02080027 OF
CI BUILDI c p ESIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10145 POTTERS HATCH FOUR SEASONS ROOFING 02080027
W ER'S NAME APPLICATION UB DATE
MEM6 S AND PI Y 645 HORNING ST 0806/2002
PHONE: (408) 278-0330 SANITARY NO. CONTROL NO.
O O ARCHITECTIENOINEER: BUILDING PERMIT INFO
to- BLDG ELECT PLUMB MECH
<5 LI O CJ O
LICENSED CONTRACTOR'S DECLARATION
o 5„a Job Description
z_C 1 bercbY titian mat 1 am licensed under xxd Profe of aCca and mmecense REROOF
F=C J with son 7000)of Division me Bus sand Professions Cade.and my license
is in f e`free and Rect.
3 a. Date las. .,r 2�O
Dam — cr
ARCHITECT'S `DE RATION
C LL C g understand my plans shall W used as public records
iO O Licensed Professional
o OWNER-BUILDER DECLARATION
1 hereby effimi that 1 em exempt from the Convector's License Lew for the
is Z< following reasn(Section 7031.5.Business and Profession Codem:Any city county $8000
MFC which requires a permit to canon a,alter,improve,demolish,or repair my structure
E3� . poor m ms issuance,also requires the applusm,fo...ch permit to file.signed statement
tbarPe is licensed pursuant 16 the Provisions of the Commences License Low(Chapter9' a (,,,., tr,mal C ay ,srr'p^+ l Valuation
(commencing"It Section 7(0)of Division 3 of the Business mN Professions Code) �'i Jlk�'I 34;L"17 'V �.y�.Ck:y5.1P. J
or that Ke is exempt,here(mm'and me basis for Ne allliod eieniptiob,Any violation
-of Section 7031-.5 by any applicant for a permit sub*,;the applicant m a civil m penalty- 3 O 5 Typ
.of nmore than five hundred douas($500) A2N ,�_ Occupancye
°1.as r of Ne property,u my employees with wages its their sale compensation, 307 - INSULATION
owner
-will- ii rod Prk,-ssi the ode:Th Co m e,tor'ded'm offered does
alenot fsmr70i n - - 6 O 1 - ROOF TEAS Q�Ins ec: ions;r I+^•
'BuiiheisinO Professions Cade:The Camrecmr's License law dos not apply m in q p
owner of property Who builds or improves thereon,and who does such work himself 6 02 - ROOF PLYWOOD NAI L
_nth gh his ownemployees.provided that h improvements e t intended J or
)o((ercd'for sale If,h 'Me building'i n Provemcm sold nh,n'one y '_ _.. _..'--ROOF
._._ ..__. _____ -_ _. .-
°r. .. 603 - ROOF-"BATTENS '.'
completion,the owner-budder will have the Widen of proving that he did nm build ar
improve rm p.rpose at soled. 604 - ROOF IN-PROGRESS
col ct f die progeny,am Bassin IY moa t si m licenseitconContract m e I�fl����'
construct t a project(Sec 7044 Bus d e Professions Codc)Th improves
the on, (f I i
..d.whLicense Lew does not rapplysuch
mon owner of property who) Ids se mprovee thcmnn,
.vnd who castanetsforL such prolan- tit uaemrfs).1¢enud.Pursumt m me
C1..ese. nmlea JAW2 9 2003
❑Ion eacmpt underS c - 3� B&PCfor thsrceson ir'�` l ..
0 nor '.:..Date
r -T WORKERS COMPENSATION DECLARATION �'�®I��
' 1 hereby a(Grn under penalty of penury one of the following declmvtiens:
° I have and will mvinluin o'Cenificme of Consent to self-insure for Worker's
_ Compensation, as provided-for by-Section 37M oftheLabor Code, for the
_- - - performance of the work for which this permit is issued.
Cl 1 have and will maintain Worker's Compensation Insurance,es requiteA by Sation
3700 f the'L'ho'C de f m pert rmance f the work f r hich Ihls perms
-issu my W rk r'aC mpeni ton lnsumncec er endP Icynumbe _,"_. . .____ _ . ...o._- _ .._ ..-.--.._�.._..- _.�.._ .-..................M...._
_. �y. g e� . . .._ ..._..-.... .�.
