03060110 CI '°.�
TY OF CUPERTINO , + zm # :'" '"'� sir
BUILDING DIVISION PLUMT CONTRtfi,G OR INF.OItMATIQN
fiY
BUILDINCADDRFSs: FOUR SEASONS ROOFING Pen"'03060110
• OWNER'S NAME: 645 HORNING ST PE"`'S" IY0716/2003
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITEMBNOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION O O O O
4(Y F 1 hereby affirm Nal 1 am licensed under provisions of Chapter 9(commercial Job DeSD1 PNIJ /cal II E
n�2 with Section 7(Mg).fDIA.1m,3ofthe Business and Prufessiims Code,and my license is Yr B H'aA,SSe�m
in full Porro�Wsaasnd cf J� REROOF
11F--? Dames CL`t���Comunor .I �OOJ
']
ARCHIIECI'S DECLARATION JUL O V
I understand my plane shall be,used As public records
' BUILDING
g C Licensed Professional
1 OWNER—BUILDER DECLARATION
2 0 0 I hemhY.(Bars that 1 1. exempt from ti r Cnniectoh License Law for the
00 following reuon. emit t EDLS,Bumess end improve.
deruns Cale:Any oily acounty -
$ which mquira a Permit to earnru. siren improv,deermit or e.Pat,,ig any tatcrostructure
met heor A,itsiensedpslsore to tIM the Applicant Or memactertm Oles Law(chapter
< (commis license)punuanl mthe provisions of the eBusinesWcenselaw(C ook)or Sq.Ft.Floor Area $4 s��lOn
zt8 (eat he
(commencing Section 7000)the
Divisionisfe of Nceedi casept Professions Cook)or
3�
that h 4 utmpl Nem(mm and Ute bu4 fa Ne alleged eumptlm.Ansi violation of
Session 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of 3 APA M ilbber 0 0 Occupancy Type
Out more than fivo hundred dollars(SSW).
❑1,As owner or the property,or my employees with wages u their sole compensation,
will do dm worle and the soucture 4 not intended or offered for We(Sec.7061,Business — ReG
Add ProfeWou Cade The Conummra License law does roc apply m an owner of 3 0 7 - INSULARN' Pfd Inspections
propeny, m
who builds or improves humq sed who dueue
sah work himself or through his
own employes,provided thatauch improvements arenol intended croffered for We.if. 601 — ROOF TEAR OFF
however,the building or Improvement is cold within one year of mmpledon,encounter.
builder will love the Worsen of proving that he did not build car improve for purpose,of 602 - ROOF PLYWOOD NAIL
sale'j' 603 - ROOF BATTENS
❑I.AsOwner of the property,Am exclusively contracting with licenced mnoutorsto 604 — ROOF IN-PROGRESS
construct the prefect(Sec,7010,Business Professions Code)The Contractor's Lb
come Law dose not apply to an Owner of property who Wilde or lmpmm thereon,and,
who convects for such pe jecu with a eonuactol(s)licensed pursuant he the Commence,
License law.
O lameaempluMersee. ,BRPCf.ui. on
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under peulty of perjury one of the following declarations:
1 haw and will maintain a Certificate of Consent m selGinsum for Walker.Compere
131
u provided far by Scotian 3700.(the Labor Code,for the performance of the
rk far which this permit is IssuedI have and will maintain Workors Compensation lu car one,As inquired by Section
00 oftheLaborCodo,fmhepnfomonceofd workforwhichthispermitis4sued.
Worts/(a�Comf r-adonInshwnceaierendPolicysn/ryy��mrtier. t�.w.l�i.6t l'—l! P Polity No.:;T1 o'�tl�`
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
molssection need not Is,completed if the permit 4 for ane hundred dollao(SI W)
tone)
I comfy,Net in the performance of the work for which this permit is issued.I shall not
employ any pens.in any mgnn`rtso ,come subject Ne Worlmos Compcnution
Laws of Cei forrylD to r Y
Applicant 5
NOTICE TO APPLICANT:If.after making title CeniRate of Exemption.you should
hemm,subject to the Worker's Compensation provisions of the labor C.de,you must
.,O forthwith comply with such provisions or this permiuhall he deemed revoked.
y'y CONSTRUCTION LENDING AGENCY
I hemby eRmm that them is a menstruation lending agency for the performance of
x > the wort for which this permit 4 issued(Sm.309'1.Civ.C.)
YQ Lender's Namc
2 Lender's Address
J 0 1 cent that I hew mad this application and mm dust the abase Infra ollm"4
com et.I agree to comply with dl city and county ordiunm and some dew relating to
building convection,and hereby Authodm mitres onatim.(this city to enter upon the
above-mentioned property for inspection purpaae:
.w (We)agree to sew,indemnify and keep harmless me City of Cupertled against
y Iiebllitinjudgmeme.coN And espouses which may in any ray Remo ag mstsud City
..j Z in consequence of the gmnting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 9 �
Re-roofs
HAZARDOUS
Signature of ApplicaDam
HAURDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or( uni building oaupmt atom or handle,handle, u m
haeardoemdal
A,defined by the Cupertino Municipal Code.Captor 9.12.and the Health and Safety
Odc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes poo
Will the applicant or future Wilding=upon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hvardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
strict? y('
❑Yea L'I nu ,
I have mW the huardhmsmamr4b requirements underCMpmr 6.95 of the Califon440-1 -
.qoi
niaHealthhSafc,yCde,S==25505.25533aah25531.1understanddesifdo Wilding
doe no ntlyMwa ant Nu it 4 my responsibility m wtify the mcupmt of Ne on which mdpsianuiuumccofaCeniRcateofCcu a�X Signature pplicant Date
Owner or au then AgentDa¢ All roof coverings to be Class"B"or better
Community Development Department
Building Division
j z City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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 complywith the above stated policy on re-roofing.
Homeowner's Name: 1'e 4 -1 Z`^{� -/��CQs H 6-A
Job Site Address: / 01�q V `IC��S L C,-�c (�
Roofing Company Name:
A plicant's Signature: Date: � 6 0
• Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO0
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# _ Date: /
Building Address: )31 q�
Owner's Name A� D� Phone#:
Contractor: _ C��'C.' Pon #: License#:
(—boe- s�t�,U�s a�� 3o
Contact: w Phone#: J Cupertino Business License#:
a�
Type of Roof Covering:
Existing: Proposed:
Cl Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles { ❑ Wood Shingles
0A Other(Specify) Ce'"l`� C ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed O Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: I t
tro I /C(J Sflu i
Residential/IrlCommercial ❑
Confirmed with Planning Dept. if
Fire Zone: Yes 0 No/ there are anre tctions: Lf
Cost of Proj ype of n ton: Occupancy
Qty. if
AoaWe 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