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05060080 CITY OF CUPERTINOs �-.^w@*+ BUILDING DIVISION PERMIT BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNO05060080 2224c; POPLAR rpni7p. q() OWNER'S NAME: PERMIT'ISSUE DATE ROBERT ONE: SANITARY NO. CONTROL NO. 08 27 8- ARCHITECTIENGINEER: BUILDING PERMIT INFO nBLDG, ELECT PLUMB MECH �86 LICENSED CONTRACTOR'S DECLARATION 90b!Desc11ri tion YI I homey afOrm that 1 am licensed under provision of Chapter 9(cammancing P y�, U� with Section 70(10)or Division Softhe Business and Professions Code.and my licensee ^ in full form and Lkene"c , ns o REROOF W/SHINGLES . `j �•/ nU� a Dam Contnmor T ARCHITECTS DECLARATION 1 undersand my plans shall be used as public records p j{ Licensed Pmfaelnnal �� r. � \ OWNER-BUILDER exempt DER DE Ce Contr ON r v a y 1 booby+(Sec o n 1 a1.exempt from the GOnuacloo License Law for de . p o following u amu.(Section 703 L4 B.abor. and Improve. 4cm ns Cade:Any city or county $ which rtqubea a permit re cones iW alar,improve,h permit er W,fi mpNr mmy swctum ZSQ prior mits issusdpurml�olte lWiosapplicant for Cmucrmi a o as Law(Catemcnt thwromminnwit pursuant to the of Division of the Conuinss and Prase Law(Chapter9 Sq. Ft. Floor Area Valuation zC (comm is exempt Section a and t f Diviaiof r of al egad Business and m.Any laganComof 3$ that he a uempt Nem(rom and the bile for Jur alleged taempJan,Any vlalNon a( Section 7031.5 by any applicant for a permit subjects de applicant m a civil penalty of 3 44TB13DdJ1r* '0 0 Occupancy Type not more dam ase hundred dollars($510). ❑1,as owner of the property,or my employes with wages as their min compensation, will do thework,and the stanctum is not Intended oroffmcd(mask,(Sm.70M,Business Required Inspections and Pmfessiona Cade:The Communes Llcause law docs not apply m e an owner of q P property who builds or improves Neuron.end who does such work himself or through his Own employes,provided thatkueh improvements are not Intended oraRered forsate.IL however,the building or improvement Is mid within oro year of complWon.the owwr- builder ,will lave the burden of proving that k did nm Wild m improve fm purpose of axle.). 0 1,as owner of the progeny,am exclusively contracting with Iimnsed contractors or construct the project(Sec.7014.Business and Professions Code:)The Comractors U. raw Law does not apply to an owner of property.who Wilds or improve thereon,and who contracts for such projects with a contractor(s)licensed pursuant in the Communes Lkmse Law. ❑I am exempt under See .B&P C for this msson Owner Dam WORKER'S COMPENSATION DECLARATION 7 kreby alRsm under penalty of perjury arc of de following declaruions: 1 have and will msintsin a CCnlOate of Cansenl m wif-haum fmwwkcesCampen- tylion,as provided for by Section 3700.1'the Labor Cade.for the partalmmm of the wok for which this permit is issued. ❑1 haves and will maintain Workers Compensation Insurance,as mquired by Section 3700 of the Labor Code,far the performance of the work for which this permit a Issued. My Workers Compensation Insurance carrier and Policy number art: Cmwn&i6AC a .4uilF�v Policy No.:ie.YV-!M/OY¢IOnY CERTIFI TEOI7 EXEMPTION PROM WORKERS' COMPENSATION INSURANCE (The section need not k completed If the p urnh Is(mane hundred dollars(x,100) or ICs+) 1 certify that in the performance of the work for which this permit a Wood.I shall not employ anymaxon in my semantic as to become subject to the Workerf Compewdon IA.of Califomia.Dae Applicant NOTICE TO APPLICANT:IL after making the CeniOcate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must OZ forthwith amply with such provision or this Knelt shed k deemed revoked. Z rn CONSTRUCTION LENDING AGENCY [r Ikreby m.the there is ac...umwn lending agency far Ne performantceaf E .�.v the work for which this permit Is issued(Sea.3097,Cn.C.) W�Q Landers Name , z Lenders Add. U O 1 cattily dot I hive read the application and sum the the above information is DO correct.l Lame to comply with all city and county on Innen and saw laws relating in 0 Wilding construction,and kreby authorise representatives of this city m enter upon the W above-mentioned prapeny for Inspection puquws gL (We)agree to save.indemnify and keep harmless the City of Cupertino against y liabilities,judgments,cents and expense which may In any way accrue against said City In consequence of the gaveling of this penult. APPLICANT UNDERSTAN ND WILL COMPLY WITH ALL NON-POINT Issued by: Date jS�l 3-r Q ,2(r SO,,�pRR/��E REGULATIONS. /� 3Z2=;zign pvncanoc "" — ��oa�� Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupanumro arhandle haamom material M defined by the Cupertino Municipal Code.Charm,9.13,arta the Health and Safely ade.Section 255324» / All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or(elute Wilding occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove atoll hsvandaus air contaminants as Jc0 thy`Ik Bay Area Air Quality Management all new materials for inspection. anv . District? ❑Yes u I have mW the haasrMw materials requirements;under Ckpter 6.95 of ft Califar- - nrsHealth&Safety Cade,Seen=24505.25533 aNA534,l understand thattrue Wilding does peirwar 4 ly have a tenmt,WI It e m e mibilhymsBdfy t amupmt of the requircart ichmusabometpdarm lga eL'i�aw of mpaney. _ Signator fApplicant Date -� All roof coverings to be Class "B"or better wile,or anthariv ecnl Dae Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C 0 Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS- PERMIT# S- G QSa G oo,&�q OWNER'S NAME:X1E PHONE # ' GENERAL CONTRACTO FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' o tion: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood • Glass/ Glazing Heating Insulation Landscaping a 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 UPE�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 with the above stated policy on re-roofing. Homeowner's Name: _ Job Site Address: 40 Roofing Company Name: a ` Applicant's Signature: Dater "- Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINOaw REROOF �q S CUPEkTINO PERMIT APPLICATION FORM APN# Date: 13 yj Building Addr s: 0 er's Phone# Yob/ C actor: J Phone #:i/08 License ct: Phone �Qyq Cupertino Business License#: 7U Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 1�4 Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles / ❑ Wood Shingles Other(Specify)__-Z' oo ❑ Other(Specify) umber of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and ill Comply With .Cu ertino's Tear Off Policy: b Description: r` .t c Cb Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: T f tion: Occupancy group: 5 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 � "24 / 7z , 7 ?-,