03040004 CITY OF CUPERTINO " "�°`y�r"g'.°'"Ij R*'t'"-T ,
BUILDING DIVISION PERMIT
1, � ON `,
BUILDINOADDRESS: PERMIT NO.
10972 NORTHSEAL SQ FOUR SEASONS ROOFING 03040004
OWNER'S NAMEPERMIT ISSUE DAM
Isk C.M. S . , (LOGAN MUTHU) 645 HORNING ST 04/01/2003
E: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INPO
BLDOO ELECTO PLUMB MMECH
loo LICENSED CONTRACTOR'SDECLARATION Job Description
1 bunchy affirm Net 1 am licensed under previsions of Chapter 9(commencing
6 with$%tim7000)of Division of Ne Business and Polmstma Coda and licensors
in full fortt end eR ! `L
License Clue Lk.N REROOF
1211 Dem ARCHITECCTSDECLA roe T/O CEM WOOD, INSTALL ASPHALT SHINGLES
i understand my plans Wall he used As public records
5 G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I em exempt from the Conlrector's License law for WC
p o following match.(Section 70 IS,Business and Profesioro Code:Any city or county -
$ which mquios a permit W coronet,alter,improve.demolish,or rtpuh any malum
prior W is issuance.also requires the applicant for such permit to rile A slgned.tatement
Cthat he Islimmodpursuant tothe provisioronfthe Contractor',LhnnmLAW(ChaPmr9 Sq.FL Floor Area Valuation
(commencing with Section 7")of Division)of the Busincu and Professions Code)or
Nu be is exempt therefrom and the bola for the alleged Oemp ion.Any violation of
Section 7071.5 by airy applicant for A Permit sobjeeta the APplieset to A civil penalty of APN Number O Type
non mom than fin hundred dollars($500).
t]1.u owner of We property,or my employer with wages As Web NO eomPerommn,
will do the work.And thx"Mon,1.Out intended malfered for Ne(Sce.7044.Basbmu - Required Inspections
and Profession Code:The Conlao e
n ctoe,License w does not apply an Owner of q P
property who buildsor improve thereon,andwho doessuch work himmlforNreugh his 305 - FRAME
ownemployces,provided that such improvements see trot Intended or offered for uta If.
however.the building Or improvement is sold within one year of completion.the Owner. 307 - INSULATION
bulldu will ban We burden of proving that he did not build or Improve for pompous of
Ore.). 601 - ROOF TEAR OFF
01.ss owner of the property.am exclusively contrasting with licensed eonuacWn to 602 - ROOF PLYWOOD NAIL
construct the pmjm(See.7044.Business AM Prefeumm Cade:)The ContnctOl"U- ria^n 0 _�4�
came law does not apply to an owner of Property who mlws or improv thereon,and, 603 - ROOF BATTENS IIS BV Vc,y
who contracts for uch projects with A conmcmKs)licensed pursuant to the Contractor. 604 - ROOF IN-PROGRESS
License law,
❑Iemeumptunderim ,Bk PCfmlbismssan SEP 2 9 2003
Owner Dam
WORKER'S COMPENSATION DECLARATION BUILDING
j g^g dap
1 hereby afflrm under penally of perjury ore of the following declarations: B U!LDI I y G
haw and will maintain a CenlOnte of Consent o self-Iroum for Worker's Compcn- �7
Comport-
"0.u provided for by Section 7700 of the labor Code.for Ne performance of the
work for which this permit is issued.
El
I ben and will maintain Worker's Comperoadon imm�na,u requlrM by Section
7700 of We uPor Code,for the performance of tle work forwhlch this permit is IssuW.
My Worker ampenulket Inormce caner end Polity��p//psober rt:
Caner: Polity No()n� r) 2 ADO
CERfl ICATE OF EKEMPITON PROM WORKERS'
COMPENSATION INSURANCE
(ihlssectim need not hecanplemil Irmo Permit Is foranehundm4dollan($100)
or lees.)
1 coolly that In the Performance of the work W,which this permit is Issued.I shall not
employ any person in any m rmrso as to become subject to the Weelmrs'Compewllon
Laws of CAI comm.Dem
Applienl
NOTICE TO APPLICANT:If,after making this Certificate of Exception,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
,J 0 forthwith comply with such provisions or this permh shall be demur rooked.
��- CONSTRUCTION LENDING AGENCY
F' Iherebyelfnm that there Is.comnc0on leading gency for the perfmnanco of
l5: 7 the wmk for which this permit Is stood(Sec.7097,CN.C.)
WM Q Leuces Name
.7 Z Lender.AMM..
C)O 1 certify that I haw reed this application and now that the show infomatlun is
Is, correct.I agree to comply with all city and county cadinalwes and ataW laws relating to
O building construction,and hereby sumoder representatives,of this city W cost upon the
!T7 above-menliomd property for Inspection purposes.
4k, (We)agree lm sew,indemnify and keep hamtlm the City of Cupertino against
(f) IleNliacs,judgments.costs and experoes which may in my Way amts,against and City
V'l' In consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCIEGULATIONS
Re-roofs
Slpaium ofAMliantrConncW� Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We Applicant or future building Occupant stem rehandle hazardous material
As dcrincd by the Curtner,Munkipal Code.Chapter 9.11,and the Health and Safely
Code,Section 15571(07 All roofs shall be inspected prior to any roofing material being installed.
❑Yet 1-1 No
Will the applicant or future building mcupam use equipment m devima which If a roof is installed without first obtaining an inspection,I agree to remove
It hanrdous air contaminants As dented by the Bay Area Air Quality Management all new materials for inspection.
WIe17
❑Yes C1 No /L
IhrvcrtW theh.e U.ous mW05.255ul 2554crus .1..haptemb.95ofthe Celdi.g ,v % t!J
do.IaHellh&Salcey Calc,Sono,that
t 1my Ar 15531.1 to nualnde occur
huildihe
docs not currently hove a tenm4 Wal It b mg .pmrolAlllly W nntilY the mcupanl M the
rtquimmen wnimmmtbe'""�`RT a f.cWflwanc
e.f0ecupy.
Signature ofApplicant Date
111 nom—= Dam Owner anuthodnd spent All roof coverings to be Class "S"or better
-
Community Development Department
mu Building Division
t City of Cupertino
10300 Torre Avenue
CITY OF! Telephone: (408)777-3228
C U P E�T 1 N 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) ht-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/a'r 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: n{i�
Job Site Address: -./ d 7 7 "."dS e-'A Z
Roofing Company Name:
A plicanYs Signature: ���` Dater
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
n
CITY OF CUPERTINOO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN#
iDate:
Building Address:
io9 /V/C1
ner's �s �A �
OwName: `���`7 /� � M A,, Phone #:
M
d, S, "K oB ss^ 1277
Contractor: Phone#:tLicense#:
Y7a /Od'
S 'A <oNS o �
Contact: Phone#: Cupertino Business License#:
Sr 0,1" 7 0 330
Type of Roof Covering:
Existing: Proposed: - — - - - - - — —
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles - '2L Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles // (3Wood Shingles
-f Other(Specify) C.,f-f ❑ 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 Com 1With Cu ertino's Tear Off Policy: ❑
Job Description: .
O
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrict'
Cost of Pro' / ype of Co o Occupancy group .
r'
Qty, if
A 1• Fee ID Fee Description Fee Group
ESEISMICOM
EE Bldg Permit Fees BUILDING
Y Ener BUILDING
CRE Seismic Fee Res BUILDING
Seismic Commercial BUILDING
HK Plan Check Fee BUILDING
BUSLIC Business License BUILDING