04070033 ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT.___r0R�INFORMATI
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BUILDINGADDRESS: FOUR SEASONS ROOFING PERMIT No04070033
OWNER'S NAME: PERMIT ISSUE DATE
D
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
0 0 0 0
Lop LICENSED CONTRACTORS DECLARATIOND Crl tion
u I hereby affirm that l am licensed under provisions of Chapter 9(commcneinglessNAL p
with Section 701X17 or Division 3af the Basin.and Pmfeasine Code,aed my lice-.Is
^ ? imfall roreeo-aoff
paeeNk. REROOF SEP �r 2004
j Licence u& L_"g Lk.N
F Dau Cunlrei55
A CHPIELTS DELLA ION
-r 1 uncensored my plans shall x used As public mcnres
S 15
u LkcnuJ Pmfcuinnel
yes
OWNER-BUILDERDECLARATION BUILDING
f r hereby.(firm that I t. exempt from the Cnmnnm's License Law car the
0 o which m moon.(Sado-71131.5,Business and improve,
derioli Code:Any city m many
$� which rtyuiru a permit m construct,alter,improw,dcmolieh.or ropair any awcwre
Fz< poor to its issuance,else patches tx applicant forsuch permit o file a signed sulemenl
thalhe is licensed imonanllo the provisions of the Cmentoma Leon.law(Chapter 9 Sq. Ft. Floor Area Valuation
heFG (commencing with Section 7000)or Division 3 of Ne Business and Profeuinm CMe)ur
Nal he u exempt therefrom and the basis for the aincged exemption.Any=of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of 3 442BTElt t®er0 0 Occupancy Type
not more than 0w hundred dollen(SSW),
0 1,as owner of the properly,or my employees with wages As their sole compensation,
will do the work and the atrectum is not inunded or offered for sale(See.7044,Business
and Prefeuioe Cade:The Carmine,License Law does not apply to an owner of Required Inspections
property who s,Amos improvech improvements
and who m euuch work Aim.har duough his
awn employee,provided the such impmwments are not inuedN mpletioraffered the Owner-
builder
the building or improvement is sand within ane year of completion,the oweor-
bsia.). will have the hurtle-of proving that he die not build or improw for purpose of
ole.).
0 1.as owner of ate Property,am exclusively convecting with licensed contractors to
construct He project(Sec.7044,Business and Professions Code:)lbs Canuacuri I.I.
came Taw does not apply to an owner of property who buinas or Improves Hereon,and,
who convects for such proh cls with a comr.to(s)limnxd pursuant to the Conuactar's
License Law,
0 l am exempt under Sm. ,B&P C for this reamn
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing deckratimu:
1 have and will maintain a Certificase of Consent o self-iaaum for WarkehCompbn-
7301W
inn,u provided for by Section 3700 of the labor Code,for the performance of the
rk for which this permit is iuuce.
I have and will maintain Worker's Compensation Insurance,as payuired by Section
of the labor Code,for Ju performance of du wwit for which this permit is issued.
yWorker'sCnmpewtian In nota-mire end PoI ey number art:
rrier. t1 M�,m Polity ROMWOKERS' (.Opp
ERTIFICO OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Oluaacmion need not x complcmd if Ix permit Is fnronc hunereddolhn(5100)
or lrss.)
1 certify Hat in the performance of the work for which His permit is issued,I shall not
employany peon in any mann"! as to esub{geatuthe wmtcns'Compensation
Laws of California.Da
Applicant -
NCTICETO APPLICA ,afar m.king this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions or the Isbor Code.you must
.JO
EroMwiH comply with such provisions or this permit&hall x doomedro Iced.
Z'-' CONSTRUCTION LENDING AGENCY
M I xrehy affirm Hat drove is a construe,inn lending agency for Um performance of
r�r the work for which Bola permit is issued(Sec.3097,Civ.C.)
al Lender's Name
0.5 z Lender's Address
U Q 1 mnify Hat 1 have mad His apidieation and sou Hal He elbow information is
lg [P Ganem.l agree in comply with all city and county ordinances and sum laws relating to
C V building convection,and hereby euthoom representative of this city to enter upon the
Na aImvememioncd property for iepemum purposes.
(We)agree to on.indemnify and keep harmless lx City or Cupertino against
uF'a cn liabilities,judgments,costs and expenses which may in any way accrue against saidCity
V z in eonsequcnce of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
j/8I0
( '" Re-'roofs
Sig cure a(ApplicaDO
rr DataHAZA
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building OccupantChapter
store or handle huardous
and Safety u de.See Section
the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
otic. Ely.
All roofs shall be inspected prior to any roofing material being installed.
❑Yrs �u
Will Ix applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it han olous air contaminants u dchned by the Bay Area Air Quality Management all new materials for inspection.
DiatricR
❑Yes �u
I have read the Wanders;materials Mquimmumm under Chapter 6.95 of the
nia Hrsith&Sat Joos 25505.25533.d25534.nundcnundcwifthexildiog I
des ever .m a un 4 Hat it u my mobility m notify 1M occupant
ma whin calx i"orianthiafeanman cemBeatsnramp,n Signature of Applicant Date
o�
owns m.athodaeasmt Dau All roof coverings to be Class "B" or better
,} Community Development
10300 Torre Avenue
n .' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOADDRESS: PERMIT#
fn N 9 << �G� �s ��� a
OWNER'S NAME: PHONE # _p 3 6
GENERAL CONTRACTOR: f S ¢asoma 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
_oL
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEI,TINO
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: 0, v-,S 0 L-5iA y\
Job Site Address: f (] � Vpb -rA-C—'_- S b� t
Roofing Company Name: Gc i rr S
A plicant's Signature r -----Date: ,_'0`/
l� \A/QSINO�Jct
Greglel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF o `( c> 7c, 03-3
CUPERTiNO PERMIT APPLICATION FORM
Date:
APN# 2 3 S-- v O z� 6
Building Address:
Owner's Name: S Phone#
ck-c �es3 -
Contractor: Phone M License
D✓/i" `mow /fex� q7ZA09
Contact hone#: Cupertino Business License#:
Type of Roof Covering:
E)dsting- Proposed:
❑ Built-Up Roof ❑ Built-up roof
❑ Asphalt Shingles QW�—Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles (3 Wood Shingles
!)f Other(Specify) ❑ 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 rtino's Tear Off Pofic .
Job Description:
Residential ®..^ Commercial 0
Fire Zone: Yes ❑ No Confirmed with Planning lfft if
there are an restrictions:
u
Cost of Project Type of Construction: Occupancy group::
V22e-)C>
Qty--if
A l; a Fee ID Fee Description Fee Group
BPERNTEE Bldg Permit Fees BUILDING
BENERGY Bnergy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEM4 HCOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING