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03080012 CI'T'Y OF CUPEwrlNp BUILDING DIVISION PERMIT 4CONTRACTOWINFORMATION: . w BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT N(b3O8OO12 872 ROSE BLOSSOM DR OWNER'S NAME: 645 HORNING ST PERMIT ISSUE DATE JORDAN HAZEL M Q8/04/2003 °NE: (408) 278-0330 SANITARY NO. CONTROL NO, ARCHM-CPENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 I00 LICENSEDCONTRACI'OR'SDECLARATION - IObDCSCFI Description i Z C I hereby affirm that 1 on licensed under provisions of Chapter 9(commencing P e<U with Section 7UlRpnr Division 3 mom Business and Professions Code,and my license is n n :Ln, icel In s nfulall andcffen k. LN REROOF FINALED _ eF Datc Consents ATiON L 1 undcraand my pla s shat M used asspuh public accord, AUG 12 2003 re. u. Licensed Professional 7 3 OWNER-BUILDERexemptDECLARATION ��I�'�Q Hi I hereby affir111 that 1 ore exempt from me Contractor's License Law for the H7 O following reason.(Section 7131.5,Business and Professions Codc:Any city or county <2 which requires a permit to construct,alter,improve,demolish,or repair any structure $8700 prior to its issuance.also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant o the provisions nfine Contmemri License U.(Chapter 9 Sq. Ft. Floor Area Valuation r�FC (commencing with Section700)mDivWml3 title.Busineseand Profesitim Code)ur $ ma he is exempt thctefmm and the basis for the alleged exemption.Any violation of 35904014 . 00 Section 7031.5 by any applicant for a Permit ubjects the applicant to a civil penalty of ApN NbO not mare men me hundred d.11... umer Occupancy ars($500). P Y Type ❑ 1,m owner of me property,or my employee with wages as their sole compensation, will do Ne work andlhesuocrum isnot intended or offered formic(Sec.7614,Business 3 05 — 11RANTEg��� and Professions Cade:The Conuacuri License Law does not apply to in owner of 307 - INSULA'IIVffd Inspections property who builds or improves thereon,and who d.essuch work homelier through his own employees,provided that such improvemcnu ere not Intended oroRered for side.If. 601 — ROOF TEAR OFF however,the building or improvement is sold within one year of completion.the owner. builder will have the burden of proving that be did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL "'e')' 603 - ROOF BATTENS ❑1.as owner of the property,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS construct the project(Sec.7044,Business and Professions Code:)The Cortmetori Lt came Law docs not apply to an owner of property who builds or int prow barren,and who committ for such pmjecu wi lh a eomosetor(s)licensed pursuant to the Contnclori _ Liccnm law. ❑ Ism exempt under Sec. ,B h P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury tree of me fallowing declarations: - 1 have and will maintain aCca ficam of Consent to self-inaum for Workers Compea- 7;C1111 .n,as provided for by Section 3700 of die Labor Cattle.for the performance of the e for which this pmmit is issued. I have and will maintain Workers Compensation Tamarac,as required by Section 0 of the Labor Cape.for me performance of the work for which this Permit is issued. Worker Co rest n surence nntierandPolicynunlberam: nter. T ✓ Policy FROM WORKERS aO CERT FICATROF COMPENSATION WORKERS' - COMPENSATIONINSURANCE , pTu section and not becompleted tribe far mil is fm one hundred dollars(SI W) nr less.) I.miry,that in the performance of the work for which this perms,is issued,l shall not employ any person in any manner so as us heeotic subject o the Workers Compcnsauon Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should Winona suhjeet to the Worker's Compensation provisions of be Labor Code,you must �,Z fanhwith comply with such Provisions or this permit&hall be deemed revoked. ZO CONSTRUCTION LENDING AGENCY 1 hereby affirm tha inert is a construction lending agency tar the perporaams of rho wuh for which this permit is issued(Sec.3097,Civ.C.) yQ Lcnter's Name 7 z Lcndre.Address L)O 1 certify that 1 have mad this application and sum that the shove information is (~ contact.1 agree to comply with all city and county ordinances and state laws relating to �U building construction,and hereby impactr,nPresenratives of his city to enter upon the 4 donw-mendiated property for inspection purposes (we)agree to rave,indemnify and keep historical the City of Cape.time against SIA himiliues.judgmenu.eosu and expenses which may in any way scent.against mid City Uz in consequen of me granting of this permit. APPLICA NDERSTA AND WILL COMPLY WITH A�I�sPDINT Issued by: Date SOURCE E LAI Re-roofs Signature of ApplicanVContnctor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant to,future building occupant atm.or handle hammer.material ="a" dcfmcd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety aleSection 25532(a)7 Ig N.No All roofs shall be inspected prior to any roofing material being installed. ❑Yes lWilt the applicant or future building accident use equipment or device which If a roof is installed-without first obtaining an inspection,I agree to remove It harardoe air cm urnimnu as defined by the Bay Arta Air Quality Management all new materials for Inspection. suin7 ❑Yes �Hu 1 have mad the hanalour materials requimmcnu under Chapter 6.95 of the Califor. 7reqnia H "A Safety Cale,Sections 25505.25533 and 35534.1 undcrsund mat ifthc buiding l esutnmcuncndy have a almostthat it is my responsibility to oul,IM rceupem of me uimmenu which must be met pour m issuance of a CCNficete of Occupancy, Signature of App cant Date . Owner or aulmewd agent Date All roof coverings to be Class "B" or better Community Development Department f Building Division /f City of Cupertino 10300 Torre Avenue L Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 UPERTINO 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: Job Site Address: (osSo ,L4 �A Roofing Company Name: 0-t& r/� s ► W ''_` VV vt A plicant's Signature: Date: � a Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 03 C'e o 'D/ Z wo REROOF CUPEkTINO PERMIT APPLICATION FORM APN # 35S-5 5S-e 0 •© l Date: � 03 Building Address:: 70� �L1S2 IO�fJVt4 d�1� Owner's Name: YPhone#: kK ✓vl�l( .JC��' Contractor: PA one#: License#: Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles A? Asphalt Shingles 0 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# if To be Removed ❑ Provide Mfgr.Installation Specs. . I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: iz- Job Description: �-- Residential Pv Commercial ❑ Fire Zone: Yes ❑ No JR Confirmed with Planning Dept. if there are an restrictions: LJ Cost of Projec � Type of Construction:, �^ ccupancy group: Qty. if Applicable 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 4 -2 v7°,3 R�1, 7qo