04030262 C[TYI DFN DIVISION
PERMIT CO�iTRACT0' ,R 1,N AT ON-
<r5
Buaomc ADDRFss: FOUR SEASONS ROOFING PERMITNo04030262
e OWNER'S NAME: PERMIT ISSUE DAM
EDWARD VE
TONE: SANITARYNO. CONTROLNO.
(408) 272-0130
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=1 t�
u o O LICENSED CONTRACTOR'S DECLARATION - - lob DeSCrI s�.yy��.�, s
1 hereby union that 1 am limnxI seam rovisions of Chapmt 9(commencing psawsa1 M .
aFP
it Sccion )of Divlalon Sof Om Buu Profcssiunx Codc,mtl myliccn¢ie YY
6 in full fq nd effee l'1I
b � License Clps Lk.s `h ` REROOF
Dam Gan MAY 27 2004
ARCHITECTS D ATION
1 understand my plans shall he used or public records
i C Licensed Pmfcsaionel
BUILDING
OWNER-BUILDER DECLARATION
1 hcrehy.(Sec tat 11. exempt from to Contnnots aLicense AC Lew for the
y p aO following reason.Permit
t ]1131.5, s.altar. and tae,demolish.
Codc:Any City s county
ctur,
y$LL which Mgakel 8 permit re consumes.to altar.improve,forsu demrmiit t fi repair any ned statement
iFIZ} 200
prior or its iensedp pursalso uant
prevision of the Common's License aw(Cha mens
£ o tbuthce ceanwadpuection7 h)ofDivision oftheBusiness
tfuessandmnsCLaw(Chepmr9 Sq.Ft.Floor Area Valuation
J! (cat he 1.
and of leads
ofr thstaged essand Professions Cade)of
3.. that ha is exempt them(rom mtl to bvu for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3W42ft*Cr0 0 Occupancy Type
not mom tan five hundred dollars(5500).
❑1,as owner of the property,or my employees wit wages u their aide compensation,
will do the work and he sbecone ie not intended or offered for sale(Sec.7044,Businw
and Professions Cade:The Carmine,License Law data not apply to an owner of Required Inspections
property who builds or improves mescen,and whodmssuchwmk himselforthrough his t
own..pier.,provided tmauch improvements are oat immnded ora@red Tamale.If.
however,lie building or improvement is mid within am year of compledon,to owmr.
builder will have she burden of proving mal he did not build or improve for purpose of
pie.).
❑1,as owner of the property,am exclusively contorting wit licensed ennmcrors to
construct de,project(Sec.70",Business and Professions Cade:)The Constraints U.
came law does not apply In an owner of property who builds or improves lherrnn,ad,
who canstucts for such projects with a mammonist licensed pursuant to to Ceremonies
License Law.
❑1 am exempt under See. .B&P C fm Ws moron
Own. Data
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury one of to following duc u a ons:
I have and will maintain a Certificate of Canunt to self-Inure for WorkeesCompen-
sation,as provided fm by Section 3700 of he Labor Coda,for the performance of me
work for which this permit is issued.
❑1 have and will maintain Wmko's Compensation Insurance,ss sequined by Section
3700 of the Inbar Code,for to performance of the work for which this p arah Is issued.
��`��`My JJJWJJJorketan lion Inmwance camiv and Policya be
a,: Polity No.:��
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thesuction need not lmcompleted Bills,permit is formic hundred dollars($100) '
or less.)
1 catttfy mat in the Performance of me work for which mice permit H issued,1 shall not
employ any person in any manncrm ss to become subject in theWorkers'Compensation
Lawsof California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Caniffcam of EacmNion,you should
become subject to the Worker's Compensation provisions of to Labor Code,you must
�Z formwith comply with such provisions or this permiuhall be decreed revoked.
'y O CONSTRUCTION LENDING AGENCY ,
(r Ithereby&MTm dues mem is a construction lending agency for to perfusmmce of
p$7 the work for which Nis it is issued(Sec.3097,Cih,C.)
WM Q Leader's Nurse
z Lender's Addrep /
U Q I ce tit have read this application ad roam that the above information is
coach Ise to reply wim all city and county ondinamu and auto laws relming m
V building can c n,and barely autodre representatives of this city to Cott upon 0th
ahovommil property for inspection purposes
tF^y a (We) e to wave,indemnify and keep harmlms to City of Calamine against
fn liabilidei.jud TIB.Coats and expenses which may in my way accme against mid City
in consequeim the Starling of this permit.
APPLICADERSTANDS AND WILL COMPLY WITH ALLIN -POINT Issued by: Date
SOURCE S. %I
Re-roofs
nam o App dcormactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
II ens upantor futureipal Code.Chaptetomm handle Health and Safety al
az define by me upenino Municipal Code.Chapter 9.13.and the Health and Sefcty
ale,Se don 255 20)? All roofs shal b in pected prior to any roofing material being installed.
Yas No
Will pbaan r future building
accupem esu cyuipmcnt or devices which If a roof is ins Il without first obtaining an inspection,I agree to remove
mit Im.dom 'r can inants as delhal by the Bay Ama Air Quality Mmugement all new materi s r inspection.
District?
❑Yes �No
I have mad h ¢otic mamrialsmquimmenmundcr Chapkr6.95ofmc Califor-
nia Hcaldu&Safety .Sc mu25505,15533md255M.1un0orstmdtetifmchuilding to \
does not cuncndy h 4 tat it u my usponsihility,m notify dm ace mm of me /1161
mquircmcnuwhich t at prior 1.homes.ofa Ccnifict ofQ p-7a�n Ignature of C ate
Owner or mmaorita nth -I.-Bi A 1 roof coverings to be Class "or better
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Buildin I g De artment
JOB ADDRESS',Iz/ tel/ R V\- , PERMIT . _ „
OWNER'S N 'V` VvA7 PHO
GENERAL CO CT R: FAX # F16 7�'c�S f�3i
I am not using any subcontractors:
Date
Please check applicable subcontractors and c 1 to the following information:
SUBCONTRACTOR B IN SS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
�i Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing K
Septic Tank
Sheet Metal
Sheet Rock
Tile
�f ctor Signature Date
• COMA Development Department
Building Division
City of Cupertino
w 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E TIN 0 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 the above/stated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name: - f a+�3 �06�`'�
A plicant'sSignature: Date:
Greg teal
Building Official
Revised 1/30/03 /
Printed on Recycled Paper
0
CITY OF CUPERTINO Q o3 02 62
OREROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3 7 5 4 Z.0 1 +J Date: 3
Building Address:
iM� c� Svc �i5o�
Owner's Name: 1 , 1 Phone#:
C Q u J�✓ V t/5 Ct„ A/e; L r" oS- 4/vlc - laze
Contractor: Phone#: License#:
y6F1 ?z 16�-
Contact: Phone#: Cupertino Business License#:
oma✓ G✓E Z-78 -6330
Type of Roof Covering:
Existing: Proposed:
^Built-Up Roof C 1 f1'sG� ;K Built-Up roof CO,n 5
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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: E�__
Job Description: / T
Residential 7w— Commercial ❑
Fire Zone: Yes ❑ NoK Confirmed with Planning Dept. if
there are any restrictions: LJ
st of Project: e Type of Construcd Occupancy group:
Qty. t
A li le 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
•