04060243 CITY OF CUPERTINO
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13UILDINGDIVISION- PERMIT '✓!Q1,.'� !-^ O N.0
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMiTNO04060243
. 10174 POT7EFS PATCH
OWNER'S NAME: PERMIT ISSUE DAM
Alk DE ANZA OAKS HOA 645 HORNING ST or/29/2on4
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BillBUILDING PERMIT INFO
ELECT' PLUMB MECH
0 0 0 0
_00 LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
I hereby affirm that I am licensed under previsions of Chapter 9(commencing P
a with Section 7000)of Division 3m`the Bremen and Professions Code,a rase is
infullmmeandeff3 L,ex - - REROOF W/COMP. SHINGLES
v�z License s
Deho Contractor
dqq� A HnEC'S DECLARATION
Y C< I understan my plana shall be used as public records
Licensed Professional
S OWNER BUILDER DECLARATION
I hereby affirm That 11. exempt from dm Contractor's Co License Law for the
X p O which re mason.(conic t 7(131.5,Business and Pm,demob Code:Any city or county
K$ which requires a permit re construct,aaller.pplicant
improve,demolish,n repair any structure onn
-
rZ>• prions,fiaaaencc,also requires to he t rovibi.of for such Contrator'lofiensele a signedstatement
ES<
Out m ncinnwJpurstion7 7")
eConusiness LicenseLaw(C ode) 9 Sq.Ft.Floor Area Valuation
(cat he Is
(commencing with Section nan d the
Division]of the alleged
exempt and Proreson.Any
Code)of
Net he u exempt Nelefrom and Ne bazis for the alleged emmption.Any vialad'on of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of 3 er0 0 Occupancy Type
not mom than Eve handled dollars(55(X1).
0 1,as owner of the property,or my employees with wages as Innersole campemadon,
will do Ne work.and the structure is nalMended ofaffemd forms(See 7044,Business Required Inspection
and Propulsions Code:The Contractor's Lt..Law docs not apply to e ns an mane,of q P
propeny wha builds orimprowe thereon,and who does such work himselfor through his
own employees,provided thalsoch improvementsme not intended wormed forsale.If,
however,Ne building or improvement is sold within one year of completion,the owner
builder will love the burden of preying Net he did not build or improve for purpose of
salede
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
come taw does not apply to an owner of propeny who builds or improves thamon,and,
who contracts for such pe jecho with a comments)licensed pursuanuo the Contraeota
License Law.
0 l am exempt under Sec. ,B R P C for this,case
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of On fallowing declarations:
I have and will maintain a Cefllficato of Cmucnl to self-Insure for WoftesCo nter-
u0on,as provided for by Section 3700 of Lee tabor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Crude,for the Performance of the work forwhich this permit is issued.
My WorkaLy,�/oopen I gc!!s`sm��e caninand Policy number..-
Carrier. I / Policy No.: '
CERTIFICATE OF EXEM MON FROM WORK
COMPENSATION INSURANCE
(This section need not he completed if the peril is for one hundred dollar($100)
or less.)
I certify Nat in the performance of the work for which this permit is issued.I shall not
employ any person in any manner se as to become subject a the Workcrs'Compensatian -
Laws ofCalifornia.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker'a Compensation previsions of the tabor Code,you must '
OZ forthwith comply with such provision or this permit shellac deemed revoked.
,z,,,y CONSTRUCTION LENDING AGENCY
[-t l hereby affirm that there is a construction lending agency for the perfurancc of
!Yi Be work for which this permit is issued(Sec.3097,Civ.C.)
W�Q Lender's Name
z Lender's Address
V Q 1 certify Nat 1 have read this application and shote that the above information is
IL comecL 1 agree to comply with all city and county ordimnma and suite laws misting to
C.) building conswctme.and hereby anthodm repremmatives of this city he color upon the
ahoved.(we)agree
Propeny for inspection purposes.
W (WC)aaid l0 ertsave.far
indemnify om keep harndeL NC City Of Cmpenlao against
IiabllNes,judgments,casts and expenbea which may in my way accrue against Said City
U in consequence of the gmntin is permit.
r
UNDE DS . D WILL COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs
f ApplicantfConuector ala
HAZARDOUS MATERIALSDISCLOSURE Type of Roof
l Inc applicant tar fumrc building acupamscamarmhandle he'rallosmamriai
by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safetyon 25532(x)?�+ All roofs shall be inspected prior to any roofing material being installed.
es ��l the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ous air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection.
OYes ONo
I he.mvl Ne hasallod ahorials requirements under Chapter 6.9.is Health A Safety Code,Seeaon 25505,25533 it 25534.1 undersand thenirNc building G'
Jots not cunently he 'I B my responsibility b mildly the¢cupant of the
mmmcnmw must et prior 'iasuancc of a Cenlficam ser Occupancy. Signet re Of Applicant Date
Gwen or Gazed agent Dale All roof coverings to be Class"B"or better
Community Development
I .
10300 Torre Avenue
y Cupertino CA 95014
Telephone(408) 777-3228
CITY 0 Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: —r/ G°% p/ PHONE 4 '555?-/ F7
GENERAL CONTRACTOR; FAX #
I am not using any subcontractors: G
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
l
Heating
Insulation
Landscaping
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
�t City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
C{7y OF Fax: (408)777-3333
,UPE NO
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 V4"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: 8eCJ�'(14�
Job Site Address: _D �� � � x e
Roofing Company Name:
A plicant's Signature:
ate:
Greg teal
Building Official
Revised 1/30/03
CITY OF CUPERTINO
REROOF �j °6 ° 2- q3CUP0ER INO PERMIT APPLICATION FORM
APN# Date:
Building Address:
l�-
Owner's Name: Phone M
Contractor: Phone# License#:
pc4i��z� -�•-� /tc Z?SS—cJ 330q 7-2–
Contact:
ZContact: hone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >WLAsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Pb Other(Specify) �c'R+ur sx ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
AI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
nom, c .'
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: IIJJ
Cost of Project: Type of Construction: Occupancy group:
i
QtY •
A is e 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
zG 21X37 � o