08010062 CITY OF CUPERTINO 7777=«
BUILDING DIVISION PEIRAHT .`° f")I T'
BNLLNG DORESS: PERMITNO.
TO53 , 61, 63 , 71, 73, 81, 83 FOUR SEASONS ROOFING 08010062
OWN FERMrT ISSUE DATE
PML MANAGEMENT P 0 BOX 1210 01/11/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
RCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30p LICENSED CONTRACTOR'S DECLARATION Job Description
rd u I hemby affirm Nn 1 am licensed under provisions of Chapter 9(commencing
with Section TOM)of Division 3oftha Business and Pretentious Cade,md my license is REROOF-REMOVE (E) ROOF SYSTEM & REPLACE W/NEW
^ h in full forte and clap. - �/
z uaenanoat Llo.w o _FAF
ea f, Dam RCHIEC'S DECLARATION GRAND CANYON.
y 1 undur and my plans shall he used a public rnenrds
�yU
5 G y Licensed Professional -
5 OWNER-BUILDER DECLARATION
S I hereby affirm that 1 am exempt from the Contractor's License Law for ace
C p O following moon.(Section 7031.5,Business and Pmfun ors Code:Any city at county -
9 which roqulms a Permit to construct,alar,improve,demolish,or repair my mature
_try^ prior in its issuance,also requires tint applicant for such Permit a file a signed suiamem
mm<
that he is licensed pursuant to the provisions,of the Commeloei Litmosts Law(Chapter 9 Sq.Ft. Floor Area Valuation
~$ (commencing with Section 7000)of Division 3 of the Business and Profession,Code)or $29229
.. that he is exempt therefrom and the basis for We alleged eaemo on.Any vlelauon of
Section 7031.5 by airy applicant for permit abject,the applicanuo•civil penalty of 316 410100.Ln ember Occupancy Type
not more than Ove hundred dollars 5300
I,as owner of the property Or my employees with wages u their solo compensation,
will do the work and themalum is notInica ded or offered for sale(Sec.7014,Busies
and Prafessi as Code:The ConmctoA Lianas Law de not apply to an owner of Required Inspections
pmprtly who buildsterimproves themen,endwhe doessoehworkhim ndrorthrough his
own employee,provided thatstch improvements ace not intended uroffered for ale B,
however,Ne building or improvement Is sold within one year ofcompletion,this own"- .
builder will have the burden of proving tot he did set build or improve for purpose of
ale.).
❑1,as awe of the property,m exclusively contracting with licensed m oseems to
censer the pmjm(Sec.7014.Business and Professions Cada:)The Conwear's I.I.
me law does not apply in an owner of property who Wilds or improvra Nemon,ad
who contracts for such project,with a eonkacar(s)licensed pursuant in the Conuactoes
License law.
❑I am tempt under See ,B&P C for this ,an
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pevBy of perjury one of the following declarations:
I ova and will maintsin a Cmifna of Consent in self-imum for We lanes Compen-
u provided for by Section 3700 of the ISWr Code.f"the performance of the
rt for which this permit is issued.
1 hate and will maintain Worker's Compensation Insurance,u enquired by Sermon
37 of the Labor Code,fw the performance of the wort for which this Permit is hoed.
My Worke�r',, 1
s/Compasatien InmArance rani"and Policy number am:
�
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(11m,auction need active completed lithe permit is rwanehundretl dollars($100)
or lest)
I cenifv that in the performance of the work for which this permit is Wood.I shall not
employ any person in my macer ante W become subieci to the Wodeni Compensation -
Laws of Califomia Data
Applicant
NOTICE TO APPLICANT.If,altar making this Certificate of Exemption,you should
become abject a the Warme's Compensation provisions of the lahw Code,you muss
.J O forthwith comply with such provisiam w this Permit$hall M deemed revoked.
'Z" CONSTRUCTION LENDING AGENCY
[r mom. I Mosby affrn that then is a contraction lending agency for ace Performance of
Qi ti tit work for which this permit is issued(Sec.3097•Civ.C.)
