05070155 (2) CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORATION
M„a ° Ya� _
BUILDINGADDRESS: FOUR SEASONS ROOFINGnµ PERMIT NO.O5070I55
OWNER'S NAME: PERMITLSSUEDATE
CORRINE DEVINE 502 HORNING
,yE: SANITARY NO, CONTROL NO.
(408) 278-0330
ARCHITECT,ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
0 0 0 0
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
i C 1 Comby affirm that I Am licensedde
under provisions of Chapter 9(commencing p
?Z� with Section]Cl of Division 3 of the Busimm,and Professinv Code.mul in,license is
°may in(ullParteandertecY��� k-A'}a%09 REMOVE EXISTING ROOF/INSTALL 30LB
j�2 Liccnu Cla (.i - Lic.p
Contractor FS0. A_T eve. FELT/40YR GAF ASPHALT SHINGLE
ARCIIITEC'S DECLARATION
I undersand my plans shall W used As public records
to U
Jo'
g u. Licensed Professional
OWNER-BUILDER DECLARATION
$ I hereby affirm Nal l am exempt from ftContractors License Law for abe
2 p o following reason.(Section 703 I.S.Business and P oicssians Code:Any city oT county
`e m which re4viwa A permit to consumer,alcor,improve.demolish,in mpzir-any urvaum
u aprior to its issuance,also requires the applicant for such permit to fix A signed sta¢mm
e
s< met heislicensed pursuant tothe powisiomofthe Contractors Lictrue aw(Chapter 9 Sq. Ft. Floor Area Valuati`� O O O
YFG (commencing with Section 7000)of Division Sof the Business and Professions Casae)or
i 3 Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects thc applicant o a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(stool.
34242026 . 00
❑6 the
work.
the pmseny,ser my cmnloyca oith wags a shev ses.7W.Business
ation,
and
Prole woes and Ne awmum is not intended License
sew ed dos not apply t oAn owner
of a -rt
and Professions Code:The Contractor's License Law dam not apply m Su owner of Requiretd�Inspections
own ertywnohuildaorimprat suthimprowmenu Aressuch work himueed for enix a a/{ / fes®
property
who builds
oridthmaucencon,and who arenminmnrk or himsBeretlforsale.is Y tffgw_
however,the building or improwmenere sold within one you of completion.the owner.
builder will have dm burden of proving Nat he did net build or improve for purpose or
We).
O h as owner of the property am exclusively contracting wish licensed contractors to
consumer be p ojem(Sec.7044,Business and Professors Cade)The Come con's Li.
cove law docs nor apply m an no,of property who Wilds or improves Norton,and
who contracts for such projects with a eonuamor(s)licensed pursuant to the Contractors
License law.
❑ 1 am exempt under Sec. .B&P C for this meson .. _... ... !f �
Owner - Dam
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury one of the following decorations:
❑1 have and will maintain a CeW Gram of Conserv to self-insure for Workers Compcm
sarion,As pmvided for by Secuon 3700 of the Labor Code,for Ne Performance of the
work for which Nis permit is issued.
axiidWn and will maintain Wudoe's Camiamoul n Insurance,a required by Section
700 of the labor Code,for the performance ofthe work for which this permit is issued. .
My Worker's CampemaIt Insunntt c.Lartiv end Policy number am:
Carrier: /tn, N.r'l •Policy No.: 4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Oldlaoxim need nor tecompleted if the permit is fmonc hundmd dollars(SLOB)
or Icss.)
1 cenifv Inst in the ps rmonance of dm work for which this Permit is issued,l shell not
employ any person in any manner sn m in become subject to the Workers Compensation
Laws of Califouia.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become Subject to the Worker Compcwuan provisions of Oc Labor Codc,you most
.JQ forthwith comply with such Provisions or this Permit shall te deemed revoked.
Z .rte. CONSTRUCTION LENDING AGENCY
(. 1 hereby affirm that there is a construction lending agency for the Performance of
a the work for which this permit is issued(Sec.WO.Civ.C.)
aQ Unit r:s Namc
z I.elldef a Address
O 0 1 certify that 1 basic mad shies application and Aram Our the about let...run is '
correct 1 agree to comply with all city and county oNin cA and Arne laws relating to
O V building construction,and hereby autherine mpraentNves of this city to enter upon she
abovcmentioncd property for inspection purposes
HG (Wx)agree to save,indemnify and keep harmless she City of Cupertino against
h
liabilities,judgments.costs and expenses which may in any way accmc against mid City
U z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE UQULATIONS.
Signmufe a Apph M �W Dam Re-roofs
HAZOpOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or fumm building occupant store or handle baralloos material
As defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,section zsslz(a)?
❑YG All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future Wilding occupant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
cunt hazardous air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection.
Distrito]
Ycx
I have mail the havardnusmamdals requirements under Chapter 6.95 of the Califor. <
nia Health&Safety Code,Sections 25505,15533 and x5534.1 undersand Nat iflW Wilding 2 6
dors not currently have a tenant that it u my responsibility to nouly drc arupant of the
require tornpriartoissaanceorAcutirteamort]cea aney. Signat eAl%A: plicae Dale
ow a,aumarn<dagem Date A11 r f c erings to be Class"B"or better
Community Development
'w 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS- / PERMIT #
101S2 p 6>167o! sA
OWNER'S NAME: JPHONE #
GENERAL CONTRACTOR FAX#
I am not using any subcontractors: e_.r
gnature Date
Please check applicable subcontractors and c m Tete the following ' 0 tion:
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
4as; City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
C U P S IST I N O
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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 comp.1y with the above
stated policy on re-roofing.
Homeowner's Name: O/.P�il/�l/F � �'/.t/'47
Job Site Address: c
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
3 of 5 PERMIT RECEIPT OPERATOR: suem •
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34242026.00
DATE ISSUED. . . . . . . : 07/26/2005
RECEIPT #. . . . . . . . . : 30508
REFERENCE ID # . . . : 05070155
SITE ADDRESS . . . . . : 10187 CAMBERLEY LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CORRINE DEVINE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2632
RECEIVED FROM . . . . : CARLOS CAZARES
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- ----------
BPERMFEE VALUATION 6,000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6,000.00 0.60 0.00 0.60 0.00
TOTAL PERMIT 126.96 0.00 126.96 0.00
CITY OF CUPERTINO
M I2EROO
*CUCMOF
PEkTINO PERMIT APPLICATION FORM
APN# Date:
34zy 7 z S-1 off
Building Addre s:
J6018
's Name: 0o,-r ; ., e D e� *^ e Phone#:
CZ
C acto Phon o8 License
.-'aw / 7?/&J)
Contact: Phone Cupertino Busin ss License #:
if -pr>0
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes / ❑ Wood Shakes
❑// —Wood Shingles
�C -�" LlWood Shingles
Vuther(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
id I Have Read, Understand and Will Com ly With Cu ertino's ear OfPolicy:
Job Description: �7 �Nf
idential ommercial ❑ 70
/� A
Fire Zone: Y6 ❑ N Confirmed with Planning Det. if
there are any restrictions: lJ
f Project: T ction: Occupancy 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