05070100 (2) CI'rY OF CUPERTINO > '�' '4� �•��' sA '.r '% �`"� " "
BUILDING DIVISION PERMIT COORINFORMATIQN
B UILDING ADDRESS: FOUR SEASONS ROOFING PERMIT Nod 5070100
W IR'SNAME: PERMIT ISSUE DATE
E:
SANITARY 0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION
�F❑ I hereby affirm shat I am licensed under provisions of Chapter 9(commencing Job.Deseription
W with Section 7")of Division 3 of the Business and Professions Code.and my license is jpj,',�. "�
SMZ mienrrr«a.ae t. yea/ok REROOF-REMOVE/APPLY ly/2(�PLY.WOOD 30LB FELT
;'q= License aloes tie.«
�rD Dam -o cantracmr ASPHALT SHINGLES
�'3 ARCHITECTS DECLARATION ba„y
I< 1 understand my plana shall W used u public records
is,
G l q $p
isC,
Licensed Professional
5 ._ OWNER-BUILDER DECLARATIONILD
.00 ' 1 hunch,lesso alum Nat 1 ore exempt from the Cssions o :License
yc Law for the tl
Kn0 which g.tu.n.(Secitt RDLS, t.sim.imrand Professions Coo.:Archly Or county „rtTn.
m which tits std a permit re consuiresrthe alkn improve h permit
t ri repair any struculd tatchoc
pastas itsiensedpa0ant 1.ms thevisima of for suchp en's item.rite a aw(Ch cmem �.aLay'I
ESD that he in licensed pursuant 70th.1 pm visions 3 theof
Conuumr'and Prulaw(CMpur9 Sq. Ft. Floor Area Yd �rl �Valuatd 000
in that(cohe s clary with t erefr m and the
Division r of tW m,ed Business and on.Amy
Curie)of R��Yl 4�
.y 3� that he u eumDt therefrom and the buts far Bu alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanus a civil penalty of APN Number Occupancy Type
not mom than Eve hundred dollars($500).
❑1.uowner ofthe pmprny,ar my employees with wagesu their sole mmpenutlon, 34242013 . 00
will do the work and the swnure is nos intended or offered forsake(Sec.]014.Busineas
and Profmaimel Cade:The Contractors License Law arcs not apply to an owner of Required Inspections
proper who Wildsorimpruves thereon,and who does such work himulf or through his
own employees,provided Nat such improvements are not intended or offered for sale.If.
however,the building"improvement is amid within one year of completion,the owner,
builder will have the burden of proving that W did not build or improve far purpose of
saki.).
0 I,as owner of the proper,am eaclusively contracting with licensed contractors in
construct Or pmjen(Sec.7004,Business and Prafimmons Code:)The Contrumr's Li
cents law does not apply to an owner of proper who Wilds or improves Wcreon,and
who contracts for such projects with a mrst acter(s)licensed pursmanuo Or,Convenors
Lima.Law.
I am eacmps under See. .B 6 P C far this mason
«r CodeWORKER'S COMPENSATION DECLARATION
1 hereby affirm under peaddly of perjury one.f the following declarstions:
Ehave and will maintain a C.ruOcase of Consent to self-insure for Worker's Compere
dI10,u provided for by Section 77W of the labor Code,for the performance of the
.,it for which this permit is issued.
have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the labor Code,for the performance of the work for which this permit is humid.
My Wormes Compensation I^nsurance eartin and Polity number am s�vas
Cartier.- A . k7•/^ Policy No.: I _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This account int not Iccanpleted if tie permit is Toronto hundred dollars(21Ia1)
or less.)
I cenify Nat in the performance of the work for which this permit is issued,I shall nut
employ any person in any manner so at to Wmme subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificae of Eacmpli.n,you should
become mbjcct W the Worker's Compensation previsions of the labor Code,you must
forthwith comply with such provisions m Nis Permit hat]W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-+� I bereby affirm that thea is a construction lending agency lot the perfurmanm of
W 7 We work far which this permit is issued(Site.3097.Civ.C.)
W Q Lender's Name
D+
D derLen 's Address
U.Q I"out,ee that I have read all
application and sure Nes Ne above infm fisting is
W f-' cortin.l agree ct comply with hereby city and county nNin.n«s and cute laws relating to
Q O Wiwc-rocansvunion.end mauthon porpoises.reti.ss of Nis cirymcnmr upon the
�CL above"(We)aed as inivy for impaction
mnify mad keep
(Wit)ague m v«,indemnify asM kith hay in an On w City o Cupcnst s against
F•'N inconst,,judgmentsecoarsing expenses which may in any way accrue against said Ci
tJ z APPLI ANT of We RSTgranting of this permit.
^� APPLICANT UN RSTANDS AILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R AT�t�i.
�� 'Dam Re-roofs
Stgnawre of Appkor bntruwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant arum or handle hLJrdWs material
u d.fined by the Commando.Municipal Code.Chapter 9.13.and the Health and Safny
de.Sectio.25532(0/7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes lf--9U
Will the applicant or future building occupant use equipment or devices whicM1 If a roof is installed without first obtaining an inspection,I agree to remove
.mit haeardous air contaminants u dcOned by the Bay Arca Air Quality Management all new materials for inspection.
District?
Q yes
1 have read the hazardous materials mquiremcnts mulcr Chapter 6.95 of the Caiifor t1
nice Health kSafcty Codc,S«dans 253U5.2myresponsibility
espk2553d.1 understand!ths,=up Wilding - /Q ,-0�—
dtsea not c aye a t. L th my uh ora CcriY ic notify tic occupant of We
- uquiumc ichm m norm s<aan«rncemfreareofamparey. Signature of Applicant Date
• owner rr aathrnved ascot Dam AI roof coverings to be Class"B"or better
CITY OF CUPERTINO
9m 2 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34242013.00
DATE ISSUED. . . . . . . : 07/18/2005
RECEIPT #. . . . . . . . . : 30406
REFERENCE ID # . . . : 05070100
SITE ADDRESS . . . . . : 10246 CAMBERLEY LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GEANNIE MARY HANSE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2633
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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 253.92 VISA
TOTAL RECEIPT 253.92
F - Community Development
10300 Torre Avenue
/ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
J B DTA ES / PERMTr #
D S-rT?0O U
OWNER'S NAME: .r _ PJJONE #
GENERAL CONTRALTO AX #
I am not using any subcontractors: /
Signaf9e Date
Please check applicable subcontractors and com l&e the followinginformation
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
® Linoleum/ Wood
Glass / Glazing
r
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
low
Owner/Contractor Signature Date
Community Development Department
Building Division
SI® City of Cupertino 10300 Torre Avenue
CITY OF` Telephone: (408)777-3228
Fax: (408)777-3333
CUPEIITIN®
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
y 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 comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Sife Address:
Roofing Company Name:
Applicant's Signature: Date: 7�S:C��
® Greg Casteel
Building Official
Revised 17/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CITY OF
CUPERjIN0 PERMIT APPLICATION FORM c/2SD
APN# Date:
Building A ress
ner's Naxne Phone #:
ractor: Phone #: License:
/
t: n5K' : F�J Cupertino Businessicense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles KAsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles 12 ❑ Wood Shingles
Other(Specify) t3_Other(Specify)I ,
Number of existing coverings U Provide I.C.B.O. Repon u
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and ill Comply With Cupertino' Tear Off Policy..?
Desert tion:
10 1
Residential mercial ❑. _
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pro Typ C ru 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