0. •K Pori Wr7Lt:Il` ;ZcA
y,,7(CBRTIFICATI NOF E%ESShhhh1111N1PNIP'TTIIIn711110N FR0 WORK—� BRSI, i.7+Yacr+ Las .lt it a'�''y i�a.r Ss n
c -. •, COMPENSATION INSURANCE r i --Y -,•N.,.
"t't(This section need wt be'compined f the permit is(ar oec hundred dollar it
'ff100)ar ka.) _
peI_m fY lath ,hp performance nccf thework for which this-pe t is W 1,
IInotemployanyPerson m any m nerso a m became subject in fire Workers'
ComnmionwsofColifomia
-
Doe
NOTICE TO APP LICANPrs B making Certificate of Labor ode,youm Id. "•' r ',�
'bc a rico reth WorkersCompensation prons of the Labor Cade,y you must
z 0
r
.y CONSTRUCTION LENDING AGENCY' I•`v
a 1 h mhy eRum Nm to a co scan n I M ngg ag xy(o the per(onn n e t.,fl
t
of the work fo Aich rho perms a issued(Sec JIW7'Ciy C)
yps 'Canoe sAdd
V ,1..„�1 certify mm I have rtaa this application and mate that me above infortnmiad is
-'ts-Fa .correct.1 ogrce to comply,with all city vnd county ordinances and sine laws relining
HV rebuilding conmrbnion.and hereby amhorim represenmtives ofthis city reelmerupm
eg) tth bo ant Coned p party f span n p rpo s -.
S (We) gree w a< mdem fy ami keep hamilas the C ry of Cupertino against
y n
blhues fudgmenm m is a d o n e h h y es a y y eg m said
,d
'
C.1 y City n conseq Ince f the ggmnung of mm permu ^ w /
'APPLICANTANDERSTAVDS ANU WILT COMPLY WIYIfALLrfON-POINT (/V
sf i RCERLcuL,WONs ' •� I r sY A•L...p2„ Issued by: Dale
_ - to onOTA ( BrnodO CD
- - sure OTA 'E�';,Oa¢ y. Re-roofs
a. Sen odt25 C=a' M roc it c,Chapter 9.12, ad the
_ HAZARDOUS MATERIALS DISCL ,'rypeOf.R00f
W I i�c pplocant forum'bu Id ng p rot tore or handle haiallous material ..,
°Yy' �)R s No' p ' date Health and Solely,
I i _ ,a::'.�elje I '-.s �''� 5� k t, ti� ' .5'F..•' � I-
_, t. _ All roofsshall be..inspected pr or-to any roofing material being installed., _-,-
• WII th ppl eam rfuture Wilding occupant eeq ,pment rdr e which If a roof is installed'without first obtaining an mspection;'Lagree to remove
e t h warm e contaminants ae defined by the Bay Arc A!,Quality M eStm t
Distret all new materials for inspection. Applicant_understands and will comply with-
”
0 Yet1 .; t all non-point source regulations:. ,
' 1 h ve•tead,me hazel don. pine Is req Tanana rod rChapter 6 95 of tile'
Calf Health&5 hyC d Seaians25505 25533.nd25534 1 underma dth o
;ictufsallo' the res notcurrentlylhich u tcnant`et it is myresponmblliry tomoufy the"
'occupant of the rcgmrtmenia which muni be,net prior to rssuawe of Ccm ficate of� `A 0-kby�� A _ g
°P'r`y. �$ 86 02 Signature of,Applicant ate
t. ear Date All roof coverings to be Class B or bettermcmmdgm
,M1
. . - .a _. . ' -. - .. -- - ---- .._. ._ ---------
OFFICE - -...... .— ---". . ..
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
* CUPEkTINO
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: _l_Q_( A rz) Po N s t✓�
Reroofing Company Name: �o V`r- S-Q SQII.S&C(
Applicants Signature: `LQ& t`t� QW-2-SCO • Date:
Joe Antonucci
(Chief Building Official)
6/25101