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04060241
CITY OF CUPERTINO • '— ' '" - _ < a<s - __ BUILDING DIVISION Pl;RMIT CONfiRACTOIi TN `OItMA.TTON _.', Y'a•z .dn�.lf.aa. cL,NhPre_�z ., Paw. RUILDINGADDRESS: FOUR SEASONS ROOFING PERMIT NO 04060241 PERMIT LSSUEDATB OWNER'S NAME: DE ANZA OAKS HOA 645-.HORNING S1 ' SANITARY NO. CONTROL NO. DNE: (408) 278-0330 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDGELECT PLUMB MECH t� 1 0 y0o aZ LICENSED CONTRACTOR'S DECLARATION Job Description .�s I hereby 0)of Na 1 am licenud under provisions of s CmR. Y(commencing n� with Section]WO)of Diviaion3of NC Businesaand Pmfcaiuna Code.and myliccucia nfull(areetndefr _ Z. L REROOF W/COMP. SHINGLES P? LlCan¢G s Lk.N Date ARC CPS DECLARATION 1 understand my plans shall he Peed as public C.W.rt ?y 3c G Licensed Professional OatNEm BUILDER DECLARATION I hereby.(firm on 1 em exempt from the Cssions Co 6iecme Lew for the i O O following reason.(Section 703 1.5,Business and sae,de rum Code:Any city m cnumy u$tai which requires•permit tae cnnstrlel,plots Improve,decant for such ermitt or mash ed ao-uotum - F y poor miulensedptlwrntotherof lhevisimatofdueContrarmisLumosele a Law(Chaptem Valuation �< that me ccenwit puntion7 the of Divines of Nc Contractor's License Law(ChaPmr9 Sq.Ft. Floor Area (commis exempt Section and the themson3 of the eged essmt ProfessionslatM)or tha io h 31.5 b my i mli and ver burs for be alleged mmemart to Any violation of Section erydred d.I i($500mis subjects the applicrosm.civil penally of 4+;5$I3xU3�er00 Occupancy Type nos mort than five hundred dolurs(SSW). ❑1,as owner of the property,or my employees with wages a d ehmle compensation. will do the work and the swnum is notinteneed or offered formic(Sec.7044,Business Requiredk1nS ectlons and arty wh ou Codc:The Convacmfs License Law Oars not apply lf,t owner ofpro q and pon emi build.or ewe:The Co Nereors ndwhoLicense da w dead work himmlf verathroughowner own employees.provided that such improvements tae not intended oroQered(mak.If, however,the building or improvement is sold within one year of completion.the owner- builder will have has burden of proving that he did not build or improve for purpose of / sans). ❑1,as owner of Use property,am exclusively convecting with licensed contracmn=o commas the project(Sec.o an owner of and pitchmproperty whoWilds ds of i The Cmvacmre LI- who Law does not apply ja an with a of property who Wilda ver and to u thereon.red, whocompact,UW. for such proKcts with aconuecwr(t)lice=sxe0 puautntmthe Convacsar'e 7 Lneue Law. ❑I em exempt under Sec. ,B A P C for this meson Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the fallowing dttlamiou: 1 have and will maintain a Card theme of Conant to self-insure for Worker's Compcn- 137M ion.u provided for by Section 37W of the Labor Code.for the performance of she ork for which this permit is issued. 1 have and will maintain Worker's Compensation insurance,as required by Section of the Labor Codc,for the performance of the work for which Nis permit is Issued. y Worker' a on ra==ce=artier and Policy number are: sricr: "r/�P'y�' Policy No.: / CERTIFICA :OF EXEMPTION FROM C S' COMPENSATION INSURANCE O'buacctism reed not becompleted If Ile parrot is for ane hundred dollars($103) or lux) I certify Not in the performance of Ne work for which Nis permit is issued,I shall not employ any Person in any manner an as in became subject o the Wurl err Comperdi Laws of California.Data Applicant NOTICE TO APPLICANT:IL titer making this Cenificam of Exemption,you should become subject in the Worker's Compensation previsions of the Labor Code,you mum Z foMwith comply with Such provisions or this Permit shall be deemedhawked. Z Q CONSTRUCTION LENDING AGENCY E(Y, Ihereby affirm that Vert is a convection lending agency for she performance of 7 the work for which this permit Is bawd(Sec.3(197,Civ,C.) W Q Unders Nene 0Y Lenders Addreu UI certify that T haw mad his application and stag that the W.information I. U.2 =Omc=I.I agent to comply with all city and county ordinances and sum laws relating to savingmmied wriae construction. hereby Nohapmau nuvea of this m city enter upon Nc in rapery for inspection puarpossax. (S (We)agree to save,indemnify and tech hay in a dm City o(eupenino against C UZ Iiacosegenceo judgments,cons and of this expenses which may in anyway ettme agelnstaiO City V z A APPLICANT of UNDERhe STANDS ingot this North. r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signuum of ApplicaOete HAZARDOUS of Roof HAZARDOUS MATE RIALS DISCLOSURE Type Will the eCtipeuorfM.aiWilding oceupantstore or handlh Health ad Safety u defined by de Cupertino Municipal Codc,Chapter 9.12.and Ne Health and Safety odc.Su,"25531(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑res Will the applicant or future building occupant am equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air mnmminanu u defined by the Bay Area Air Quality Management all new mater' r pection. 4a' YeshavemaddmhmsrdousmeerialsmquimmcnvundcrChapmr6.95ofth for"SafnyCodc,Seccvou25505,25533mJ25530.1undcmundNesifdm Willing many responsibility m notify she occupant of Ne cnts wh st Wm at m issuance of a ccrdneam of Occupancy.mNorned.gcnl Dae All roof coverings to be Class uBn or better Community Development ss r £, 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # CC> ( 5�- mac-,-S 14-L,V+-e-L _ © o 6 2�l OWNER'S NAME: L—(C—r i/ GR1 p PHONE #-5` -- GENERAL CONTRACTOR: ` FAX # I am not using any subcontractors: 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 • Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing T;ou'- SepticTank Sheet Metal Sheet Rock Tile / Owner/Contractor Signature Date Community Development Department. - Building Division e � 0 City of Cupertino • " 1.0300 Torre Avenue Telephone: (408)777-3228 Cl ©f Fax: (408)777-3333 ;UPEkINO 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 approv al 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. & 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 t/a"per foot slope and demonstrate that there is no ponding. on the job site at the time on inspection. 2. An I.C.B.O.report is required to be I understand and will comply with the above stated policy on re-roofing• Homeowner's Name: tA- Job Site Address: 10 Roofing Company Name: _' Al2plicane s Signature: ------7ate: _ Greg eel Building Official Revised 1/30/03 CITY OF CUPERTINO REROOF ° b� CUPEI°T`iNO PERMIT APPLICATION FORM APN # Date: .� q2-c-716 � Building Address: 5c- S t Owner's Name: hone#t 5-27 - /5 Contractor: Phone i License#: Oc4.''�x's�.x�•,.r., CXR' Z?�—c'J�3G� ?'Z/D� Contact: hone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof O Asphalt Shingles J&—" Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles P� Other(Specify) �'[�+tc"u tam ❑ Other(Specify) Number 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: Job Description: ' Residential [fir Commercial ❑ Fire Zone: Yes ❑ No [Z} Confirmed with Planning Deft. if there are any restrictions: Li Cost of Project: Type of Construction: Occupancy group: t AQ . i i e Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING A/� 8