02080026 ;CITY'OF CUPERTINO
%'Iiii1LmNG'mV1SION. ' PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10125 POTTERS HATCH FOUR SEASONS ROOFING 102080026
N E: APPLICATION SUB DATE
JONATHAN Z 645 HORNING ST 08/06/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
O O �ARCHITELTIENGINEER:., BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Zm Z LICENSED CONTRACTORS DECLARATION Job Description
o z_m . . I n rebs m n I r s3en under pm Islom of Chapter Uommencing REROOF
p y t w ��Omaaw
'nvon 3 of th us nets and Professions Code,and my licenses� I,�p ULIC.X [a. Gan alarw- JANLLw GARCHrrECr LARATION 2 9 2003
0y 1'r jIl undersmnd my plans shall be toed m public records
i o .Licensed Professional
OWNER-BUILDER DECLARATION WILDING
t: 'o hereby eRmi tnm 1 em e3cmps from be Comrxmr's License Law,for die 'rV
t?< folio g .(Section 70313 B titans and ova.de oro Code.My mny st county $8000
ig❑
which 1 rtts res n Permit I construct,elu improve.demolish.t fi repast any tmemor ,
3$ ..p�ormns asuantt.of rtqulm nh upplicant(r hperm rmfleesignod sou t Ftr�p�
tgaphkol een;ed,pur dagn the pct;visim fm Cmmcnols Llnnu Law(Chap 9' ., 1 a4C7r..9'r/`Y�r.pawn 3 qrV"L k Valuation
(commerlc ng irh SecggnA0f10)ol Divs Jofm 9usiness and Pfn'a.'ons Code). {,,itll LCy11S7 -V,zl.`Y I_,IU.•C/-.,I,:}....� z. \°
or that hen exernpl themfmm dnJ the basis for me elkgod excmpdoh.Aa.
ny v plat an -'
--of Section]031:5 by any.,tevin fm a pemdt zubjno the epplieun m a civil pnelly
of not more than Bvs hrmerititen lS5fxk 3055 ABN fti + ;u:'d.•.ur•l, Occupancy Type
❑1,os owner of rhe property,m my employees with wages as their sole compensation. 207 - INSULATION
-'wltlJo;rhe work:and the'sr e, The C not aim's d or a Lux,Yoe oak(Sec mHA: .. 6 01 - ROOF TEAK GIi N Inspections- %ks '_a c
'Buundss and Professions Code:The Comrvcmr's License Law does not apply to
en q
aw
mer of property Who wads or impmKs thereon,and who does such work hinualf 6 0 2 - ROOF PLYWOOD NAIL _ __
m though his own employers. buildN that such impend,snn are,not intended or __ _ _ _
completi firsale.If.eowtilder ewdvet eburden ememrsstha whin one year of " '-- "603 - ROOF BATTENS' ' '1 ''1
,
completion,rh meow ides will nava the Horden of proving that he did not build or
improve 604 - ROOF IN-PROGRESS
-- - - -... ...__.... ------------ --- _.
f91;ss owner_of rrhe pmpenY.sm exclusively contracting with licensed contractors to
con ton the pmjes:r(Sec.]PAA,Business and Professions CII The Contractor's ) �., r
Wcena La don not apply to an owner of property who bu Ids or Improves tabs a,
_sand.w1ho.conamels,.for such projects,wit...,mumetor(s).hcemed.purnant.in me' .-.-.. ..
3
Contractors Or me Law." ❑lam exempt under Secl &PCfmnhis rcunn
. ., .:Lail
m
WORKER'S COMPENSATION DECLARATION
_. .1 IhercbY off rot J IPe II d "pe)ueyoa, the following declarations:
❑ 1 h.4 aW'''will malnl e C mficem f Consent to selFmsum for Worker's
Compenrauoni.ex mvlded for by-Section 37M of-do-laiwr Code, for me
rrtu
r y ,perforKe of the work for which tis Ilennit ix issued.,
❑1 have andwlll m nMln W rker'e tompenmuon Insurance.as required by Section
3700 fthe',Labor Code far the perfuntr rice of the work for which this permit I,
issued M�ygqW.ke Cm-riperromon In.umn tam d Policy puriber isn. -
INPl-[tii\kl.rr t e,.PolW CZ1191A -L 1 --
C e
1! )CERnMCAn0NOF,FAEM ROM WORKERS 4 4;,V .i3::3...
