05010173 CITY OF CUPERTINO new K a.s.�x•F 3 <.�' �'"�•< -� °x '
BUILDING DIVISION PERMIT 10NTRAC'°TOR4NFORMATION
auILDING ADDRESS: FOUR SEASONS ROOFING PERMITN'65010173
OW NER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRACTOR'S DECLARATION JobDescri Description
O O O
U 1 Mrcby affirm Mat 1 am licensed under provisions of Chapter 9(commencing p
^� width Section 70110)of Division 3 of the Business and Profcssimns Code.and my lien.is {r��
��?> in fun fortt and eDgq�j Coss tt—�n p asrt a Ips®
Licenso Clue ` 7y7jEROOF W/ COMP. II I�IV`ACIntIY/�(gi\l)lnh tufo
z_� Dose / Conlnnor f �O� rI
ARCIII ECTS DECLARA ON
s 1 undersand my plans"I be used as public records
at; LwousedProfessional MAR [4 2005
3 OWNER-BUILDER DECLARATION
.� I hereby alarm Not I am exempt form Me Ciummo.es License Law for the
i S 0 following reason.(Section 7031.5.Business and Professions Code:Any city or ounty
which requires a Permit to construct.altar,improve,demolish,or repair any structure ( � O
iy prior m its issuance.also requires the applicant for such Permit m rile a signed statement
HF NnhcisliccvcdpursuantmMProvisiouofMeCantr•cUA'&UMnxlaw(Chapter 9 Sq.Ft. Floor Area �' bearHValuation
o (commencing with 7000)a Division 3 of the Business and Professions Cndelar
k g— Wt he u exempt therefrom and the lois for Me alleged exemption My violation of
Section 701.5 by airy•pp Lean for a permit subjects the applicant in a cin]penalty of hundred Militia not mom Nan 3 18153ffieA 0 Occupancy Type
Eve n($500).
❑1.As owner of Ne property,tar my employees with wages As then sole...'radian.
will do Ne work and Ne structure Is not intended or offered for sale(Sec.7060,Business
and Professions Code:The Contaam's License law does not apply in in owner of Required Inspections
propeny who bui,N orimprovm thereon,and who doessuclt work himse,fur through his
own employees,provided Nat such impmvummu are not intended oro(ferW forsaln IL
hwevcr,the building or improvement is sold within one yev of wmp4don.Ne owner.
Wilder
will have Me bard.of proving Nat be did rot build or improve for purpose of
sale.).
❑1.as owner of Me property,am exclusively contracting with Rcensed mnoacurs to
construct the pmjca(Sec.7006,Business and Professions Code:)The Commcurs U. -
ecroe law does not apply to an owner of property who Milds or improves Mercer.ad
who contracts for such projects with a contrnitor(s)licensed pursuant in the Contractors
License Law.
C1 am exempt under Sec. ,B k P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury one of the following decly nimma
I bsm and will maintain ACerti&ata of Coroem In aclf-insure for Worker's Compcn.
71,11Y. It
tion,ss provided for by Section 3700 of Me labor Code,for the performance of Ne
rk for which this permit is issued.
1 lave and will maintain Worker's Compermthot Imunnce.u mqu;rcd by Section
00 of Me laborco le,for Ne performance of Ne work for which this permit is issued.
y Wor Compensadon Insurance caamer and Polity numberare
« v celiry No.: v `�+ U 7a OGogGCERTIFICATE OFEKFMPTIONFROMWORKERS�` COMPENSATION INSURANCE
or less.)(This sectio recd not be completed if the permit is for one hundred dollars($IM)
I ceniry that I.Me pterfonOmm of Ne work for which this permit is issued,l shall not
employ any person in any manner an As to become subjeeuo Me Workers'Compensation
Laws of California Dau
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Exemption,you should
become Subject to Ne Worker's Compensation provisions of the lahm Code,yet most r
�0 forthwith comply with such provisions or this Permit mall the gecmW mated.
Z� CONSTRUCTION LENDING AGENCY
(-+ I hereby•Rim that there is a construction lending agency for Me pmpummO,of
a the work for which this permit is issued(Sce.309'x,CO,C.)
�W A Under's Name
r7 larder's Address
U Q 1 certify that I have read Wa application and state Mn the abme information u
cimmetly F
Wilding
1•green,comply with all city and county nuouneaes and suss laws rupen the Ze U btAw.mennonedpmand hcmby auNonprposes. uuvn ofNiscityrocntar upon tn< o,
aabilim ,judgm p,cost for
An inspection purposes
fir+1 (We)agree to save.indemnify and keep harmless the City of Cupertino against
to in
Me granting
oxpemus which may in any way attorc against aid City
in consegnence of Mre Booing of this permit, v
^ APPLICA ER N D WILL COMPLY WITH ALL NON-POINT Issued by:
souxc cl �� Y Date
�" �- "� Re-roofs
Sgnawrc of AppharWCo r Dau
HA US MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building recupant stone or handle hvallout mauri•1
As derirud by the Cupenino Municipal Code.Chapter 9.12,aril the Health and Safety
IDi,t,ic,?
de, Dyes 25532(a)? � All roofs shall be inspected prior to any roofing material being g installed.
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 Int.omm air cicuminenu n ncd by Me Bay Area Air Quality Management all new materials for inspection.
❑YesI have mad Me hzvndws materials mquimmenu under Chater 6.95ofdre Ca,ifor-
.OuNkSafnyC Scctimm25N)5.25511am1255J0.luMcravqNvifNc WildingGos rot eurtr55pptlN my responsibility b notify the azupant of thef 6uirtm tfwh-h rot prior to issunnueTf•'emir...ofcccupanry.
Signature o pplicant Date
owner mr,omnrncd agent Data All roof coverings to be Class"B"or better
a Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: S �O 0 PERMIT # / / 73
X031 1-7 /U ��•(1 �✓o a
OWNER'S NAME: 4un Lam IPHONE # �1 -cv330
GENERAL CONTRACTOR: Fc,,r $ec4sovts I FAX # 2-7g - o3s3
I am not using any subcontractors: / .2"? • 0 T
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
illass / Glazing
Heating
nsulation
andscaping
athing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing r Sco.S S n 14 7a I8
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner Co tractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U���I�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 LC.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: Lca in LOM
job Site Address: 01031-4- 0 o rtl't'ov oo IL S1
Roofing Company Name: _ Four S'eaSonS 9oo'Qi�
A plicant's Signature: a.-� Date: / -.Z7—o Sr
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEf�TINO PERMIT APPLICATION FORM
APN# 3 16 3 g O 6 6 Date:
Building Address:
Owner's Name: L u n L.a M Phone#t
.1-7 �'-6 33 O
Contractor: Phone #: License#:
Four Sea.soe.s /01?
Contact: Phone#: Cupertino Business License#:
14 1_FfaC/o Co.Z�rcS �--78-0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles e�IP Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
AP Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
iI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
10 CAL-3WAV� ("NSA-114 .304* FS-(.T I APPIL-Y GAFGraA C" ow r+p
Residential Q�_ Commercial ❑
Fire Zone: Yes ❑ No R7 Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: S' _ Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMIE'E Bldg Permit Fees BUILDING
j BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
� Il � � a