05060077 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CONTRACT, UI2INF',ORMAT O
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NG05O6OO77
2280r; POPTAR nRQ17R. SO
OWNER'S NAME: PERMIT ISSUE DATE
Igh MARY CLARK 502 HORNING C;T nrJ_13.L).nnc;
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHfrELT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job lescri tion
1 Mre,by affirm W[1 Am licensed under provision.of Chapter 9(tco mating R,
with Section 70W)of Division 3 oflhc Business And Profeulons Code,and my license i. y /
^� in full force ang..gcct„ REROOF W/SHINGLES .
j�Z Lee Lk.N
c � Dam47.6f Conusmr f
ARCHDECI'S DECLARATION
I understand my plan.Aldi M dead u public recrank OQ Sl
rC�
3Q
Licensed Professional /f®
OWNER-BUILDER DECLARATION
� I hereby affirm that I em exempt Item Nee ComrsCommmort Licence Lew for the xJ
i p O following Memo (Section 7031.5,Business and Professions Cade:Any city at county �}
$ which ra lune a permit to construct,Aller,improve,demolish,or repair any structure
ZS^ prior m in Issuance,than require the applicant for such permit to file a signed statement
�< that he is licensed pursuant to the pmvialonsof the Contractor,Licaen lae(Chapter 9 Sq.Ft. Floor Area wV Il��w Valuation
(commcing with Senian70W)of Divbion3ofthe Bui.0 dPmfusiom Cade)or
.. that heenb exempt thartfrom And the basis fa tic alleged a emption.Any violation of
Section 7031.5 by soy appllant for a permit mbjecu the Applicant to a civil penalty of 3 41X$>2ejh Ber0 0 Occupancy Type
not mom than five hundred dollars(ML
0 1,u ower of the propeny,m my employee wlth wages u dmtr sole compenudon,
will do the work,end thensecture is not intended stuttered forsam(Sec.7044,Busin'tu Required Inspections
and Poelm Atom Code:The Committees tters Lime law does not apply to sn owner of q p
property who Wilde Orimprowa thereun.and who duessuchwmkhimselfor dough his
own employers,pmvided that each imprewmerm tae not Intended oroRamd to,sat.If.
however,the Wilding or improvement Is sold within ate Sou of eempledion,the owar-
builder .will have the burden of proving that he did not Wild or improve fa purpose of
tate.).
0 1,in owner of the property.am exclusively contracting with licensed mnvaters W
construct the pmject(Sec.7014.Business and Profesions Code:)The Comisco ra Li-
mo Law data not apply in an owner of property who Wilds or Improves thereon,and
who moment for such projects with a cams ser(s)licensed pursuant to the Convector's
License law.
0 l ons comp[under See. ,B k P C for dib moon
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby.Man under pettily of perjury am of the following decleoul
I have and will maintain a Certificate of Cement to self-Insure for Workers Compen-
sation,As provided for by Section 3700 of Lee laWr Code,for to performant,of the
work for which this permh bread.
0 1 ban and will maintain Worker's Compensation Insumm,u required by Section
3700 of the lata Code,for the performmce of the work fa which mij permit i.luded,
My Workers Co pemeI Insurance cartiv and Polity number Am:
Carder,,,Q Policy No.)6.�t?1CRPYOZWOW
CERTIFIC ATE MEMP71ON FROM WORKERS
COMPENSATION INSURANCE
(Thio section mod not W completed if tie permit I.forms hundred dollua(518)
or ice..)
1 sonify that In the performaaa of the work for which this permit Is Issued,Ishall not
employ anyperson In any manner an An m Income subject in BM Workers'Compeasation
Law,of Ce irmem.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Ceni0ete of Exemption,you thouW
become subject m the Worker.Compensation provisions of the labor Code.you most
.,0 forthwith comply with such provisions or this permit W deemed raveled.
CONSTRUCTION LENDING AGENCY
ed
F Iifvm that them ismnsoucdnn lending agencyagencyfor the performwu:e of
ori the I.which
ns work fa which Iib permit b issued(Sec,3097,Cly.Cd
aQ Lemlees Name
z Lenders Address
U Q 1 candy Nat I hove read this Application and,tate that the show information is
It,!'. cogen.I Agra to comply with all city and county ordinance,and tum laws muting W
SV^ building construction,and hereby Hamden representatives;of this city in now upon the
137 Ab m•me.Ua property for Inspection purposes.
G (We)agree to eve,indemnify Ane keep hmmlm the City of Cbpenno against
H liabilities,judgments,man and expense which may in any way aeme against said City
In
of the
V APPLIS aMeUNDERSTA go AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO C EQULATION -�
C- T- Re-roofs
Ignemrt Appli ca=
ter Date
RDOUS MATERIALS DISCLOSURE Type of Roof
Will me Applicant or future Wilding Occupant nam or handle haurdons material
As 0ad by the Cupenna b! id I Cade.0tapmr 9.13.and the Health Aad Safety
Ade,S[I en:ss33(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant Or future Wilding Occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardous air conumimav As dcfmcd by the Bay Aron Air Quality MmA9CM m all new materials for inspection.
District?
Ye. �NP
I heves nail the buardw.mAmriW requirements under Chapter 6,95 of the Califon
W Health B Safety Cade.Seetias35505.35533 And!35534.1 understand than ifthe building
does not curren0y haw A minnl.mu it is my responsibility an Modify due occupant of the CO
re m
At which rtelss n0camof mpanry. Signature Appliean Date
to
J -dbJ
owner dr AdO rte.gaol Dam All roof coverings to be Class"B"or better
Community Development .
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS:,,, PERMIT #
OWNER'S N .9' c7PHONE #
GENERAL CONTRA O • 1 / FAX#
I am not using any subcontractors:
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
UPEI�TINO
Building Department Fax: (408)777-3333
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 inspection 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 comply withthe above
ststated
�policy on re-roofing.
Homeowner's Name: �QP�I? Da"_
Job Site Address: 6 a �✓
Roofing Company Name: '/Co
Applicant's Signature: Date: l0•/3-oS'
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO �b
z1o
REROOFCUPkTINO PERMIT APPLICATION FORM
APN# Date:
3 42 - -
Build' Address:
miner s �' Phone '�B
®,V s
ft/ac,..: - I Phone#:h0R4 Li ense#:
7812150-
tact: Phone Kq08D Cupertino Business License#:
Type of Roof Covering:
Existing: Propos
❑ Built-Up Roof ❑ colt-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ oo Shingles ❑ Wood Shingles
af Other(Specify) X k1r)0Cz ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Und rstand and Will Comply With Cu e ino's Tear Off Policy:
Job Description: /t% ak,s w9 SOD T.is<r / x' ' S�'�O Tisa cbrj� a
Residential K Commercial ❑
Fire Zone: Yes ❑ No' Confirmed with Planning Det. if
there are any restrictions: LI
Cost of Project: / 5do Tp e of o struction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERWEE 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
2 ,
72-