COMPENSATION INSURANCEI s'.4N ��. . . . ................. ......._.,,.. __....--------- -
''y I t',fro s section rood not be completed If the permit is for one hundred dollen
(3100)or
cert fY rho rh perform tad inti - ikfi hlhml pemdT HnW'I! _-_.'- . . •-.-_ -2 _�. f ,t'I'! i ,G„tlid.bt S, ,s ; . :.- - --_ _- .
shall t employ any:pe n m any ma r to becomesubject m rhe Workers'.
C .l pelion lnwv ffCalifornia.Doe
=NOTICE TO APPLICANT;If:after making this Cenifmau of Exemption,you should,
• berhwith comply
rhe iuchps Comj¢mation ploailshoofte Lswr Coda yoo mum' '
O � Tanhwit comply with ioch'pmvisions ar this pertnir shall be deemed rooked.
A+ "''r'�CONSTRUCTION LENDING AGENCY ,,
a- i'{ Ih by Won that th 30 conuummo Ing
ugenry for the perfomiance
.
of the ork for which mix 7-ii is Inucd(Sco.3097Civ.C)Qa
o Z ILend Address` ._.._.-
V_O `1 Iccnl(y IhmIh read rns pplct tad tare that above informations
ttX.P rte” 1 agree to comply,with all city and countv on inunc a and state laws mining
O V ,to building c an wand hereby outu onrepresen at ves of this city t e to poo,
W ,ih abo i r n dp pony f fand p rpous
L (W<)agree Ib indemnify fy anJ keep hwminc the Qry 6f Cupemno against
(A liabilities,jdgmentscosts and aspemcs which may in any way,pccmq again"said
V y .0 ry in c nsequerice of oharma.
'vAPPI1CAJVT'UN,I RSTAI VD WIIICOMPLY WITH ALI.,0 POINT'
srn cYL
c RECUCn Gips„e' ,4 r, Issued by: Date
loawrt afAppticam(Contradmr» }': -:;;�,1"k. ':". • ' .'Dau'^� Re-roofs /
,k i HA]ARDOUS'MATERIALS DISCLOSURE
(; III me.,lic t Tum hu Id g a p I sone handl hawdoux mmewl Type of Roof. ._�...._......-..,......... .....,....,.............:.. .
mdifir' by,t Cup,r MncplCd Chprr912andnh Hahhand Safety tr It;.. ¢-A ih.`) `,[ .7•IA q, 'F. 1 i
2YS532(a) �� 11 111!} X ,
All roofs sluill be inspected prior_io.any_roofing,material being installed.,._,.,__,,,
III the apply ma tat .e .it g p n( seequlpmentor deviser which If a roof is installed•wi[hou[first obtaining an inspection,Lagree to remove
1 contaminanum defned by the Bay Area Quality Management, all new materials for inspection. Applicant understands and will comply with
D stn t
/14' - _ P
prequirements
q' y k ` ' all non poo[source regulations.-
Lame
egulanot s
- F Yes N
� r
I h Health rhe Safety
a}'morons 2 Oqmu505,25ieno under 4.h ur 695 0!to
Cahe buil Health& cu Coda Sechave
ate 25505 t it is and 155JA I to not that
aunanr morn soyresponsibility.l notify the
t Oce
a pencyf the rc u tats which man he incl Poor m Issuance of a Cenif<a(e of ✓
frh building docsnot curtenrly hoe
/ 8 06r o2 Signature,of Applicant Dale
All roof
e
one r aathadj d gent, CM1� 9 f coverings to be ss "B" or better
_OFFICE--.. .. ..... .... .._.. _. .. .........._ . ... .,_.. _.
In
- 4 _ta ..., _n .a . .. 1 __ _ —.L_.. _ tail -„4' ,ilt:•
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 0 Fax: (408)777-3333
CUPEPTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the'
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of VV 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: (�
Address: _ 1 �2.5 'f O Wt�v� gaA-
Reroofing Company Name: -6o Ur � S 0 T�
Applicants Signature: 1\ a-k N . �K�rst CC(n Date: g- O 6 - 0-?-
Joe
2Joe Antonucci ~1
(Chief Building Official)
6125101