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03050121 (2) CITY OF CUPERTINO yX �"Al�' 110"A+11"`` BUILDING DIVISION PENT eCONTRAORINP99MA N : BUILDING ADDRESS: PERMIT NO. FOUR SEASONS ROOFING 03050121 91119 NAMC. PERMIT ISSUE DATE 645 HORNING ST 05/27/2003 '77A QA 74 NETIS HGA SANITARY NO. CONTROL NO. - (408) 278-0330 ARCHnELTIEtgGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MHCH 3000 LICENSED CONTRACTORS DECLARATION JobDep'guon 'v(iig i hereby aRnm that 1 un lice ual under pavisiou of Chapter 9(commencing < with Section 7")of Division 3 of We Business Bud Prefeuioot Code,and my license is M/� a I'LL® < in full tune and eReeL�-3 a I p .ry Ura tGm ; b Lkena a Lk.w ,.� REROOF Dau .t C q DECLARATION '] ARCHITECTS DECLARATION JUN I O 2OOJ f 1 understand my plans shall W used As public rtrnMa s Licensed Pmrcuional OWNER-BUILDER DECLARATION BUILDING t o F I hereby affirm that i 1 exempt from d r Comas Co e:Any c law for 1W p O following reran. emu A]0313,Business and n.de oli Cade:Any city s county 5$ which require,1"A a nes shin re Brancato,We alar.bnpmse,dmmolbh,m e a repair my avucnme -i 1" fWmaiuboance,ceanquins We applicant or fm Contramabta0les Law(Chapter < BnlhcalianadpulaantmNepnwisiounfdu:Conuaar'sl3analawlChapm9 Sq.F[.Floor Area $4a'�ITtion 0$ (commencing with Section TODD)m Division 3 of the Business and Professions Code)or that W b exempt therefrom and We basis fm the alleged eumPON.Any violadon of Section 70313 by any applicant for a permit subjects the applicant a a civil penally of �p�N"OF}� P y Type .at Hart than few hundred dolbn($500). 3 4'L^Y'1'UF0 0 ecu ane e ❑I,u own"of the pmpeny,m my cmploym wlw mages u deb ale compeautim. will do the work.and the structure is not nwrided or offered farsak(SAO.7044,Business 305 FRAME Required Inspections and Professlons Code:The Conuacmes Liana Law dors not apply a - e ns in owner at q P Property who Wildsorimpmves thesran.and whodoessuchwork himself arthrough his 307 — INSULATION own employees.provided that ash lmpmwmenu Are not Inured moReeed(maale.It. 6O1 — ROOF TEAR OFF however.the Wilding m improvement b ne sold within oyear of completion.thm e wwr- bullder will bow the burden of paving Wt he did nm build a improve fm purpose of 602 - ROOF PLYWOOD NAIL MuJ. ❑1,as owner of We property,an exclusively convacting with licensed conaa"on a 603 - ROOF BATTENS construct the project(Ses.7044.Business and professions Code:)The Gmnca l U. 604 — ROOF IN—PROGRESS sae Law does not apply to an owner or property who Wilds or improves douse.and, who convacu for such prujeeu with a contractor(s)licensed portion,to We Contractor's License Law. ❑1 am exempt under Sec. .B k P C far this mason Owner Dau ANIL WORKERS COMPENSATION DECLARATION 1 Wrtby si ran under penalty of perjury arc of the following deckrsWons: ' r Iluw and.1111. .I We.CenlOcau of consent a self-insurt fm W~. js Milan,u provided for by Section 3700 of the labor Code,for the performua of the work fm which this permit is bound. 1 haw and will maintain Worker's Compensation Insurance,As required by Scotian 00 of the labor Code.for the performance of the work for which this permit b Issued. My WorkeY Cn//mf�nMdol//"I��ssanna earoiu and Polley nfLL,miser Grokr. �`U. _� I�e+Ac� PoIIry NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Obb moria reed ant W completed If We remain b furarc hundreddollus(SI00) m ICU I sonify that bre the perfarrmem of the work fm which Who paranh b load.I shall am emPloyanY pe I., ��r /ukersuatW WorYen'Compewtian Lawsaf CabfO Ir 4--c.� NOTICE TO APIf, making this GniOcau orExemption,you should become me o the bootComiprovisions of done Labor Cnde,you muss JZforthwith comply with such previsions or this permit Mll W deemed rtvnked. z y CONSTRUCTION LENDING AGENCY (—i I hereby affma that dart Is a eonsumtla leadingagcacy,far the performance of 7the work for whichthus Permit Is Issued(Sea 3097.Civ.Q Q1.does Name O Z LeM es Add. U O I certify that I Mw read this application and sou NM the above infomudun is V. correct.1 agrte a comply with all city and county an inanas and sou tem misting in O SV' building convection,and hereby authodM mpesenuuws or this city to on I wr upon the 137 ahovo-menOaned property for inspection putlaar 6t (Wc)agree in an.indemnity and keep harmers the City of Cupertino against s y liabilities.judgmenu.cold.6 operates which may in any way&=me against old City U in consequence of the granting of his permit. APPLICANT UNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicamIXORMActim Dae HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the ,Copeapplicant or(Muni Wilding&,Chantnmemandth Health sd Safety al u deOnM by dte Cupertino Municipal Code,Chapter 9.11,and the Heslth and Safety Code,Section 15531()7 All roofs shall be inspected prior to any roofing material being installed. pYu WIII the applicant or future building Occupant Mee equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mil hasaous air caumianu As milacd by the Bay Arca Air Quality Managnmcnt all new materials for inspection. District? //�/�/ ❑Yu e. I have road the husrdasummumb requhmns nu under Chaps695 of the Glifw- ^� nb HMlthk SefetyCode,Senim1s75505.25533 and 25534.1 uniformed WW iNr Wilding does at PAINfly Tuve a unsot.OW It is my msperw Wity in adfy de Occupant of We V(„= aqui&nfmsh.=, orwinumm.faceWrimearomu Signature of Applicant Dae 'I All roof coverings to be Class"B"or better Owner or kutbom gen Dau Community Development Department Building Division ff City of Cupertino 10300 Torre Avenue OF Telephone: (408)777-3228 CITY C U P E k1 I N^ 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. 1 Homeowner's Name: Pry r I Job Site Address: Roofing Company Name: A plicant's Signature: Date:✓G iL `�3 C�ll�Sl/t10C.�� Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEI�TINO PERMIT APPLICATION FORM APN# Z Date: Building Address: © C7 0 n 0 &t`c1(.e_4 Eft' If 1Je �,t.�� tt Owner's Name: Phone#: i Contractor: �/n� one#: License#: �Duv $ ca1 S ► Lr� d -033 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 0 Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles Other(Specify) Ceri.u/v 4k ❑ Other(Specify) N7 Nber of existing coverings El 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: _ / c fL'Z ( czt/ 04V C2�u2 c!J � T` IJL5 kyr ` LS J4 cC to/� c Residential `®- Commercial ❑ Fire Zone: Yes ❑ No-JU Confirmed with Planning De t. if there are anrestrictio Cost of Type of C ti Occupancy group Qty. if ApphQble Fee ID Fee Description Fee Group BPERMFEE ldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING � Z