03060060 (2) CITY OF CUPERTINO � ` ' ' "
BUILDING DIVISION PERMIT i COW1UCTQR I1 '.aR�VIAT,I ;N .;
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO.03060060
1
OWNER'S NAME: 645 HORNING ST "I /'06/2003
ME' (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 o p LICENSED CONTRACTOR'S DECLARATION
f 1 hemhy eRirenNat 1 am Ikmnsed under vhd of Chapter 9(cewom.I.g Job D§4�tion ^, T
n� wide m]O(10)ol DivWan 7 of Um euencu 1'rofeuons Cade,ud mYiiceue is N
intuit ardeff
L n�A, t, a.IG REROOF
tt-- JUL 0 3 2003
`p u ARCHIIECIB DE CLX ATION
G�a+ Iurkewnd my pWU Nell Ee used As public records
5� BUILDING
Licensed Professional
OWNER-BUILDER from
DECLARATION
1 hemhy,(Oto on I am eaempt from Ne Committees r'a Lkcnse law for the
p o which as moon.Permit in
8171.3,Business and us.do Professions Code:My city or county
S$ which requiresa ,dwrecnft slur,nt for sPermit
ti file
e a sir anyaeement
Z'y^
prior ois.Mme,danrequires to etM applkant for suchpctoi's Ruse Luudsaumcnl
< that iace wideSewentmNcpmviviorm 3ofOn nuumrindProfssw(CNpur9 Sq. Ft. Floor Area $c}r8lg�jion
atheis(commencing wide genian]00 d the
basis
r the
al Business end on.Any vi Coca)oon or
of
diel he Ie attempt NCR(10111 Nd BC beeif(IX Ne allCged CMmpBOM1 Any V101adnn n(
Section 70313 by any applicant for•permit subjects the applicant to a civil penalty of 3 ARN N(IiBikr 0 0 Occupancy Type
not mom than Ow hundred dolkra(SSOr.
❑1.u ower of tiro puopaty,a my wployeu wide wgeu tieh anummpenswm,
will do the work.and decauunum Ism,NNnded mattered fIXde(Sec.7044.Butineu - jRj�eTQind Inspections
and Processional code:The CmerMmes Lienee Law does net apply m an owner of 307 - I NSULAT i V N p
property who builds IX improver Hereon.end who docs such work himself ver through his
own employee,provided that such improvements arc not Intended IXaBered forule.l4 601 - ROOF TEAR OFF
however,We Wilding or improvement Is mid within oro year of completion,the owner.
Wilda will haw the burden of proving NU M did not build or improw for purpose of 602 ROOF PLYWOOD NAIL
sake). 603 - ROOF BATTENS
❑1.as owner of the Property.Am exclusively co somm,with licensed conuMmre to
construct We project(Sec.7ad,Business and ProreWansCode:)The CmuacmrfLi. 604 - ROOF IN-PROGRESS
cause law dura not apply m an owner of property who Wilds or improv Neuron,and
who conuacu for such pmjcm wide a conuaaor(s)Iiceoed Famous ve the Conuuon's '
Lka"Law.
m
❑laeempt undo gee. .B Q PC car His recon
Owor Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Faulty of perjury one of He following declaration:
1 have end will maintain•Certificate of Conant m self-insum(IX WorkeYsCeopen-
70371W1,
on,u provided fIX by Sado.370E of the labor Cade,for the performance of the
k for which this permit is Issued.
1 ban end will mainWn Worker's Compenstion Tnsuranco,u required by Schon
of the labor Code,for Ne performance of ds work car which Nis permit is issued.
WorteJpC RequuIr�usutarra 'eandPoOq nuf2=u c,O�(�,)) CER7 FIFICATEE OF E%EMPHON FROM WORKERS*
COMPENSATION INSURANCE
This sectim read ran he completed if Ne p:rmh is fosse hodicd dollar($100)
or leu)
I certify that in the performance of dee work for which this permit b issued,I Nall not
employ any pence In any manncr a u to becamesubject to the Workers'Compensatlon
Laws of California.Dau -
Applienl
NOTICE TO APPLICANT.If,After making this Certificate of Ssemption,you should
become subject ne the Worker's Compensation provision,of dm IaMu Code,you most
=0M
fowo Nram
itd comply with such provisions this Permit all W da reverad.
�'.rynCONSTRUCTION LENDING AGENCY
I hemhy ARrm the there is conaructim lending ag=my for the pmformamm of
the work(ur which this permit is iuwd(Sm.3W],Civ.C.)
Y A Lender's Nurse
=z Lender's Addmm
:.)Q 1 cenify that I have mad this application cad mm that the above information is
;^ cones.I agree to comply with all city and county ordinates and sou laws relating to
SU' building conwuNon.and hereby authorial representatives of Nle city to mw upon plc
W above-mentioned property for Inspection purposes.
(We)slime ce use.indemnify and keep humleu the City of Cupertino against
y liabil.dmjudgmenu,ceuandexpeuawhich may In anywayammalAins aid City
U4 nnPPnse mnceuNNegram. DS Aof ND WILL WILL COMPLY WITH ALL NON-POINT Issued by: Date
6 23 Fi S R G
Re-roofs
ignuureaf Appu onwctmam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will du applicant or forum building aecupantatom m Woulle Waardous material
As dcftned by dee Cupertino Municipal Code,Chanter 9.12,and the Health and Safety
ods.SalWill plc applicant or(alum Wilding comment use equipment IX deoom xss7z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye 1-]No
It If a roof is installed without first obtaining an inspection,I agree to remove
vices which
it'darardnus air cmuminanu u declined by the Bay Ams Air Quality Management - all new materials for inspection.
i
❑Yca C]No `.1
I have mad the hundms materials requimm=nts under Chaser 6.95 of the Califor.
I.HelN 85afcryCme,Sees J05.25577 and 715N.l wederoa tiro if tis Wilding
does n0ec h
ave it k my respoulbility reify du=upmu of Ne C
mWilmcnu h. prior In Issuance of a CemOcau a pan Signature of Applicant Date
Owner IX.athad ,k D G All roof coverings to be Class"B" or better
F
Community Development Department
a' Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U �I{/� Fax: (408)777-3333
CPEkTIBuilding 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 Y4"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: I✓r 44 2 Lt S 4 04,
Job Site Address:
Roofing Company Name: ro�'r sS o-,S rzoo C
AplicanYs Signature: Date: 663)
IAJ��tA1DLJ�
Greg eel
Building Official
Revised 1/30/03
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 — _ Date: /
Building Address: b
lolb7 C a� �•Pr� e
Owner's Name: Phone M.
Contractor: Phone#: License#:
FOt�r Seg-Sins f���>;,�a oZ7g— �3�t� l4)a2L09
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) C42'^4 6wo�_ ❑ 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 ertino's Tear Off Policy: iff
Job Description:
I t-w• o(,� �� ,5 �.-ty ►(a` tp! 301_ 6 �et+ �i L. s eyy�e�
Residential Commercial ❑
Fire Zone: Yes ❑ No E— Confirmed with Planni a t. if
there are anyres • ons:
Cost of Proj�rt: Type o n ction: n Occupancy gro
_�tbb 1i a—roo
Qty. if
Applieab)p 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
9- 77. 5