03030100 CITY OF CUPERTINO �' 'r�t'�x
BUILDING DIVISION PEW41T y �" :�affOR NP9 pd1V y�y�� O�lSeri g
BUILDING ADDRESS: PERMIT NO.
FOUR SEASONS ROOFING
OWNE - partmalSS
645 HORNING ST '
Ens _ SANITARY OL NO.
(408) 278-0330
ARCHITECDENGINEER: BUILDING PERMITINFO ,
BLDG ELECT PLUMB MECH
O
iDo LICENSED CO ACTORS DECLARATION Job Description
1 Wmby affirm that 1 am licensed under provedons of Chapter 9(commencing
with Seder 7000).f Division Sof Ne liolimm5foul Proresslnm Code,ml my lieens:is -
,i milum effeL
Liecnm' 7 / 0 REROOF
j Zc, Lic: �s
i °ale Aa ECrso sur
RATIONREMOVE SHAKE/ 4082.780330 YR. #FELT & COMP . SHING
I I mmiersland my pletn.hail W used obit.¢corm
p
c Licensed Pmfeaeionel
d� OWNER-BUILDER DECLARATION
I hereby.(Been the 11. cacmps from the fessins Co License,law for the
O D which
owing rcesan. orMb t 703 L construct.
&bM Business and proimprove.
de nm Code:Any city s county
$ which rcquirce a pctmh re quires el,ellen.impow,h Permit t m repair ed nmdunt
y pdorwiucensed ,also sttothethvvislo oftnt hrsuchpermr'sLm WLaw statmem S Ft. Floor Area Valuation
�O (comms be licensed purSecsuant )of Division
of the eBusi Business
Lkc.mlaw(Chapter)or Q•
that k I.exemng pt ionefrom and 0.basis
3 of Me B ed extu and or,Any
Code)or -
Net he b exempt tWmfrom and or bsaa fm the cu the uempdon Any l PBmon of
Section 7031.5 by any applicant(ren pesmll subjeeu Nc applicant to'civil penally of ppN Number up racy Type
But mora than Bve hundred dolUr(5500).
❑1,As owner of Me property.in my employees with cages As their role compensation,
will do Me voids,and the womm.is not Intended oroffemd for um(SAM.70th,Business Required Inspections
Intl PmW
fcons Cadm
Cade:The ConbaoM1 License Lew does ret apply m m owner of Q p
properly who bulkhor improves Moreno.endwhodWl suchworkhountrorthmugh his 305 — FRAME
awn employee,provided that such improvemenle ate not Intended oroffend for We IL
however,the building or improvement is sold within one yew of completion,Ne owner- 307 — INSULATION
builder will have Ne burden of moving Out he did not Wild or improve An purpose of
601 ROOF TEAR OFF
sale.).
❑1,As Owner of the properly,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAI p �p
construct the project(Sec.7014,Business and Poefeadoe Cmc:)The ConOctee,U- 603 — ROOF BATTENS 1a�1ALE
e mse law does not apply to in owner of property who Wilde or improve memon.andAlmody
who contracts for such projecu with a conuanorD)licensed pursuant o the Contractors 604 - ROOFIN-PROGRESS
Licence Law.
❑Ism,mmptuBderSoc. .B&PC for this room. MAY 12 2003 -
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One Of the following dedwations: BUILDING
I ham and will maintain a Certificate of Consent o self-Inaure ren Workers Compm- -
smion,As provided for by Section 3700 of the labor Code.for Ne performeme Of ted
work for which Nis permit Is Issued,'
❑1 have and will maintain Workers Compensation Immnance,As required by Section
Tritium.labor Cmc.for the perforromem of Ne work for which thiapmmll is Wised.
My y'orkme.omPen ed�on/�nsunrmamivmd Politymno c,aAw.r.l- ^ Da Q O O / '
�BbT/err'0'�S U.✓/D Al I.4Y�Po1Rxlto.: fL
CERTIFICATE OFE%EMP17OKFROM WORKERS'
COMPENSATION INSURANCE
(Ihls sMien need not bewmpleted if ted permit is fmoec hundred dolmoiSI0(y
or less.)
1 ceNfy Net in the performance of the work for which Nis Permit is Issued,l Nall not _-^-
employ any person In any marmrm as m become subjut to ted WOHMM CbmpensaM n
Lew,of California,Dam
Applicant
NOTICE TO APPLICANT.If,after making this CeniOcete Of Exemption,you mOW
become subject to the Workers Compensation provisions of me labor Code,you mush
.,'7,. forlhwith comply with such provisions or this permit shall he commit mwked.
Z O CONSTRUCTION LENDING AGENCY
I Woby affirm that More is a convection lending agency fon Ne pcomrmem a of
Yv 7 me work for which this permit Is issued(Sec,3097,Civ.CJ -
17 Q Lender,Name
Undoes Address
Jcertify
p 1 certifyNn nd rate NI haw read this application eu the above Inform Won Is
LU
F building l agree to comply with ell city and county ntatencee and cute law mutton to
V
building construction,wmmd hembysohonP representatives or this city to enter upon ted'
�fol show-(We) ro Propene for Inspection and keep he
W (Wc)egmewsav0.lndexpenandkith hay In
the city of Cupertino against
ti pq IlablllOes,Judgmenu.com ad expenses which mryln mywy acme gein,l slid City
in consequence of Ne granting of this permit
J APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEpP GULATIO
lti D Re-roofs
namore of ApplicanVConmctm Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building Occupant mom or handle hvudous material
as defined by the Cupimm.Municipal Code,Coupler 9.12.reit ted Health and Safety
Code,Section 25532(x)? 1 All roofs shall be inspected prior to any roofing material being installed.
El Yes )(Nu
Will the applicant of future building occupant use equipment or devices which . If a roof is installed without first obtaining an inspection,I agree to remove
It herndoue air contaminants as dcfrnc l by me Bay Arca Air Qua ily Management all new materials for inspection.
iwict7
❑Yes '�j No
I have mad the nexard,sm mawri 1.roquiremome ands,Chapter 6.95 of the Calif or.
nix Health&Safety Code,SeNmu 25505.25533 and 2553/.l undetsund the if the Wilding
does not currently haw a mnen4 l sin my rm'so ibiln,o notify mccuPant of the
mqu`ImenjSyhtchmust) tarwnuance.f.ccnifamOfOc Signature of Applicant Da[e
Yy/� L
�^1 All roof coverings to be Class"B"or better
l;wner unumodrtJ agent Gam
Community Development Department
� at
Building Division
City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
C U PE kT]# O 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) 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 Y4"per foot slope and demonstrate
that there is no ponding.
2. AnI.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 st ted policy on re-roof, .
Homeowner's Name:
fob Site Address:
Roofing Company Name: '_� Q1 4r so.v
e
/y /
A plicar-e Signature: Date:
Greg eel
Building Official
Revised 1/30/03
' - Pdnlod nn Parvrlad Penar