01070126 OF
CIBUILDNG mvtsIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20175 NORTHGLEN SQ FOUR SEASONS ROOFING 01070126
`K6kYW9bINT H.O.A. 645 HORNING ST A61`/I��`. ?BA l
(408) 278-0330
PHONE: SANITARY NO. CONTROL NO.
NZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a Z LJ L_J L= LI
bran
LICENSED CONTRACTOR'S DECLARATION
�5 y? Job Description
Don—Q I hereby 0)of Nat 1 am licensed under p ad Props of Chapter 9(commencing RERObF.
cont. with Secsion]OW)of pivision3of she Business and Professions Cotle,antl my licenu
a S kimmlforeeameff-e-3 2 sac g z T/O CALSHAKE, INSTALL 40YR.
z N U Licenu s
x o d Date z � Com aclar - GAF GRAND CANYON COMP.
w 3 n ARCHITECT'S DECLARA ION
O g 1 undommnd my plans shall be nod as public records
SgyY
y Licensed Professional
B o OWNER-BUILDER DECLARATION
u� 1 hereby varef that I nm exempt from the Cerins o License Law for the
C? fellmvire «mon.(Senior venstr, t,slid, and 1ve,de inm Code:Any city of enuvy
or x❑ prior t requires n permit to cunstme applicant
improve,demolish, fie asig ed statement or prior its issuance.oleo requires prevision o for thesuchpermimofilereignedshapter 9 - - -
thnNgiilicgwithSisetwit jepiovasionsoftheConuacmraLicenulaw(Chaptm9 n S Et.,FloorArea,c I $ N14uation
fcommencin8 with SrdpnE]000I of Division 3 of Ne Business and Professions Codel i_ r ',t } }�, 1.q i s'� r 'sl s .:+ 1s_ . . SOVP/
ar that he is exempt therefrom vN tM basis for the alleged acraption.Any violation of Section7031.5five hundred
1permit subjects Ne applicantmacivil pemlty 316$x'0171 \f0 Occupancy YP
of nosmort Nan fivehundredcantdollars for
6500). bGGn ane Type
°I,as owner of Ne property,or my employees with wages m their sole compensation,
will-do the work;and the structure is not intended or offered ter sale law. .,., 3 O 5 — FRAME Required Inspections
Business and Professions Code:The Contractor's License Law does not apply to an ,}�'f❑❑ N p
owner of property Who builds or improves thereon,and who does such work himself 3 O 7 — NU T
or thmu h his awn employees.presided that such imp rmo me ata ere not intended or b
comply a .ale:It,however,the Wuvetauren of proving we did nae year or 6O1-' RO F FF._.._ .
r ,
completion,purpose
owner-W ilder will have the bonen of proving that he did not Wild or
improve for paryou er tele.). 602 - Oq LY NAIL
- _ . -- - - BPIF -'
❑h ns owner M Ne propcnY.enlsadnsiul5je9n12'CL linen co cton to . .
- construct the pmjat(Sec.]04 Buainesi antl Profs, art, ade:I tractor's bb
License
law does not apply to aw=e;of property wee bvi ds or i rov thereon. Ix
O4 R Fandwho.comrucss for such djsas-wlth.a canuvcioi(s)q$emed ha t m
Contractors Licenu law.
- - ❑I am eaemps under Sm. I I j C• B&P A,or on
Dwner ;` fete r•� -
WORKER'SCp�f--..-- -AR •"
1 hereby uf0em under penalty of perjury ohne of the following declarations:
❑ 1 have and will maintain u Certifcee'of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the labor Code, for the
perform...of the work for which this Permit is issued. E
°1 have aril will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Cade,far she do..of the work for which Nis permit is
issued My Workers Camperuntion Insurance carrier and Policy number art:
camrP:r'+'r:t•.lY'dl•.eoBcr Na.r.✓GL'/�8'S9 r/3 ,
. CERTIFlCATION OF EXEMPTION FROM.WORK , s.
2RS' •'s!' t h Y "• .
COMPENSATION INSURANCE t s . ._...__.. _.__....._ ..__._..__._
f1Tii rection need not the completed if the permit is for one hundred dollars
(EI W 1 or less.)
- ...
1 sandy Na m the pe I.any ate of the nark for which u pe tit a issued,I ,. _ r• s - -
'shAl not employ any person m any manner so as to become subject m the WorkcT.i
Compensation Laws of Cvlifomia.Date
Applicant
NOTICE TOAPPLICANT:the Workers Comter pensation
this provisions
ision of of Labor lon.de,you ld become subject to the Workers Comncmadon Permitt shall
the Lahr Code,you must
CC forthwith comply with such provisions or this permit shall b<dumW revoked.
Z .. .-
ay
-ECONSTRUCTION LENDING AGENCY
' of1 hereby M.the them is a ionswaimi leading agency for the performance
y ^ ework for wNch Nis permit is issued ISec.lW].Civ.C.1 _ _ _A 'Lenders Name. .. . .. • ...: __. - _. ..
;5,Z Lender's Address t -
C.7 0 1 certify that 1 have read this implication Emil state that the abuse information is
r3s Pcelreat.1 ua.to comply with all city and county entrances and sat,laws relaying
C'U t building enstructn and hereby authorize representatives of this ty to enter upon
the boa attuned Property t pe y p opo.
As (We)agrers,s indemnify and keep harmless the City of C menti against
V1 liabilities
^ 'SAOPPULRICE'judgment d
U-Z City in consequence m y nsosth ph h t
C, IND T�B�AND WILL COMPLY
inWa ITy H y NON-POINT said e0- Issuedb : .
C
Signvwrto pplicarmContmcrnr - Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
' W II the applicant of f sru¢Wilding occupant vers,or handle hazardous material Type of Roof -as deflnad by the Cupertino Municipal Cycle,Chapter 9.12,and she Health and Safety
Code.Scction25532W1' .. ti . . . 9s.J £: t' :•:""'�t f. . .
AILroofs.shall_be.inspected.prior.to.any.roofing.material being installed..........-._.
will the applicant or fume buildog occupant a,v equipment or devlecs which If a roof is installed'without first obtaining an inspection';Fagree to'remove
emit hazardous air c.ousum ants m defined by the Bay Area Air Quality Management'
District" all new mater' is for inspection. Applicant understands and will comply with
°P`s, -5—N. all non-poT sou/pp/regulations'.
I have read the hazardous materials5052533requirements under Chapter fi 93 of the
M California Health Safely Cade.Sections 23505.]3513 end 25531.1 understand that
rf�Idareae nay haves mnam.that it is my responsibility to=city the
oqu team which must he met prior to issm nce of a Certificate of
Zero/ Signature of Applicant Date
Owner or authorixetl ngcnt Date All roof coverings to be Class "B" or better
„.. _
., .. .. . . . ` OFFICE a. .
Building Division
10300 Torre Avenue
I Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/n" 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 61/y�9 �m NS/I— A O A .
Address: �/ 7 S /lJC'rd�(../ 6/p,/
Reroofing Company Name: oa <7o"
Applicants Signature: Date: 7
Joe Antonucci
(Chief Building Official)
6/25/01