e Cenificsie of Consent m self-insure for Worker's l{, j_ Cnmpensmion. as-provided for by Section 3700 of the Labor Code, for the perfonnece of the work for which this permit is issued. °1 have•and will Wdiniaie Wotkar i Compensaiion Insurtnce,As mxgmred by Section -= 3700 of the labor Code.for the p6fomre,«e of the work for which this Permit is Issued My W rke,s is pe]]]ggg...rrruuu��tt�on���I���niun«e nat/e�r a�nd Policy' mbar arc: - Corti lley N �lJ C� /' Z llll���� "` 'CERTIFICATION OF EXEMPTION FROMWORKERS" �. .64It.GI' . % ff , r, r h.?E.:IL',T!i r. s •' :11' COMPENSATION INSURANCE', "� mlis'Rfll6n A ttd not E<'rompleied If the permit is for o«hundred dollen ,shl Ian,loy.y I 6inmi A in eof the as,to become11.­ to is iseded,l ;It, : pr;p.1'•,fil'�"' �• ` shall not employ Ws.f rwn in'Iny'manner w 1 m become wbjen m"Ne Workers' ' Compensation Ws.f fabfomra De.. ..AppLcani '�•. 'r � . 'NOTICE TO APPLICANT If.Workers Comkingpensation n OTC Lnsnsof of Lempton.y you mulct '.r- becomeh comfy thewith such Colons or this proriaani I the dLGWr Code,you must 00 _forthwith comply wiN each pmvi,ions w this pemsit elull W domed revoked. CONSTRUCTION LENDING AGENCY - lhemby willom that there is a construction lending egencyfo� perfo W-,Q ofrh sk fur hrch N ape t Isivad leer 309]Cs C.) LendNam .. ... .,. I u.... . ...___ _, .._._...._ _- ._...... _ ..._ Lend Add' r c .._.. v' '..b, 0 1 certify Nat I have rtW this application and nate that the above information Is tq correct.l agree In comply with all city and county ons inanm and nate laws relating 0"E to Wilding mosWction,and herttiy authorise rcprtumaiiJes of this city to enter upon the aWvemcmioncd pmpcnyfr inspection purpose, „ G.r'p,t ' IWe)epreemube indetlln fy and Jeep hennless the'Clry fCupenrno El.rat Fr V] cit liabilities,c Judgmen0 f 1h and expenses may,n any way a«rve against said C.J aZ City m consaaqqu, f Ire go ting of Nis PA.Y "- /VL APPLICANT STA.\ AND WILL COMPLY K ITH ALL NON.POBJT I''a so RE nD� �,1C�� Issued by: ate SI ppl HA2,nvacmr Det Re-roof Roof HAZARDOUS MATERIALS DISCLOSURE . Wll tea eppllcam orfatare Wilding 6cc pwtarae o hwdle hazardous ten V .Type O OOf -- u defined by m Cupertino M nrctp.1 cede Ch pre 9 12 end the Health and S.f.ty - - ` "' -- Cade S«uon 25532(elo Ts I ,i t I 5 's .,f. s 1 e a t s 1 - -. °Y" °i,: t P" All roofs shaD be inspected pnorto.any roofing,matenal being installed,_,-,_._.__.- . . Will die applicant TaalonWlldln`«cap.I uequipm nt rdevl aWhich If a roof is installed without first obtainingani ins ectio'tFa Tee to remove ithe dbytheBeyArce it alnyMinagetnens P g D' all new materials f r inspection Applicant understands and will comply_wlth `i _.- - em t haxudous ser conumsmnts u define 4 ` Wnam and mw rtnte I ;' all non-point so a regulations °Yrs Cat Vs requirements under Chepier 693 of tha fo a HeeIIA k Safny Code Sections 23505 23533 and 25534 1 u denund that f th 8 y nimt that t is my rceponslbduy to notify the AeE t of die quisenunuWhich must be met pnorr m Waimea of a Certificate of Oce • " p'7 Si attire f Applican[, Date r uthom ed sent Date, „ All roof coverings to be Class"B"or better Building Division y 410 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 Fax: (408)777-3333 CUPEkTINO 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 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 /wiith this policy. . Homeowners Name: Address: / O✓�Q�JLpcJ� Reroofing Company Name: (nytC) �,c c Applicants Signature: 1,2 Date: Joe Antonucci (Chief Building Official) 6/25/01