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04060176CITY OF CUPERTINO(v "�^"ja`p"' '" r BUILDING DIVISION PERMIT 0N��q�"'��,�VyATJQ..p,y�- BUILDINGADDRESS: FOUR SEASONS ROOFING PERMITN"04060176 10134 POTTERS HATCH OWNER'S NAME: PERMIT ISSUE DATE DE ANZA OAKS HOA 645 HORNING ST 06/21/2004 ONE: _ SANITARY NO. CONTROL NO. (408)278-0330 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED COMRACfOWS DECLARATION lob Description p I PmbY ,firm Her I am IicenaN under Pmvistons of ChaPRr 9 (cammendng me with Se OfU7 of Divisior. ButlnesleM Rofculov Cade, end mylicenu is in rant anderc 0 7Z/OF REROOF W/COMP. SHINGLES cemefull `,; LicN Dam Cunu AR ITECrS DECVARATION 1 d u public rtCoNsundmund �l PLlttnscd DECLARATION OWNER -BUILDER 1 hereby affirm that I am exempt from Me Conummaes License Law for the following Rosen. (Section 7031.5, Business and Professions Codc: Any city or county which requima a permit to cmuomt. slor, improve, demolish, car -pair any sous -re $8000 pd., to its issuance,.lata requires IW applicant (.,such Permit to file a signN su Orman Sq. Ft. Floor Area Valuation that he is licensed pursuenuo use provisionof Me Contractor's U.. Law (Chapter 9 (commencing with Session 70W) of Division 3 of the Business and Professions Code) or Net he ts exempt the -from and de has8 for Ne alleged cxempdan. Any violation of a Occupancy Type SeNon 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of not mom Nan five hundred dollars ($50)). ❑ 1, as owner of the property, or my employes with wages as their sale Compensation, Required Inspection will do Me work. and Me sommu a iscotimanded or offered forsale (Sec. 7004, Business and Professions Code: The Condamine, License Law does not apply m an owner of property who Wildsor improve Nercon,and who doessuchwork himself or through his own employees, provided Ihatsuch improvements are not intended croRe,ed for sale. IL however, Ne building or improvement is sold within one year of completion, the owner, builder will have the WNcn of proving that he did Out Wild or Improve for puryou of i / sal 0 1. with licensed ountRmmra to I, as owner of the property. ,m u mama l Code:) The Countersue, 704 Bnemeal and Professions Cone uctLa NC pmKtt and ny wh Wi McCmr, cad cave tat does not apply je an owner Of Property Who Wilds of improvss Mercer, and. apply s an P whocontractsLace fm ouch projects with a <onvacmKs) licensed m ed pursuant the Canvadore Lice jV Clem exempt under Seu . B & P C for this matin Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of Ne following declemtions: ❑ Ihaveant will mainuina Cenificamof Conunlmulf-InsumforWorkerYCompen- sui.n, as provided for by Section 3700.1' the Labor Code, for the performance of the work for which Nis permit is issued. 0 1 neve and will malnmin Workers Compensation Inu en e. as required by Section 3700 of Ne Labor Code, for the performance of Ne work for which this Permit is issued. My Works,' do ngn.M. artier and Policy number art: L�jRI=y TPolity No.: ' CERTIFICATE OF EXEM WORKERS' COMPENSATION II ANCE COus section need not he cumpleRd If the pemlt is (nronc hundred dollars (SIM) or 1ex.j I certify that In Me Performance of Ne work for which this permit is bound, I shell not „ employ any person in any manner u as W become subject to the Workers Compensation Laws of California. Data Applicant NOTICE TO APPLICANT: If, ,fur making this Certifteam of Exemption, you should become subject to Me Worker's Compensation pmvitlom or Me labor Code, you must forthwith Comply with such provisions or this permit hall W deemed reeked. CONSTRUCTION LENDING AGENCY I hereby arcum Nal NCR is lending agency for We Performance of s ed is... 3 thC work for which Nis permit u issued (See. II9'1, Civ. C.) Undoes Name Lcndcrs Address j I cenify that I have read this application and state Nat the above information is cone, I agree to comply with all city and county ordinances and sum laws relating to building construction, and hereby R, this city to Ne uponen above-menduned pmpeny for inspection purposes. d erter ' emnify keep the City or ago (Wj2agrees, Cost, indemnify andkeep hay In an gamuls,debit cUsts ad Which may In My way we= BgBlnsl,ald City flabilRinconseq jeceof a sisiatkilim Pa in consequence of Ne gar is Permit. ' A LICANT UN TANDS A D WILL COMPLY WITH ALL NON- OINr Issued by: Dee a ;;rRe-roofs _ Date gnemrt ofAppli Roof HAZARDOUS MATERIALS DISCLOSURE Type of Will the applicant at future Wilding occupant store or handle hvmdous material as turned by Ne Cupertino Municipal Coda, Chapter 9.12, and the Health end Safety .dc. Sects.. 25532(a)? o All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or foto swing occupant esu equipment devices which emit havardnus air contaminants as dammed by Ne Bay Area Air Quality Management all new materia r Ins Ctlon. District? ❑ yes I hoc read Nehr&Cuumaubusrequiremenn under Chapter&95 ofdte Cali( - nuHcslNhS Sonans 255(15,25533 an! 25534.1 molmsuM Multiuse Wilding ka d tt'u my ropoNihili y m notfy Ih ammo rot car Mc CJ or mode. w MUUW elpd.rmiasmnecof.ccNrc.m.ra gna[UCe Of Applicant o All roof coverings to be Class "B" or better owneeaathndzed eget ,= U Ylease check applicable subcontractors and rmmnla+a flip fn71MAAri 1;: f.,,......}t--. 2 G Dat SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting I 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 2 G Dat Community Development Department Building Division Ate City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 OUPEkTINO 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. 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: l6 11 q o* E— S Roofing Company Name: Greg CaXteel Building Official Revised 1/30/03 Printed an Recycled Paper FA CITY OF • CUPEfI;TINO F_ i CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # Bldg Permit Fees BUILDING Date: Energy BUILDING BSEISMICRE Seismic Fee Res Building Address: BSEISMICOM Seismic Commercial lD Owner's Name: BUILDING BUSLIC o #: 17 Contractor: Phone #: IF License #: *ter' Sr tea. c (TV L /d Contact: Phone Cupertino Business License #: r lilCSIVO — D / Z 3 Z 3 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ,1< Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles //7.� t'. Other ❑ Wood Shingles (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # 53' 'To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: Residential f Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planrun 1�e t. if ETthere are anrestric ns Cost of Project: Type of C on: Occupancy grow r Qty ctl App le Fee ID Fee Deserintion FeP Grnnn 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 3 7,