03090105 r CITY OF CUPER'fINO �++: 'K ma• x < �*�';X&
BUILDING DIVISIONPi ,MIT �iCONT," TOR INF�ORMA�TION '
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT N1b3090105
OWNER'S NAME: 645 HORNING ST PERMITISSUEDATE
NORTH POINT HOME OWNER ASSO 09/15/2003
NE: (408) 275-0330 SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRACTOR'SDECON
E 1 hereby affirm that 1 em liccnn r provisionsons of of Chopmr Y(commencing �[1
with Se iou "n OIXBof Diviston3ofth, usand Professor.Code.md my license is
' c in full to rad cf
Lmen Ma- _uc.a REROOF ..,.
Dau SEP 292003
ARCHITECr E O -
1 understand my plans shall be seed as puhlie records
cfIt;>ArU
03 Licensed Pmfcuinnel BUILDING
Oat I am exempt
from
DECLARATION
ZOO achy affirm on I am cxempl from Ne Contractor's Co License Lew for the
p o following reason.(Section III L5,Business and Professions Calc:Any city or county
ZOO
E! which.,at.a permit to construct,slur,improve,demolish,nr repair any swctue 87500
to prior In its issuance,also requires the applicant for such permit to file a signed statement
E < that he is licensed pursuant nthe provisim.ofthe Contractor's LiccnuLaw(Chapter 9 Sq. Ft. Floor Area Valuation
LHp (commencing with Section 7")of Division 3 of the Business and Professions Cao)or
I R E that he is exempt therefrom and the basis for the Alleged exemption.Any violation of 31639047 . 00
Section 703L5 by Any applicant for a permit subjects to applicant to a civil penalty of ane T eAPN Number -.- OCCU
not more dtan fin hundred dollars p1000). - ' - - - - P y yp . --- -
Q 1,u owner of the propcny,or my employcas with wags a their sole compensation,
will do the work.and Ne sweare is not intended or offered for ale(See.7044,BusinessRR
and Pmfcssions Code:The Contac tori License law docs not apply r an owner of 3 0 7�' INSULATybgd Inspections
property who builds mimproves flummn,and who doessuch work himselfor through his
own cmployco,Provided that such improvements Act not intended or offered for sale.It, 601 - ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner.
builder will lave the lumen of proving that he did nal build or improve for purpose,of 602 - ROOF PLYWOOD NAIL
"I`'3' 603 - ROOF BATTENS
co I,as owner of ct properly,,Business sivnd conuuiins with:)The Ccontractors las
cans ma mepmjct Applyooan wneoandny who
or i TheContractor'sLha on, rad 604 - — ROOF IN—PROGRESS
moss Law Jma not apply to an owner of t ra rorty who sed p or improve Chars,and
Lic cat.tmcu for such projects wit acnmran"r(q licenuJ pursuer to the Conmemr's
L'renu law. '
Q lammsmptunder Scc. ,B&PCforthiseason
Owner Date
WORKER'SCOMPENSATIONDECLARATION
I hereby apron under penalty of perjury one of the fallowing Jeclamtionc _
I bars And will maintain a Cornea,.or Conum to uiFimure for Workers Curran-
-
umpcm
1c,
on,u provided for by Section 37M of the Labor Code,for to performance of the
rk for which Nis permit is issued.
1 ban and will maintain Workers Combination luurance,u required by Section
M ofNe labor Code,for the performance of Ne work for which this permit is issued.
Worker's Cnmpensatio Insurance camor and Policy number am:
rtier: Paltry No.:
r ,
CER FI A EXEMPTION FROM WOR
COMPENSATION INSURANCE
(This union reed nor hceompieud time lomil is for one hundred dollars(giro)
to loss.)
I minify that in the perfnrmance of to work for which this permit is issued.I shell nut
employ any proton in any manner an u to become subjecno the Workeri Compensation
Laws Df Celifamia.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cenincnle of Exemption.you should
become subject to the Workeis Compensation provisions of the labor Calc,you mus
0 forthwith comply with such provisions or this Permitnhal l hvok
e deemed eed.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
x Ne work for which this Knit is iuoed(Sec.301 ON,C.)
4� Lenders Name
3.7 z Lender's Add.
J 1 certify Nn I ban read this application and sou that Ne eban information is
:L F comoct.I agree to comply with all city and county on inanms and sate laws elating to
V building convection,and hereby authorise miumsenmives of this city to enter upon the
G above-mentioned property for inspocuon purposes.
y (We)agree 1"save,indemnify and keep harmless Ne City of Cupcnino against
rq liobilitics,judgmcnu,cos. ns a which may in any way acc=against said City 1�y
J iAnPCPL CACMnce of RSTANDSthr D WILL COMPLY WITH ALL NON-POINT Issued by: Date _�2
DN .
Re-roofs
aver of AppbcenVCantrumr Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building e.Chapter
store orhandlethe
hr�ous material
As denoted by the Cupertino Municipal Code.Chapmr 9.13,and the Health and Safety
Coto,Section 35533(a)7 All roofs shall be inspected prior to any roofing material being installed.
Q Vas
vent late appheant or future building occupant use equipment or dadcea which If a roof is installed without first obtaining an inspection,I agree to remove
dl hf,.roh us air conuminsoe as defined by Uu Bay Area Air Quality Management all new materials for inspection,
ixtrir?
❑Yes
I have mad Ne haramlms materials requirements under Chapter 6.95 of Lm Califon
nix Health&SafetyCodc,Sucunn 25511 35533 and 35534.1 understand thsifthe building _ IS•tD
da.not crremly have a Arne at n. responihibly r nod ly sbe emupam of e
myyyemaahrel' rtn
at priormiss mora Ccnif a(Ixenpaney. Signature of Applic Date
mer or a— orircJ agent D,Ar All roof coverings to be Class"B"or better
Community Development Department
Building Division _
Jf < 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.
Homeowner's Name: KZ✓-Dk-� Fd%I-Al
Job Site Address: eg 023�S
Roofing Company Name: — w -.e C
A plicant's Signature: —Date: C41"1_14>
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: b 3
r �
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Qg - Z7$ -o33o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
00k&Asphalt Shingles >( Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
j K Other(Specify) 04A ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
K To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
r— GO r-
Residential (q/ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan a t. if
there are an restr' tions: ,
Costo Project: Type of Cos c ' Occupancy gro _ /
750 — �
Qty. if
Applic4te 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
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