03050049 CITY OF CUPERTINO + "'
BUILDING DIVISION PERMIT 3CONTRACT,UI2�I,NFOyRMATs Ie#0 �
Bre LDING ADDRESS: FOUR SEASONS ROOFING PEKMIT ND03050049
0480 PTNFP.VTT,T.P- All
owNER's NAME: 645 HORNING ST FERM"Iffn2/2003
NENS ERWIN J AND
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB LARCH
0 0 0 0
umpo LICENSED CONTRACIOR'S DECLARATION
Lu I he
a(0rm Nat 1 am Ikemed under provisiws of Chapter 9(commencing
lob Description
^� win Sectiam 7")of Division J of Lite Businw and Pro(essiom Code,and my licence h
„ in full rota and erfVL e REROOF
jgZ Llcenu Clore Lk.reog
�����yL.s gywtn
n F Dam Convenor l �9rme/M�
q RCHITECI'S Dm ATION
aZ 1 understand my plans shall M Lied a public meows 6 2003
Z G� Lkcnttd Profcsnionat
OWNER-BUILDER DECLARATION MAY 1
from
0I 1 hereby.(firm on I am exempt s an rte Cocoons Co :Any,Lew for the
i p o fallowing mmoa Permian]101.7,Business and Professions Coor:Any city or county BUILDING O DING
u�$ which requires a ,.I. m construct,alter.Improve,demolish,or mash any structure ® livid gtlMY1
�^ Met he its issuance,atm rcquima tic applicant for such Icrmino file mma slam(stammmm �8VS�9
FSO nal he hlianttd purwanuo nc provisions of the Conuacmri lJacvc law(Chapter Sq. Ft. Floor Area [ion
ee;$ (Co.. win Scnlon 7000)ofDivisionJof Nm Businev ale ProRuiom Code)m
tat K u exempt tendrom and the inch for use alleged exemption.Any violation of
Section 7031.1 by any applicant for a permit subjects doe applicant to•civil penally of 3 WE34h31fier0 0 Occupancy Type
not more Nan Ove hundred dollars(3700).
❑1,as owner or rte property,or my employca with wag"as their sole compensation,
will do to work,and th.moom re is out intended orofmred for sale(Sm.7044.Business - gg
and Profession,Code:The ConVlcWrs License LAW dMS not apply W N aWMr Of 307 - INSULATn d Inspections
property who builds or improves tereonandwho daessuch Work himselfornmugh his
awn employe",provided tat such impnvem"ts are nut incendedoro@ned forsale.It. 601 - ROOF TEAR OFF
however,the building car improvement is mid Within em year of ampledm.theoweer-
Wilderwillhavertprotor,
Live burden or Improve forpuryottof 602 - ROOF PLYWOOD NAIL
"the) 603 - ROOF BATTENS
❑ I.as comer of the promny,am exclusively contracting with Iicemaed contractors in 604 - ROOF IN-PROGRESS
convect rte project(Sec.7044.B"Inw and Professions Code:)The Conmerors Li-
cence Law docs not pply to an owner or property who Wilds or Improv thereon.and,
who contracts for such projects with a contncmr(U Intoned pursuant in the Crausso oes
Licata law.
• ❑1 am exempt under S. .B k P C for this ream
OweerDate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declan0one
I have and will maintain aCertifrcem of Consent m xeif-it..M for Workers COOL
Minn.
as
for by Seetion 3700 of one labor Cade.for the performance of no
Work for which this permit is issued.
f"I have and will maintain Workers Compensation Insurance,u required by Section
WO of the Labor Code.for the poRormance of the work for which this permit is Issued.
My Workers onsp1{nutlofnf lnm� rmce artier and Policy number am:
Carrier. �LIIH.S r-s.`'Q Policy No:✓w C 0'?-OLo
CERTIFICATE OF EKEM(TION FROM WORKERS
COMPENSATION INSURANCE
(Thisttctm tad not becompleted ddole permit is foronc hundred dollars(SIM) "
car I"a)
1 ecnify nil I t pea mann&doe work for which tis permit h issued,l shall mat
employany n'nary �n fmaem omc bt to doe Worken'Compensahion
Laws of CalilO la. /' 371u
Appucantr•r '�� ^r
NOTICE TO APPIAGA :If,after making rah Oci ifrmm of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code.you must
wJO forthwith comply with such provisions or this permit shall W mw
ked.
mked.
z^ CONS RVMON LENDING AGENCY
'[r Iberoby affirm does there is a construction lending agency for dhc performance of
!� > de Work for which doh permit is Wood(See.7097,Civ.C.)
Ig1 Qen
Lender's Name
0. lenders Md.
Z
UOQ I cert(y that I have mad this application and sum tat the aura Information Is
F torten.I agree to comply With all city and county ordinances and shoe laws relating to
(7 V building construction,and hereby autodm mpren
eeutiv of this city to enter upon doe
IT.1 above-mentioned property for inspection purposes.
G IWC)agree to save.indemnify and keep harmless to City of Cupertino against
V) liabilities.judgments.costs and expenses which may in any Way acerae against said City
6)Z in cortmqucncc of the{ranting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicmdConR Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the a Cupertino
future building occupant tore or handle h othis and
ss deRmd by the Cupertino Muninpal Code.Chapter 9.11.and IW H"Ido and Satny
Idoes
ade,Section 25532(a? All roofs shall be inspected prior to any roofing material being installed.
❑Ya W5 No
Will one applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rah haeamouc air contaminants a JcOncd by the Bay Arca Air Quality Management all new m 'als for inspection.
District? M
❑ya � J
I have mad the havaNausmamrials mquiremrnts under Chapter 6.97 of the Califon
a Ncalth8Safety Codc.SaUmr1lb07.177JJ and 1S731.lmMntandtimiflM Wilding
not c ntlY hese s d t it h my recpansihilityw notify tic oceupant of due
quimmc wt hmu ti ormiuumaafaCeniftcateofOccu� Signature of Applicant Date
N "'��3 All roof coverings to be Class"Bt'or better
Owner Wr au horize em I Da m
Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkT]N0
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 A" 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: T Ca,t e�5
Job Site Address:
Roofing Company Name: _ r 6 + S e� o Ls f�y o�� i C
A plicanYs Signature: Date:—00.3
Greg eel
Building Official
Revised 1/30/03
Printed on necycled Paper
CITY OF CUPERTINO
ac,70
REROOF a 3 `' S� `�
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
.,
Building Address:
lowo
Owner's Name: „ Phone#:
��te15 aS�-ifYl3
Contractor: Phone #: License#: t�
(-oma✓ s c?e Sc,.1S Y�iy . d�.t c. C`�6
0:53c)
Contact: Phone#: Cupertino Business License #:
"5 e A 275'�O33o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Rl- Asphalt Shingles
OT Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings T— ❑ Provide I.C.B.O.Report#
0 To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: C 4ti Nt�rlL
Tew-aX S4ti (< s is .[( �� `` QI 39CC - e(4 L s4, Ir
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni'ngjkpt. if
there are any restrins:
Cost of Project Type of Cotutfact` tom: Occupancy gro
Qty. if
A li 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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