04030126 f CITY OF CUPERTINO � ' -
f BUILDING DIVISION PERMIT Cd I2�1CTQjk x��'`���' 00Nn
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BUILDINGADDRESS: FOUR SEASONS ROOFING PERMITND04030126
OWNER'S NAME: PERMTr ISSUE DATE
NO
ONE:
SANITARY 0. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ye,Z LICENSEDCONTRACIOR'SDECLARATION 7obDescri [ion
1 hereby affirm that 1 are licensed Moor provisions of Chapter 9(commencing p
n� with Section 7000).(Division 3afNe Business and Prefused.Code.and my goat.is
In full face andd�J!e . (+
5qg L....seClass `�37 Lie.{ ar REROOF (20296/20306/20316/20326/20336)
qqq Dam — Contnc
2 1 understand my plana shell M used public records
Licensed Professional pInIA:Le®
OWNER-BUILDER toDECLARATION fps i
.�a I I M1cmhy affirm o n 1 am cxampe fare the Conlns Cod License Law for the A PR 0
i p O following moron.(SeNon 7o L5,Business and Professions Cote:My tiny s county
$ which its issanFarm,mmosw0.alnsramfor such
tt of repair anyawmum
poor to itsissuance,ala requlme the applicant for suchpcemi,m rile signedChapianl
thazon nchenwit psection 7.the of Diatom of the C.mrmmsand PrsalawfC ode)or Sq.Ft. Floor Area SI.'X®alUau On
(Mazp$ got me olamllh rafon 70n d the
Division f r the al B ed exemplars.c y vi Carlen s (>
3.. tut he b exempt tMrefrom and the Eesti for the Jlegctl eumpton.My violation of
Section 7031.5 by any applicant for a Fourth,subjects the applicant to a civil penally of 314tber0 0 OGGD araC gyp{'
non more Nan five hundred dollars($500). P y •Ile
❑I,as owner oldie properly,or my employees with wages as their sole compensation.
will do theamak.and Ne structure tsnotinrende l cr.ffered forsale(Sec.7044,Business
and Professions Cade:The Com actors License Law Mea not apply to an owner of Required Inspections
property who builds er improves thereon,and who doessuch work himsel(or through his
own employees,provided thmmich improvement,am not intended oroRered for sale.If,
however,the building or improvement is sold within one year of ormpledon.the Owner.
builder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
❑I.as Owner of the property,am exclusively contracting with licensed contractors to
construct the Project(Sec.7044,Business and Ptife rations Code:)The Conmactors Lt.
can=Law does not apply to an owner of property,who Wilds or improves gunmen,and,
who contracts for such projects with acontraxamod liceused pursuant to the Comeacmh
License Law.
❑Ianexemptunder Sus. ,B&PCforlhismason
Ow r Dau
WORKER'S COMPENSATION DECLARATION
1 hemby affbm under penalty of perjury one of the following decloaions:
I have and will maintain a Carillons of Consent to self-ism a for Workers Compen-
ration,ss provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Waker's Compensation Insurance.a required by Section
31110 of the Inbar Code,for Ne performance of the work for which this permit is Issued,
My Workers Compensation Insurance calla and Policy number am:
Cartier, �Rr'r�� Polity No.:
CERTIFICATE OF EXEMPTION FROMORKERS'
COMPENSATION INSURANCE
(This mMnn need wifte.mpleted iflW permit is far..hundred dollars($I W)
or It..)
1 certify that in the perfammca of to work for which this permit is issued.I shall not
employ any person in any me= a.4!1IhecyhQyr mbjF.I to the Workcri Compensation
Laws of California.D '1
Applicant – ✓ –
NOTICE TO APPLICANT.If,afar making this Car ifica a ofxempoan,you should
became subject t.the Warkar's Compensation provisions of IW Labor Code%you must
.J O forthwith comply with such provisions or this permit shall W dacmad revoked.
Z CONSTRUCTION LENDING AGENCY
IWreby.in.Nat there I,...,=it..hadingagency far the performance of v
{Yi 7 the work far which this permit Is issued(Sac.3091,Civ.C.)
WMQ Lenders Name,
z Umho's Address
V 0 1 ttAli,that 1 have rod this application and sato Na to above information is
{(.F coned.I agree to comply with all city and county ordinances and stale laws relating to
0U building c.nswctian,and hereby authorize mpnsentatim ofthis city to enter upon the
4r7 shove-meN.ned property for inspection purposes.
(Wil)agree to save,indemnify and keep harmnsss the City of Cupertino again,
faA
liabilities,judgmental,coats and expenses which may in MY way seems against aid City
U in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: 4Da �/S
SOURCE REGULATIONS.
Re-roofs
Signazun of ApplicmVCom DO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tto applion,ar forum building e,Cleantnorc or handle Health
andmaterialSafety
y
as dcOned by Ne Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
.teas c1.na5532()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnus air coatamimene,as daOnN by the Bay Arca Air Quality Management all new materials for i - n.
District? —
Yes �
I have mad the haaadous materials requirements under Chapmrli.95 of the Califor.
as Heal &"
ScNom25505,25533 and 25534.1 understand Nazi( m I L ,� V�
Docs not cumemly ha t that it is my respousiM1iliry m noW'y IW occ p n c
neptimmcnu which at tprior to usuance of a Certificate of Occupancy. S)gnalUr Applicant Date
2 All roof coverings to be Class"B"or better
Owner or am orircJ egcnl Dam
`
100F
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
2c;�-Ki , Gvo""E. 3���-c 6I-Z-
OWNER'S NAME: PHONE # 78
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature 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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
3(l2�by
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
o
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U��__'�O 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: /VD �G� �7r,
Job Site Address: .2b 3'S 6— 'tc63zG — 2—a3/L— -Pa3ic6 gc,
Roofing Company Name: T`-o ' 1,, 56:it S Zo a�� [� G /
A plicanYs(S�ig�nature: — Zr a y
\�11�1h1DtX1
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
I�
CUPETINO PERMIT APPLICATION FORM
APN# Date:
r � Q -L2 - o
Building Address:
"p336- 20 - 20 3/4 -
Owner's Name- Phone#;
ot/�tQ��— i-lo � - i�6 -
Contractor: Phone#: License#:
37 3V 4/77 aeas-
Coact: Phone#: Cupertino Business License#:
Get Z'76- 0330 07! 3 z3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof 1 ❑ Built-Up roof
❑ Asphalt Shingles C Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) I?itl'l SAWA255:�' ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
';,To be Removed Provide Mfgr.Installation Specs._C="e2e
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
kA,O-oFf
Residential Commercial ❑
Fire Zone: Yes ❑ N Confirmed wit lannmgDe t. if
there are any,restrictio s:"
Cost of Project: TyeS4 Construction Occupa y up )
4/ 7 -,
Qty. if
ApplicAle 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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