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03050088 (2) CITY OF CUPERTINO t s�n*�c a ," f�'1'`A _.'. BUILDING DIVISION PERMIT WTI BUIIAINO ADDRESS: - PPRMR NO. FOUR SEASONS ROOFING 03050088 o H: PERMIT ISSUE DATE 645 HORNING ST 05/20/2003 . 0 MvTNONY AND ANNIE SANITARY NO. CONTROL NO. (408) 278-0330 CHITECT2NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 30 j LICENSED CONTRACTORS DECLARATION O O O 1 hereby affirm Net 1 am licensed under provision of Chapter 9(commencing Joh.D (Ip tj?(1 Ig p��p ^� with Section? of Iviaion7of the BudneaAnd Profeuians Code,mdmyliecnmLLus-N9�`91ri L 0 in full forte endo Lkenw Clue �3 Lk.N Dau Contractor -- REROOF JUN 1 O 2003 S ROHITELTS DECLA A 1 undosiend my plans shell be cud u public record& 5g�] Licensed Professional BUILDING OWNER-BUILDHR DECLARATION i Y 1 hereby affirm that I em exempt from the Coereerors License Lew for the yO O fallowing Professions;ason.(Sudan 7031.5.Business and Professions; Any city or county d$2 which requires a permit m cnnsuun,Alar,improve,demolish,or repair any strourt S^ prior in its issuance.aim acquires the Applicant for such Permit to rile a signed susment 2�Fp< Net he is licensed purmant to the Provisions of tha Contractor',Linen=Law(Chapter 9 Sq. Ft.Floor Area $Valuation Ij O (commencing with Section 7000)of DM%Ion 3 of the Business And Professions Cook)or 4000 e Nat be a exempt therefrom and the basis for No alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to•civil penalty ofppppmI�L�I] .at roam 6.fl.hundred dollars 4500). 3 4'd41 dnl�er 0 0 Occupancy Type ❑I,As owner ofthe property,or my=ploy=with wages As their solecompensation, will do Newark and the n otc me u maimended mortared Bostic,(Sec.7011,BWneu end Prof^tenant Cade:The Commerce,Llttme Law does not Apply to an owner of 305 - FRAME Required Inspections property who buhdsmimpnevca menan,and who des.ach wokhouselfordmough his 307 - INSULATION own employee,provided that such Improvements Am not intended molfaned forsam.If. however.the building or Improvement Is mid within am year ofeompution,the owner. 601 — ROOF TEAR OFF builder will have the burden of proving that bu did no build or improve for purpose of 602 — ROOF PLYWOOD NAIL ❑1,As owner of the property.am exclusively contracting MN licensed emuanu.he 603 - ROOF BATTENS consumer the project(Sec.7044.Business and Profession,Cade:)The Contractors Li. 604 — ROOF IN—PROGRESS came law dons not Apply u an owner of property who builds or improves theamn,and who contracts for such pmjecu with a cw"ctor(O licensed pu.usnt in the Cashmere, Lienor law. ❑I Am exempt under Sec, .B k PC for thLL noon Owner Data WORKER'S COMPENSATION DECLARATION I hereby a0'mn under penalty of perjury am of the following declarations: have and will maintain a Cnrdficau of Comm he self-insure for Worker,Compeer ' 13C., n,u provided for by Section 3700 of the labor Cade,far me performance of the k for which this permit LL issues. have end will maintain Workers Compensation Insurance,u required by Schon a.Nc labor Codc.for tin performance of Ne work fm which Nis permit a Wised. mkees peer's n Ino otrcaller end Policy n heier. t(.. Policy No.: CERTIFICATEOF J(EMPTION FROM WORKERS' COMPENSATION INSURANCE (This uetim ned not uncompleted I f Ne Permit Is far tune hundred dollars(SIM) Of total I cerOfy then I perfnananec of Ne work fo which this permit i,issued.l shell ma - emPIyany iso In ayarm up eco anbjeclm Ne Workcn'Campenution Iawsof Ce' rt•✓t � • f%•� Applicant NOTICE TO APPLICA .If,after making this collimate of Exemption,you should became subject to the worker',Compensation provLLum of the IaMw Code,you mot Oforthwith comply with such provisions or this perch shall be deemed netted. y rCONSTRUCTION LENDING AGENCY I hereby a1Rrc that then las concoction lending agency for the Performance of y > the work fer which this permit LL Issued(Sae.7097,Civ,C.) YQ lender's Name =x lenders Address ;)0 1 unify that I have reed Ni,Application And auk that the above Information Is F career I agree to comply with all city and county ordinances And use laws meting to V building construction,aha hereby authorise represenutim of Ni.city u enter upon me shove-meMoned property for Inspection pure m (We)agree he save,indemnify and keep harmless the City of Cupertino Against i h Ilabllitiu,judgmenu,cots and expenses which may In any way new against mid City L)7 in consequence of me&.ming of is Purcell. F7 APPLI UNDER, ND WILL COMPLY WITHAL NINT Issued by: Date SOUR E ULA77 `7 Re-roofs Sig urtal'Appliw memr�� HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occup.t Hwa or handle Incursions masted As defined by the Cupertino Municipal Code,Chapter 9.11.and the Health and Safety CodeAik .Section 255324)? All roofs shall be inspected prior to any roofing material being installed. Dyes ON. Will Nc applicant m future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove t ho.Nnus olr conuminmu As Jcfincd by the Bay Area Air Quality Management all new materials for inspection. vitt? ❑Yea VON. Iheve red mehnaNtms Wrequirements5534,1 rmmard.95 of the Glding D nLL Helm& cry CaM,Sydo U3,25533 and 233N.lunMraund lhulfmc building da.not ly hew tit A my msponallohly s nbufy do over t rt( require u ich dortoissuanceOfacertificateOfOccuan Signature Of lies t D e Owner er inamHAKuni Date All roof coverings to be Class"B"or better Community Development Department Building Division ell City of Cupertino 10300 Torre Avenue 4 CITY OF Telephone: (408)777-3228 U P E RT I N O Fax: (408) 777-3333 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: r^� job Site Address: a 3 0 y Cn Roofing Company Name: ✓ SoA,5 ll L)0 le h A plicanYs Signature: JJ( Yl! Date: S d ja j Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO , ' REROOF v3 "1 o • CUPEkTINO PERMIT APPLICATION FORM APN# '1, _ © Dat Building Address: Owner's Name: Phone#: Contractor: J° t� P one#: 7/ r License#: ot,.� 5e� sas ao& 7�1D� Contact:nn-- Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: Cl Built-Up Roof ❑ ,Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Id, Wood Shakes 0 Wood Shakes ❑ Wood Shingles 0 Wood Shingles ❑ Other(Specify) ❑ 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: Job Description: T O`er'�/� ( /1 W�.S•7.} I t Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed ng Dept. if there aV'any restric • LJ Cost of Project D) Type of Constru ti ' Occu ancy oup: Qty. if A ]i le 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 • ay