0502014300
CITY OF CUPERTINO
3
I
nO
LL
j-
6
$
-x
DIVISION PERMIT
NT,.�
CORACTO—k4NF�ORMATION„
BUILDING
BUB.DING ADDRESS:
177 Nr)RTT4SR0dDK SQ I
FOUR�SEASONS ROOFING
PFx""05020143
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANTIARY C NIROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO,
BLDG ELECT PLUMB MECH
I� 0
' LICENSED CONTRACTOR'S DECLARATIONfChap
Job Description
I Mmby that 1 am under provisions of Chapter 9 (commencing
p
(h of fthe Business
with Sermon ]0011) of Division 3 of the Businea atW Profcssinns CodC, and my license is
fn fon force and 'ftREROOF
Lima. CI L'c. a
W/COMP.
Dem Contractor w.f
ARCHITECTS DECLARATION
I understand my plans shall W used u public m mes
Licensed Pnsfcssional
OWNER -BUILDER DECLARATION
I hereby affirm Not I am Cxempt from the Conoacmr's License Law far the
following mason (Smdon 7031.5, Business and Professions Coot: Any City Or County
which regYlres a permit to Construct, eller. Improve. dCmalilh, or repair soy aWelum
prior In its issuance, also requires the applicant for such permit to file a signed statement
matMlalicensed pursuant tothe provisional OfLIMContractor's LiCC WLaw(Chipter9
Sq. FL Floor Area Valuation
(commencing whhSection 7000) of Division 3 of late Business and Pru(euions CodC)or
that M is exempt therefrom and the basis for the alleged expi tion. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of
3 ]Fm�ero 0
Occupancy Type
not mom then five hundred dollars (M).
P Y
El 1, u owner of the pmpeny, m my employcu with wages u Neo sole compeua0on,
will do the work,and late structure is not intended or offered formic (Sec. 1041, Bud.
and Professions Cade: The ConuacmYs Liana law does not apply to in owner of
Required Inspections
property who builds mimpmOca thereon, and who docs such work himself sir through his
own employccs, provided that such improvements are not intended muttered for sada. If,
however. Ne building or improvement is sold within ane year of Completion. the owner-
builder will have the burden of proving that he did at build or improve for purpose of
ulild.
�+•w
(:1I,uOwner ofthe ro
contracting wins:)
copse ctpoc.704ameinessad Theedmnvacmm
Ne project (Sec. Business and Cade:) The Conhemon, Li!
La o an owner Of proper( who Wilds of
property whoWilds and
antic Law does not apply je anwith
_
/.
Comae,
who Contracts for such pmjeets wins aeonuumr(s)Iicensed pursuammlM Convacto(e
ant in
License Lew. a
❑Iamenemptunder Stt. .BA PCfm Nu maz r:
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deemadons:
1 have and will maintain a Ccruficma of Consent to self-himm for WorkefaCompen-
sation• as, Provided for by Section 3700 of the labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Wort ers Compensation hruruce, as required by Section
37M of the labor Code, for the pafornsoce of the work for which this permit is issued.
My Wor..m..tionlnmmncearer.nd PGlicynumkram:
isC
tamer. ;Ir• QL- 0-(lpolicyNoA—CO,X-0104v 10
D030
Aftk IC,,CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITu section need not he completed lith permit is froom hundred dothussn1(30)
'
or less.)
1 cerdfv that in the perfmmanec of use work for which this Permit a issued. I shall nm
mnploy any person in any manmrsi at to MComc subject to NC Workers' Compcnutwo
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL afler making this Cenificam of Exemption, you should
become subject m the Workers Compensation previsions of the tabor Cade, you must
forthwith comply with such provisions or Nu Permit shall W dccmed mwoted.
