05060147 CITY OF CUPERTINO n � xs2.z n3"tt ems• -"" � <'°'�
BUILDING DIVISION PERMIT ;XCONTRA.CT.UR;1?4V RMATiO
BUILDINGADDRFSS: FOUR SEASONS ROOFING PERMIT"cb5060147
' 22826 POPLAR GROVE Rn
OWNER'S NAME: PERMIT ISSUE DATE
Alk MONICA LODGE 502 HORNING ST Qf;/9.2 /2005
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHrrECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O o LICENSED CONTRA under S DECLARATION r r
Mmby Milan Nal 1 am licensed under poolsions of Chapter 9(commencing �CJob Description
with Smfion 70fi10 of Division 3 of the BusinesuW Professions Code.and my license is tf" I`�,- 11
u�elmegimdoIY ue,g /o REROOF W1 COMP. �L 5,,y�- tl:yf}D
Dosee-+c-- Co. 39 K L
ARCHrrECTS DEC RATION _4 /f
O 1 understand my plana shell W used u public mcom s l
itad` Licensed Pmfessionel r� N
13n OWNER-BUILDER DECLARATION �
1 Wrathy affirm Nal I son exam t from chs ConlrecRYs L icc m Law for the V n
EO O following won.(Section 7011.3.Business and Professions Code:Any clly m rounry
9 which requires a permit to construct.:Iter,improve,demolish.m repair my eaucture 111�v+ ��,.,Jf86000
prior ta its Issuance,also requires the applicant forsuch permit to file a signed statement
< Nu he isBamedpursuant othe provisions oftheConnacwriUounelaw(Chepter9 Sq.Ft.Floor Area Valuation
$ (comm'
m
acing with Secdon7000)o'Divisionlaf Ne Businusand Pmfcaiom Ctme)Or
tach hem exempt therefrom and the basis for the alleged emaciation.Any violNon of
Section 7031.5 by Ory applicant far a permit subjects the applicant an•civil penally of
oat mom Nan five hundred dallsss($SOO), B Occupancy Type
❑I,as communistic property,at my employee wit wages as their able comprdsmon,
willdo the wod,and to structure Isnot intended uroffmrd faradic(Sec.70th,Business
and Profcuiou Cade:The Commerce,License Law does net apply ta an owner of Required Inspections
Property who WIIW orimprovesteomn.and whodoessuch work himseEm through his
awn employes,provided c auuch Improvements Meant intended motioned forsale.If.
however,the building or Improvement Is sold within on yew of completion,the Owner.
Wilde'
will Mw the burden of proving chat he did vel build Or Improve(or purpose of
tale.).
❑I.u Owner of to property.am escluawly communing with licensed convector in
construct to project(Sec.7W,Business and Professions Cade:)The Contramars Li-
mme law data not apply to an owner of progeny who builds or improves tMmon,and
who comosc t for such projects with acomomor(s)licensed pursuant W the Conusttofs'
License Law.
❑l am exempt under Sao ,B B PC for cls moon
Owner Dam
Adik WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arc of to fallouts,dmlentions:
I hew end will maintain a Cminew,of Conscm m self-imu a for Wor mi Compem
sation,u provided for by Section 3700 of the labor Code,for the performance of to
work for which this permit is issued.
❑1 have and will maintain Worlace,Compensation Insurance,u required by Section
3700 of to Labor Code,far the penfamnanm of the work fm which this permit is mucc.
My Wode Compensation lnaunntt cert dPolyq number are:
Cenier. PoIICY No.:
CERTIFlCATE OF EXF1.iP 10th FROM WORKERS'
COMPENSATION INSURANCE
(This section aced not becmnpleed If the permit Is foram hundred dollen($100)
or lass.) -
I certify that In tho per(ormantt of tc wad for which this permit is issued.I that nm
employ anypetann in any mmmrm as in become subject to to Worked Compcoumon
Lawn of Callforoia.Dem
Applicant
NOTICE TO APPLICANT:If.after making this Cc tiOue of Exemption,you should
become subject to the Worker's Compensation previsions of the labor Code,you now
.J O forthwith comply with such provisions w too mrk"I W decreed Rwkcd.
-'Z�-" CONMUCr10N LENDING AGENCY
N
(~ I for whin omchatteR iLaronsuuc.30Rnding ageneyfnr to performance of
CYi the duh for which to permit it issced(Sm.3097.Civ.C.)
Q Lcndcls theme
:D
a z Lender's Address
(J Q 1 ow ify tat I have Rad Of.application and sue to the move infotmadun is
g4 correct,1 agree in comply with all city and county ordinances and Mute laws Resting an
Q building convection,and hereby authorize represenativu of tis city in mmr upon are
0. above-mentioned property for inspecdon pulses.
(We)ogee m save,indemnify tad lamp hrtmless the City of Cupenino against
vFa(/I limilides.judgments.cuts and expenses which may In say way acaue against sad City
in consequence of Lhe
V APPL ANT UNDERRSfANDf this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO C REGULATION!.
Re-roofs
IgndWR Of IMVCan r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill to epplicent or future building Occupant wore arha xile,baurdour material
as defined by the Cupertino Municipal Code.Chapter 9.13,and to Health and Seery
Corm,Sinton 25532(07 All roofs shall be inspected prior to any roofing material being installed.
❑You ON.
Will tc applicant or future Wilding occupant use equipment or dcvima which If a roof is installed without first obtaining an inspection,I agree to remove
air contsminams u defined by the Bay Area Air Quality Management all new materials for Inspect]
l'u.",ha7arrhous
nt?❑Yu ❑Nu
I have mad the Wardens maenalsse mmorma s under Chapter 695ofthe Calif n.
Hal"Safety code,Sections 25505.25533 and 25$34.I undcntwd tat iflha Wilding _2-�Q �es no ly gP me tswhkh caulhamet amu (a CcruOne of Y' _ Ig0 tUf Applicant Date
6 72 c'rAll roof coverings to be Class"B"or better
rar vel died egcnl Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OC10F Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: / PERMIT L f
A
OWNER'SNAME: PHONE #
GENERAL CONTRACTO FAX#
I am not using any subcontractors: =====Y
4glna'fCxe Date
Please check a licable subcontractors and ete 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 Fax: (408) 777-3333
4UPEkTINO
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.
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 laid 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
��with the above stated policy on re-roofing.
Homeowner's Name: AAnki i eA Lorl Ori
Job Site Address: 2 z f
Roofing Company Name: I lip QCA cfu J
Applicants Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper "
CITY OF CUPERTINO
arm)
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
342 62 -)-,0-Q
Building
-
Building Address:
22
Owne 's Name: Phone#:
it
Ctractor: (� Phone #: O& License#:
Isom 278-0330 - 47t/08
Contact: Phone# ,&?,d Cupertino Business License#:
ALQ�cdo .2,78-0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles � Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
12�,Qther(Specify)t 'C Ip o ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Ab Description: ( I
1
Residential Commercial ❑
Fire Zone: Yes E] No Confirmed with Planning D_pt. if
there are anrestrictions: E
Cost roject: Type of Cons ction: Occupancy group:
Qty. if
Applicable 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
1067