04030125 CITY OF CUPERTINO ""TNira RIVIATIOW'',,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT"°04030125
10943 NORTHEETT-T) SO
OWNER'S NAME: PERMITISSUEDAT6
NORTH POINT HOA 64S 14ORNING ST r)2 /i ,2 /,pnnA
ONE:
SANITARY N0. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O D O O
y o O LICENSED CONTRACTOR'S DECLARATION
Y I hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description
< with Section 7")of Division 3 of Ne Business and Professions aria.andmylkenot.
mfull
aseforce lasa mea Lm.Is 7o`I10 REROOF (10943/10953/10963/loMM LED
n 1tgo- Do
leas S�AR�HITECI'S DELLA ON
a I undmsund my plans shall he used as public rccoNs APR 0,1 2004
ddd
{G
Licensed Professional
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OWNER-BUILDER DECLARATION BUILDING
30 S I hereby moo.(Srm this 1 1. exempt from d r Contractors License Law for IW
L1 O following moron. etch A?03 1.5,Business and nve.de inns Code:Any city nr county
$ which requires issuance,pewit m cams the ellen Improve,h Per it t or repair any soumum
Fly Magig
nkiss ensedpalsun tot he the applicant for Contractors
refile aaLawAsmmment
< Nm(commencing
prevision Dvion3of Comrmro/sndProelaonsCou(Chapter 9 Sq.Ft.Floor Area Valuation
MR� Meth.its ixemiNgerairom and MA,hasisfrM al Burmese end Professions Code)or
Met io u exempt any
anti Ne buts it be alleged exemption.Any it penalty
of
.ancone them five
any applicant for a permit objects Ne applicant •civil penalty of 3 JPTBIRQ&Ae10 0 Occupancy Type
not more Nen fivs hundred dollars($508). P y yp
❑Laaowrmr of Ne property,ormy employees with wagesa Neirsolecompenutlon,
will do Nework.and Ne ewcmrt iswlimm.ded oroRemd lease].(Sec.7061.Business
and Professions Cade:The Conoadaes License Law does not apply to an owner of Required Inspections
property who bu ilds or improves Nemon,end who does such wmk himself or thmugh his
own employees,provided that such improvemenu art not Intended araffertA far sale.If.
however,Ne Wilding or improvement is mid within one year of completion,the owner-
builder will have tiro burden of proving that M did not Wild or improve for purpose of
sale.).
1,a owner of Ne property,am exclusively contracting with licensed contractors to
construct the pmjem(Sec.7064,Business and Professions Cade:)The Conoacmh Li-
came taw does not apply to an owner of property who Wilds or improves Rome,and
who convects for such projects with a conaactrr(s)licensed pursuant in Ne Contractor's
License Law.
❑Ismexempt.adar Sec. ,B&PCrm Nism=.
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following dmumtlons:
I have and will maintain a Certificate of Consent to self iasum for Wmkcr'sCompen-
smion,a provided for,by Section 77M of Ne labor Code,for Ne performance of dm
work for which this permit is issued.
❑1 have and will maintain Worker's Ounpe oMm Insurance,As regained by Section
1700 of the labor CoEc,for Ne performance of Ne work for which this permit is issued.
My War Compemadon Insumnce cancer and Polity number am:
Cartier. 1A/�_C_t Policy No.;GL a4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed if the permit Is forone hundred dollars($1010
or less.)
I certify that in the performance of the work for which Nis permit is issued,I shall not
employ any person in any manng IjVonn hcuo the Worlmn'Compemmlan
Lawaof Califon t
Applicee v,
NOTICE TO AP Nrk If.after Commaking this visions f M Exemption,you should
becomesubject
comply
it Workers Csions"his Permit
of MeLetterCode,you mute
.JO (oMwiNcomply with such prmiaionswNis permit shallWdcemcd rcvekcd.
i► CONSTRUCTION LENDING AGENCY
H Ihemhy.Mrm that then is a construction mdin,.,Aq lar the Koformmc.u(
Me wmk fur which this permit is issued(gee.3(197,Civ.C.)
t7 Lenders Namc
=z Lemines Address
U Q 1 anify Nal l have mad Nis Application And cum Net Ne me.infuwmkm is
ly (✓ comet.1 agree to comply with all city and county ordinances and state laws relating to
QU building construction,and hereby authorise representatives of this city in enter upon Me
�a above-mentioned property for Inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
w co) liabilides.judgmcnu.costs and expenses which may in my way same against said City ` 7
U z APPLICANT UNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued by: Date ./
SOURCE REGULATIONS.
Re-roofs
signature of ApplicanVContractor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building mcupant r 9,1 or hurdle Health
material 7
a deMcd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
oda,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �o
WWill the applicant or future building occupant on equipment or devices which If a roof is installe first obtaining an inspection,I agree to remove
it hamrdous air c.numinanu an defined by the Bay Area Air Quality Management all new mated s for inspecti n.
DlStrlct7 i
❑Yes 74.
I have mad Ne Wesrdousmatedals requiremcnu under Chapter6.95 of the Califor-
niaHealN&SafctyC 525505.25577 and 25534.1un@rsund NeNfNc building
dna not cuocpd arm a unset et it is my responsibility to only Ne mmPmt of Ne L
m uimmcnu which most here'Cilpri.,miuuma or a Certificate or olicupwally. Signature of Applicant Date
Owner di ruhhoriagrm „e All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
alol"
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
�UPEI,TINO
Building Department
JOB ADDRESS: PERMIT #
0ti PO v bk---
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
-,5 (l 6
Owner/Contractor Signature Date
Community Development Department
Building Division
&7awnw",
City of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408)777-3228
Fax: (408) 777-3333
U P E�T I N
i
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 I/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: U V� �C
Job Site Address: 1 6cjq 3 - 169 5 3 - C Der6 3 - 16 ,9-73
Roofing Company Name: '� SC/I S� 5 �d 1
A pA
icant's Signature: Date:
�JVVVeel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN Date:
'7t
7 3 _ tZ
/Building Address:
ll' - lo9,s3 - 1o�ite - to`��3 Ne>,tt„ �lb
Owner's e: Phone#:
cC t-Eow�Eoc,�,��-S C7 �. fo 37 -3
Contractor: Phone#: License#:
GY-L�- 7ZI4 F
Contact: Phone#: Cupertino Business License#:
Z) k--C� 27$ -0330 1 -52-3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles $ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
*P'� Other(Specify) C S Irk-rlti 6 ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs. Ar- riw.o CNN rat;
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Poli y:
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restriction Ll
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applic 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
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2 � 7 