Q Lender's Nate
D z Lender's Address
U Q I certify that I have read this application and sate that ace aWw information is
(L F emmCL I agree in comply with all city and county ordinances and sera laws totaling a
0U building consWction,and hereby solitudes representatives of this city in enter upon tie
{37 abase-mentioned property for impaction purpura.
gy (WO)agree to saw,indemnify and keep harmloa the City of Cupertino sga(mt
),y in Ilabili0es,judgmeoa,cents and espouser which may in my way acres against aid City
U Z in consequence of the grandng Of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P01µµµ777''' Issued by: Date
-amRC'BR TION
�1 —yF Re-roofs
Signuumof Appl(an ammeter Dana
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building eccuPantnore or handle hauNom material
as defined by de Cupertino Municipal Code.Chapter 9.11.and the Health and Safely
Cale,Section 29331(x)?
[3 Y. No All roofs shall be inspected prior to any roofing material being installed.
WIII the applicant or foam wilding Occupant use equipment or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
t ovaMnus air contaminants as defined by the Bay Area Air Quality ManagcmCut all new materials for inspection.
cR
❑Yea
I hive mW the hKmank smamdalsmquimmena under Chapar6.95of0aC�lif�r-
m,HUlth&Safety Cade.Secu= MS05,25533mdn534.1umarandtiatirMe Wilding
dwa rent currently haw a Anson Wet it is my resporihility a m ily ecu set of Ua
mquimmcnts which must be met pdora issuance oh Cc ao Signature ofA Applicant Dale
g PP All roof coverings to be Class"B"or better
Ownerwautharimd,gem / Dna' g
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31641010 .1115
DATE ISSUED. . . . . . . : 01/11/2008
RECEIPT #. . . . . . . . . : BS000003664
REFERENCE ID # . . . : 08010062
SITE ADDRESS . . . . . : 10853, 61, 63, 71, 73, 81, 83 NORTHO
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PML MANAGEMENT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SAN JOSE CA, 95120-2702
RECEIVED FROM . . . . : JAMES CALDERON
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS P 0 BOX 1-210
CITY/STATE/ZIP . . . : ALAMO, CA 95407
TELEPHONE . . . . . . . . : (408) 278-0330
• FEE ID UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- -- -------- ---------- ---------- ---------- ---------- --- ---
1BSEISMICR VALUATION 29, 229 . 00 3 . 00 0. 00 3 . 00 0. 00
1RERO0FMRE SQ FEET 92 . 00 1196 . 00 0. 00 1196 . 00 0. 00
------ ---------- ---------- ----------
TOTAL PERMIT 1199 . 00 0. 00 1199 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 199 . 00 AMERCIAN EXPRESS
---------------
TOTAL RECEIPT 1, 19.9 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF -
s
CITY OF CUPERTINO
acus REROOF
• CUPEkTiNO PERMIT APPLICATION
U g6
APN # el—I�10 �D�S/yi at
O
Building Address: 5-3 L G3- /;,Tr -.Xi —
Owner's Name: Phone #:
Contractor: Phone #: �2 33 c�
Fax #: 2� -7 3 `3
Cupertino Business License #: o2/�a Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles �7 [ ❑ Wood Shingles
;! Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ , To be Removed / ❑ Provide Mfgr. Installation Specs.
i
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ N�❑ Confirmed with Planning Dept. if
r7 there are any restrictions: ❑
V a ° , ash
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
CITY OF CUPERTINO
REROOF
• CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential . B 1SFDWLROOF
�j 1BSEISMICRE Seismic Residential B
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development Depa tment
Building D vision
City of Cul ertino
10300 Torre enue
Telephone: (408)7 -3228
• Fax: (408) -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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another insRection can be scheduled.
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 complywith the above stated policy on re-roofing.
Homeowner's Name: 1 P I �� M(d/VU9,-e.I1%d4
/*53 /off3 /v ?3 e6.t-�j4A-
Job Site Address: /08& /'f/`o�r�/ /e.)9�1?/
Roofing Company Name:
Applicant's Signature: ✓ � - C_�� n'*�: b
Greg Casteel
• Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
r` fCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO
® Building Department
JOB ADDRESS: /o9S3 - . Ore-/- /P�963 PERMIT #
/o87/- ioq'i3 - /off/-wr,�r3 �L�eGa�cs' OO�/ u�K/
OWNER'S NAME: PHONE # 02 -G33�
GENERAL CONTRACTOR FAX#
I am not using any subcontractors: Z/ GG
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
Owner/Contractor Signature Date