04070034 CITY OF CUPERTINO . .: .. .., �C�LINTRACTQR INk'URM/"W"',
i BUILDING DIVISION PERMIT ;
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO
' 10204 POTTERS RATM-T
OWNER'S NAME: PERMTTISSUEDATE
Alk DE ANZA OAKS 140A 64S HC)RNTN(- ST NE: SANITARY N0. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u p p LICENSED CONTRACTOR'S DECLARATION
�u pp 1 Immby affirm that 1 am licensed under provisions of Chapter 9(commencing O pion
Wwish Section700M.fDivision lards Business and Formulates Code,and my license is
^eiy
to oilforceandaffil �- REROOF SEP �f 2004
p�z License clasr Lic.p
Dam Cmanscmr —
y ARCHITECTSDEC A ON �e _'�®'
Y < 1 understand my plans shall he used as public mroMs
�ttiU
3 ten t; Licensed Prefcasi...I
■■■V/■■■
g NG
OWNER-BUILDER DECLARATION
M1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the
E 0 O fallowing reason.(Section 70313,Business and Professions Cade:Any city or County
$ which myuires a permit to Conswct,alter,improve,demolish,or repair any structure -- - --
ta< prior m its issuance.alae"idims the applicant for such Permit o rile a signed statement
that heislicensed pursuant tothe previsions ofthe ComiactursLeon.Law(Charm,9 Sq.Ft.Floor Area Valuation
1--� (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)or
y that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne optician to a civil penalty of 3 41J`N_gQ hbcr0 0 Occupancy Type
one mote than five hundred dollars($50)).
❑1,as owner of the property,m my employees with wages as Iheirsole compensation,
will do the work and Ne structure is not intended o,offered forselc(Sec.7044.Business Required Inspections
and Prof info ns Code:The Conuacto's License Law does not apply a e an owner of q P
propeny who builds orimp rem Means,and who does such work himselfor through his
awn employees,Provided Nmsuch improvements am not intended oroRemd for mic.If,
however.Ne building or improvement is sold within one you of completion.Ne owner-
builder will have Ne burden of proving Nes he did oat build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting wish licensed contractors to
coessmet the project(Sec.7044.Business and Perfusions Code:)The Contractor's Li.
came Law does not apply to an owner of property who builds or improves Nemmn,and
who contracts for such projects with acontmcsor(s)licensed pursuant M Ne Convuso's
License Law.
❑1 am exempt under Sea. ,B R P C for this means
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of Ne following declarations:
I haw,and will maintain a Cenificam of Consent to self-insum for Worker's Compere
a on,m provided for by Section 3700 of Ne Labor Code.far Ne performance of the
t work for which thio permit is issued.
have and will maintain Worker's Compensation Insurance,as exluimd by Section
7M film labor Coca,far Ne performance nitro work for which this permit is issued.
My Wo,lam'ss C�ompen.oil Ins nee carrier and Policy number am:
Cartier. f' W"'t Policy No. f_ O fi .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If the fermi)is formic hundred dollen(SIM)
or leas.)
1 certify Net in Ne performance of the week for which Nis permit is inroad.I shall nett
employ any person in any an `as co`e aubicct at Workers'CompensaGon
Laws of Califmni Cl
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you s ould
become subject to Ne Worker's Compensation previsions of Ne Labor Code,you must
Z formwish comply with such provisions or this parent shall he doomed revoked.
'Z O CONSTRUCTION LENDING AGENCY
[-� I hereby affirm Nat there is a construction lending agency for de performance of
C
the work for which this permit Is issued(Sec.3097,Civ.C.)
W�Q Under's Name
z Lender's Address
V 0 I cenify that I have read this application and mare that Ne above information is
F correct.1 agree to comply with all city and county ordinances and state laws raising so
QU building continuation,and hereby authorize mpremmmivu of this city m enter upon Ne
�a ahove.mentianed property for inspcedon purposes.
(We)agree to Cove,indemnify and keep harmless she City of Cupertino against
,Hy y liabilities,judgments,costs and expenses which may in any way acerae against mid City
U z '""P ooLlla'uuc';T'Olshe RST'gDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
8 CAT ON /
!1�
Re-roofs
Si stare of ApplicaData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or(Mune building Occupant.Chr 9.1 or a d M h ealth a material
as derived by the Cupertino Municipal Code.Chapter 9.13,and she Health end Safety
nu Section 35532(a)'
❑Yes Nu All roofs shall be inspected prior to any roofing material being installed.
Will its,applicant or future building omupanl use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haaardaus air contaminants as defined by the Day Area Air Quality Management all new materials for inspection.
District'
❑Yes
Ihave&Saf.t CW.,he SNnusmaa:rialsr533.dc55 4.1u d..=d.95 of lifoa 7-V /
iia Health&Sa(ctyCmc,Schou 35505.33533 and25534.1undcrsand Nmifdm her in
does not currently have a tenm4 Nat it is my responsibility to notify Ne occupant of Me
USL
met poor M,issuance of a Ccmficam of Oveupeney. Signature of Applicant Date
Owner or euthoriactl ogee 9 Da� All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OZo a 2,-5
OWNER'S NAME: PHONE # Z
GENERAL CONTRACTOR: r P FAX #
I am not using any subcontractor .
Signature Date
Please check applicable subcontractors and complete the following information:
61 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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
fCITY OF Fax: (408)777-3333
uPEkTINO
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
that
foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is requited to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowners Name: f�=�1 C��`'�Ab l S
job Site Address: L �7
Roofing Company Name: 7�S;d/ Q-®Sn , S fig
A pficanYls/S�ig�nature: Date:
\�l/4SU110U�t
Greg teel
Building Official
Revised 1/30/03
CITY OF CUPERTINO
i REROOF ° 7 b
CUcoolEINO PERMIT APPLICATION FORM
APN# 03 Date:
Building A ess:
Poa 0 9 Po -1 -s
Owner's Name: Phone#
e ✓� 12e ,1 ho��S Zbh �4+�+ OS * 6 C, — 6$S— 7
Contractor: Phone#: License#:
oar Gz'��-�,,•S ick; 7. 7 —rte�3v ?Z-
io
Contact: hone#: Cupertino Business License#:
ti ��v4-w� S - d•-t�3/�f
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles ' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O� Other(Specify) ❑ 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 rtino's Tear Off Policy:
Job Description:
Residential [ - Commercial Ti
Fire Zone: Yes ❑ No g — — Confirmed with Planning Dept. if
there are any restrictions: LLJJ
Cost of Project: Type of Construction: Occupancy group:
Qty '
A tca a Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
ENERGY Fnergy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
2,6 Zl 6
,,5