05010171 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT C®NTRACT,ORRINF�ORMA ON
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMTNb5010171
20224 NORTHOLE11 SQ
OWNER'S NAME: PEItMR LSSl1E DATE
IghJOSHUA N H
41 ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEcr,EHGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_Op LICENSED CONTRACTOR'S DECLARATION n O O O O
b I nemby affirm that 1 am licensed under provisions of Chapter 9(commerce, D �yy,VIE
with Section of Division 3 or Me Business and Profcssims Code.and my license is / � l�u""
n in full fmcc and cfRar, 1111 NNU F�(� I E rAAlk r"'
�q=
Licavea �'— lie.g 7J'- o REROOF W/ COMP.
_fN Dam�• CS DECLARATION �`"" w"f MAR - 2005
?I_1 I mbammul my plans shall he tined as public records
u t; Licensed Professional
OWNER-BUILDER DECLARATION Ip' IPI It -4 T��qp
'e F Ihereby al'fnm Nat I am exempt room the Contractor's License Law for the '1 II p g � gd( Wfl
i
20 followingmason.(Section 7031.3,Business and Professions Cade:An cit or count v FFL����E UUU II V
which mr,ores a Permit to cormucr,alar,improve,demolish,or mrWf any structure $7000
FZ< poor to is issuance.also requires the applicant for such Permit to rile a signed statement
FxG
Oat Wislicensed pursuant 1.the,provm
isioofMeContractor'sLiecnselaw(Charter9 Sq. Ft. Floor Area Valuation
n1- (comm acing with Section?000)a Division 3 of Me Business and Pmfessfis Code)or
g that he is emmpt therefrom and Inc basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
ret mom than Eve hundred dollars(ISM). A Q Occupancy Type
0 1,u owner of the property,m my employees with wags u Heir ale eompenudon.
will do dm work.and On muctum u not intended moffered Russia(Sec.7(144.Beat.w Professees Code:The Curbstone,Li.Law don.1 apply to an owner of Required Inspections
property who builds orimprowr thereon,and whodo such work himself or Omagh his
own employees.provided that such improvements are not brooded moRemd fursaln.If,
however,the building car improvement usold within one near of completion,the owns,
Wilder will have the burden of proving Nat k did not build or improve fm purpose of
sale.).
0 I,as owner of the property.am eaclmivcly contracting with licensed contractors b
camomet On project(Sec.7()W,Business and Professions Code:)The Conmctars Li.
cense law docs not apply to an owner or property who builds or improv Mercer.and.
who contras for Bush projects with aeomrator(s)licenned pursuant to the Conuactoes
License law.
0 l am exempt under Sec. ,B k P C for Nis reason
1307M
wner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm maker penalty of perjury one of the following decimations:
I have and will maintain a Coulmate of Consent to self-insure fm WorkersCompen-
ien,u provided for by Section 3700 of the labor Code.far the peaf ornmen of Or
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,u required by Section
of the labor Code,far the peffmommen of Ne work fm which this permit u issued.
y Workces Compensation Insurance carrier and Policy number are:
rver: G.ir�4&cai Co Policy N04� CCU rO/ O YA 5 100030
CERTIFICATE OF EXEMPTION FROM WORKERS
wMsca. COMPENSATIONINSURANCE
(This.0.reed not becompleed if the permit is return hundred dollars(SIM)
or Ica)
I eenify Nat in Ne performance of the work for which this Pamir is issued.l ihall not
employ any Perron in any manrmr an as w beeomesub seL b On WorkersCian,co alien
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
became subject or Me Woheri Compcwtion provisions of the labor Code,you must
wJ z foMwith comply with such provisions or this permit shall W deemed revoked.
z h CONSTRUCTION LENDING AGENCY
'N l hereby alTrm Nal them is a construction lending agency for the performance of
tyi Ne work for which this permit u issued(Sec.30 W,Civ.C.)
dA Lenders Name
z Linda's Address
fJ Q 1 ttins Oar 1 pane mad this application misuse that Me,and
slave information to -
O^. rntma 1 agrm to comply with all airy and county oNinuwor and sum laws relating e
OU building cndonadtiroend hereby suNomempreunutivcs or Nu city bents upon the
above-(We)agree,
properly for inspection purposes
y es ju agme t.save,indemnify and kith may
in m the City n Cupertim against
fA inconu ,denc of th.costs gandintlof this expenses which may in anyway semi against aid City r
(„)z in comequentt of the 8rantinPPLygpoif NMisNpermit.
Fw OURICA GULDE Nq WILL COMPLY WITH ALL NON-POINTIssued by: Date
Re-roofs
b1platme of A,Iic- Con��ppau Data
HAZTRDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding aeeupanbtore of handle haz t mjrx material
as defined by the Cupeniw Municipal Code,Chapter 9.13,and the Heart and Safety
AJIarae.seNea zss3z(aYr 4� All roofs shall be inspected prior to any roofing material being installed.
❑
Yea
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 hauranus air contsmirtansu d rincd by the Bay Asea Air Quality Management all new materials for inspection.
7d-.
gict?
❑Yea No
Ib&Safer the hvardsusm 5305, 5533als ad255menda under Chapter
minand.93 of Or Wilding —
IksIN k Safety CBM,Sec4om 75NI3,23537 and 35530.1 undersand Net ifthc building �k
net cormy�d have tenon t u my mmensbility b ramify Mc eccupnt of Neuirtm �ptn x sprig' wissuanceoraceniRveeroecupattey. Signature of ApplicantDate
ti- 4—�8 Q�ner mautheriaed,cint D,te All roof coverings to be Class "B"or better
S
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IOUPEkTINO
Building Department
JOB ADDRESS: ;20;�26j No `s �� PERMIT #
os-(s /O /'7
OWNER'S NAME: Q X L%- o G A N PHONE # -'2.,-7 g-6330
GENERAL CONTRACTOR: cu S�c o� FAX # X-79 -o33
I am not using any subcontractors: (2z / • 8 0.1'-
Signa 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 Pnjr S ^j go,,P 3L f o g.
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Si a Date
1 Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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.
Homeowners Name: —J S"a h N
Job Site Address: O A 1y N o r+t.9(en 5 G -
Roofing Company Name: Four Sea so n S Roo-pI n Q
A plicant's Signature: ��� Date:
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF nSzJ( "
• CUPEkTINO PERMIT APPLICATION FORM
APN# 31 40 q / D s-3 Date:
Building Address:
Owner's Name: Phone#:
J'osl�•�a N • Ho atn �-'� SI-6330
Contractor: Phone#: License#:
Four Sea&CD^s ?-0461 a�8-o330 �l-I21o8
Contact: Phone#: Cupertino Business License#:
I'�'l'Fredo Ca2arc.s 2"l Q-o33o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles eSSP Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
0 Other(Specify) CAlrSifAVLS_ ❑ Other(Specify)
Number of existing coverings I ❑ 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:
T( 0 GAL St4Alts- ir np% — '3 CI# FtL-r ADPL 0.AFGraAclC2,. e . 0
Residential Commercial
Fire Zone: Yes El No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:g Type of Construction: Occupancy group:
000 1Z� -(zdoF
Qty. if
Applicaye 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
f 137. 8