05060078 CITY OF CUPERTINO „ u ^N we,7;py«1 1 " x
BUILDING DIVISION PERMIT ;CCINTR, 510R INF09MATI4N
BUILDINGADDRESS: FOUR SEASONS ROOFING PERMIT"°05060078
OWNER'S NAME: PERMIT ISSUE DATE
Alk CANDICE SO
NE: SANITARY NO. CONTROL NO,
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
EO EO PLS MECH
O
o o LICENSED CONTRACTOR'S DECLARATION "
A T /v. n
F I hereby affirm Net I am licensed unkr provisions of Chapter 9(commencing Jobl IDIIIIess`crip_non
9� with Section 7000)ofDlvision 3 of Ne Business and Profenlum Code.and my license is flu '(iG^LE:s;st�®
°pG in full forte anile r. rte^
z Lieenseceu Ix.g 7 REROOF W/SHINGLES .
g' Dau Canlnctar e•
n
ARCHITECTS DECLARATION /�� 2��5
�i 1 undeand my plans shall W used u public records r. art
Licensed Professional
°^ OWNER-BUILDER DECLARATION II lI11 i11U1
is I hereby aiTnm that 11. nemps from the ConllasCo License Law for Ne
p o following mason.permit
t 7031.5.L4 Bwiteu and r".de an Code:AnY Illy or county
$r which myuima a pemN m cnnw0.aloe Improve,demolish,or e a sig any structure
_Z8 pdormihoissuance.
ensedprsuntto Me Novisio cso for uchPermit lo0lm Law(Chapter
< Nuheucce wildSection
eananlWthcproviviomofNMeBeracwbnPredllaw(Chepm9 Sq.Ft. Floor Area Valuation
Mare a is eseing nim Sec flarn and W Wait n 3 the
the B cis axe and t on.My
Cade)of
$ Nat he u exempt Nem(rom and Uu bur for Ote al1egW exemption.My.solation a(
Section 7031.5 by rely Applicants fm a permit subjects the applicant w a civil penalty of 3 4kTN3CtirBrer0 0 Occupancy'Type
nes more than Bva hundred dollars($500).
❑I.uowner of the progeny,or my emplayeu with wgesu thcu role nmpenatien,
and Professioru Cade:The aContractive,Liceme law dam roei aapply an m MAA ororq p
Re wired Inspections
property who bui1W orimprovee 0uamr,and whodoeaeuch wmrk Eimself or tooagh his
own employees,provided than.h improvements Are not Intended oro@rod formle.If,
however,Ne building or Improvement is sold within ane year of completion,the owner.
Wilder MB have the burden of proving that An did Not build m improve far purpose of
sale.).
❑1,as owner of the property atn exclusively contracting wild licensed contractions to
construct the project(Sec.7000,Business and Professlans Cade)The Contractor's Lb
cove law does nes apply W an Owner of property who Wills m improves thereon.and.
who commands for such projects with a canuanor(s)licensed puhoosu W the Canoaurs
License law.
01 am caempl under Scene .B&P C for this ancon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ON of the following decladdenue
1 have and will mainuln A CeNOcate of Consent to sel6ivum for Workers Compere
7371M
mn,u provided for by Section 37M of the labor Code.for the performance of Ne
rt for which this permit is Island.
I have ad will maintain Warkers Compcmaran Iwrman.a required by Section
of the tabor Code,for the perfaamance cruise work forwhich this permit is issued.
yWorkefs Com/p_ensaifm Inm`^nn�`ce nonsier and Paliry numWa am:
rtier.gt�[w.fXA/ J4 IGyC0 Policy No:((ft71vy/tyUga7C*ftJf
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sec0an need cool hecampleted him permll is torn.hundred dollars(SIM)
or less.)
I unify that In the performance of she work for which this permit tsWood.I shall oat
employ any pamen in my manner an An W become subjectto the Worked Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT.If.After making this CcdiBcase of Exemption,you should
become subject W the Woher's Compensation Provisions of the labor Cade,you mot
.,O faMwild comply with such provision or Nis permit Mali W dccmed muted.
Z ti CONSTRUCTION LENDING AGENCY
(.r I hereby aRam that Nine is a convection lending agcy for Me Performance or
Ix
to work for which Lob permit Is issued(Sec,3097,Civ.C.)
WM Lenders Name
D Z lenders Add.
UQ 1 cenify Out I have read Nis Application and sum that the Above information Is
V,r. correct.I agree to comply with all city And county ordinances and show laws minting W
C) building convection,and hereby anthoda mpreaenhotives of this city W enter upon Me
ab.e-mendoned property for impaction purposes.
gti (We)agree W save,indemnify and keep handled;Use City of Cupertino agues
cn liabilities,judgments,emu and expenses which may in my way aa+n against said City
U7 In consequence o(Ne granting of this permit. �J
F7 APPLICANT UND SJAND'A WILL COMPLY WITH ALL NON-POINT. Issued by:s4to�t�zw Date ./J13:r �..,r),
CE RECU S.
oS Re-roofs
m of App HAZARDOUS MATERIALS DISCLOSURE Mte Type of Roof
Will the appim'"or future building occupant Bou or leandle harudous material
deff.d ty the Cllpenlna Mu 'pal ode,Chapwr 9.12.And the Health and Safety
ode.Seetian zss3z(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building accupans tea equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
is huaadnus air conuminmu u de0ncd by the Bay Area Air Quality Management all new materials for inspectio
District?
❑Yes Nu
Ihavc mad Ne hate Wsmatcdau reyuimmcnho unJcr CluPter 6.95 ofdte Glifor
ri.H.Ith&SIdety Coda SCction255D5.z5533and25534,1uWm=dthuifdc Wilding
docs not CmAmLIY ham a ten t I u my responsibility W notary Ne occupant of Ne (J
menu which mus W Issuance of a CcvOeste or Occupancy. jg ore of plicant Date
r
All roof coverings to be Class"B"or better
wncr auldodxd agent Dau
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
oclo Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS:�' ` PE OSOGd� 7
OWNER'S NAME: PHONE #
GENERAL CON-fRACTO FAX #
I am not using any subcontractors:"}L.6,A„ .
/ 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
Ah 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
v
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino ,
10300 Torre Avenue
Telephone: (408)777-3228
#UPEkTINO
CITY OF 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.
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.
onding: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: (�jr�c el (�,i/
Job Site Address:
Roofing Company Name: c
Applicant's Signature: Date: z-or"
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF S
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
—/
Building Addres
O er's ame: Phone#:
i
C tractor Phone#. /ON License#:
,t7R-e)T5V Y72105
tact: Phone#�yoB� Cupertino Business License #:
7B -a
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
4k❑ Wood Shingles ❑ Wood Shingles
Other(Specify) Ca ❑ Other(Specify)
umber 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 Policy: ❑
b Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Typ f nst c ion: Occupancy group:
6.
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