CONSTRUCTION LENDING AGENCY
I hereby effmm thtt Nero is a canswetinn lending agency for the pent.... of
led work for which Nis permit is issued (SCC. 3091• Civ. C)
tender's Namc
Lenders Addmas
1 certify that 1 have read this application and state that the above information is
Carmel. 1 agree to comply with all city and county ordinances and stain laws relating to
building construction, and hereby authorise repmaenmim of this city to Crory upon the
shove -mentioned property for inspection purposes.
(We) agree to save. indemnify end keep harmless the City of Cupenino against
liabililau,judgmcnss.cow ud<xpcnsu which may in any waY amus against said City
in consequencc is
fthis perm'
Ft
APP N RS DS L COMPLY WITH ALL NO
Issued by: Date
SOUR EG A 5.
Re -roofs
� Lit'o
Signatufc Of Ap,heart Cortrietto Date
HAZARDOUS MANTRIALS DISCLOSURE
Type of Roof
Will Ne applicant or future building occuput store or handle hamdous mainiW
u defined by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
m
Code.Scons533(an
❑ye Na
All roofs shall be inspected nor to an roofing material beim
P P Y g g installed.
Will Ne applicant or future Wilding occupant use equipment or devices which
If a roof is installed without first obtainingan inspection, I agree to remove
P
.mit harardnu air connm n. u Oncd by the Bay Area Air Quality Management
all new materials for inspection.
Disuict?
;No
❑ Yes
1 have mad Or haurdous materialsreyvirementa under Chapterh.95 ofuhe Califon
ria Health k SafctyCodc. &Co.. 35505, 25533 mW 25534.1 understand thatifthe Wilding
does not c ettffy7ha vwypht my Tos,lilacerdity m notify Ne occupant of the
I."! t
uiu
1
ritN
requi n metpAeca¢afOccupancy.
uamcof
Slg o Applicant Date
> • X.
All roe coverings to be Class "B" or better
Owner or mthoriwcda
spent D0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: 02 0 11'1
I-
N ar 4-U bra o K- S cl .
PERMIT #
Odd 2- O/ 7
OWNER'S NAME: L l"at
t Sw-z ..•.. e, y4 ., a e,
PHONE #
2 -? 9-0?7 o
GENERAL CONTRACTOR: Fov,,
Se o
FAX #
-2-
I am not using any subcontractors: C—.� C 2 z • o
Signatur� Date
Please check applicable subcontractors and complete the following information:
60
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
e�-'
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Cont4culr Signature
2- :1 y.s.or
Date
/. I
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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:
Su
Job Site Address: AOM-) M-) N o r'u%roo i. !&I
Roofing Company Name: l-a�ar SeBSo nS ?_'.041
A plicant's Signature:
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: 2-/o -OS—
FFR 2 2 2005
t
11
WITYOF
CUPERTINO
CITY OF CUPERTINO 0-0o2.-01 1 3
REROOF
PERMIT APPLICATION FORM
APN # 16 029
339
Date:
Building Address:
a01"1"1 Noril.,broolL Sq -
Owner's Name:
L l otiA i SvS'atnne_ \4a v, a CL
Phone #:
Z-48-0330
Contractor: Phone #:
Fovr Seo.Sons Qoo-ftn C`1o%l 2 -?8-0830
License #:
/72/08
Contact: /t Phone #: K
Al'(��U Co..Zxwc-.s 5 A
Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles elff Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
)60 Other (Specify) C AL.- S I --I A Ick ❑ Other (Specify) GAF G ro n d Ce.nY eh
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: TQar a -f -f 04'j%`r%n.9 cal,. SkAaa �Le roo-F, o,PPI.l 3016 vnae+61-
M��t" i l�s'1'*RA- GAF- Gra.,cl Ca. 0V cor+. osl+IQA
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are nnrestrictions: E
Cost of Project -4V DO O Type of Construction: Occupancy group:
,2F,-2ooF
Qty. if
ADDlicable
Fre. Ill
BPERMFEE
Bldg Permit Fees
TGG lJl V u
BUILDING
BENERGY
Ener
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING