05060224 (2) CITY OF CUPERTINO ^q" .�ar «� '" '� • `•
BUILDING DIVISION PERMIT YCONTRACTORINFORMATION.'
BUILDING ADDRESS: FOUR SEASONS ROOFING pERM1TNO05060224
10121 FIRWOOD DR
OWNER'S NAME: PERMIT ISSUE DATE
41 hk ALBERTO BERSTEIN 502 HORNING ST 0 2005
113 NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
C,Z' LICENSED CONTRACTOR'S DECLARATION "' Cry n
FC 1 bemby affirm Nat 1 sm licensed under provisions o(CMp er 9(commencing Job DOSCIfhp_LOniw /, \
;zw with Section7d5BI of DivWon 3 ofd[Biuineuand Profrssirs Cads,and mylicevc is If v 11
in full forte and tiff -7
3qi LicenaOClus _ - Lie 0 � It 08
REROOF W/SHINGLES '' �'� '� •-�
e=� Da¢ Conlrectm
ARCHITECT'S DECLARATION /'♦ / 7t)�[
1 undersand my plans.hall k used az public rtcards
Jc.
3u, Licensed Professional f� (j 'pi '
0m3 OWNER-BUILDER DECLARATION t{
ZOO hereby.(firm on 1 am exempt from Nc f Contractor's mr's :License Law for tk fL}J\V;1 +
ZOO following massa Permit
t II1313,Business and wn,de um Cade:Any city tar counry u
K m which requires a issuance.also m earestruet,alter.imports,demolish,or C a sig any tatucwm 6 0 0 0
Ply that he is ensed sue mqo duee,r the vision[ant fon such C.rt ,.r'C Liecose taw(chapter
rn
that menccenudpuntion7 NcofDivioazofNC he
ndProflaonsCo 9 Sq.Ft. Floor Area Valuation
y l-C (commencing is.g wit therefrom and the
Division r O the Business and es.My
Cade)or
y�� Nap k u eumpl therefrom and tk buss far tk alleged eumppion.My violation of
Salon 7071.5 by any applicant for•permit subjects the epplicandto a civil penalty of 3A0T-%"or00 Occupancy Type
not mart than Eve hundred dolurs(5500).
0 I,az owner of the property,or my employee with wages as their sole compensation.
will do tk work and the structure is not intended in offered for sale(Sec.7044,Business
and Professuo"Code:The Canvactars License law does pat apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himeolf or through his
own employe.,provided Nal such improvements are not intended oraRered for sale.if.
however.the building or improvement is sold within one year of completion,On owner,
builder will have the Which of proving that k did net Wild or improve for purpose of
sak.).
0 1,as owner of Or prepeny,am exclusively contracting with licensed contractors to
construct the project(Sec.704,1,Business and professions Cade:)The Contractor's Li.
cense law dors not apply to an owner of property who Wilds or improm thereon,and.
who Comment for such projects with a contractor(.)licensed punuam to the Contractor's
License law.
O l oro exempt under sce. ,B&PC for thisOwner reason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of On following decimations:
1 hsve and will maintain a Certificate of Consent o ul6insure for Workers Compere
\�sation,u provided for by Section 7700 of Ne labor Code,for the performance of the
I for which this permit is issued.
ve and will maintain Worker Compensation Insurance,az requited by section
W.
Ne labor Code.for One performance of the work for which Nis permit is issued.
My Workers Com,mamion Insurance carrier and Policy number am:
Cartier. ¢pts Y G a s Policy No.:
1"w C �OyO Z. Udo`
O CERTIFICATE OF EXEMPTION FROM WORKERS' ?
COMPENSATION INSURANCE
A/�
rlTis�uctinnCis.ad not becompleted ifth Mood,isforture hundred dolln(51IXq
roles.)
1 Unify Nat in On performance of the work for which this permit is issued.I shall not
employ any person in any manner so ss to become subject to On Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cenifiate of Exemption,you should
become subject to the Worker's Compendemon provisions of the labor Code,you mus
.J O foMwl0 comply with such provisions an this Permit shall k dm
eeed or akcd.
ZN CONSTRUCTION LENDING AGENCY
[+ I hereby affirm Nap them u a construction lending agency for On performance of
xthe work(or which this permit is issued(sec.w;,1.Civ.C.)
W Q Lenders Name
m Lender's Address '
[)Q 1.nee Nap I ply read this application and sec¢Nat and
salve information
ng u
it,0 U carat 1 agree m comply with all city and county oNinances and sale laws relating to
pU abovengennswctlon,ard hereby auNotlaertpretenati es of this city to enter upon the .
D.1 a. (We)
nreproperty for inspection keep hs.
(We)agree to ave,indemnify and kith M1ay in m tk City n Cupertino a agmina
r N incoiseq judgments,Ongrauand expenses whirr may in any way accrue against said Ciry
C)z APPLICANTeUNDCRST mg of AINDoe�mYIIL¢L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE 10
Signaere of Applicam/Conlmcrh piRe-roofs
Gain
HAZARDOUS INS DISCLOSURE• I Type Of Roof
Will Ik applicant or future Wilding occupant store or handle havandous material
az defined by the Cupertino Municipal Code,Chapter 9.Iz,and the Health and Safety
tide. [3
enzss3z(a' ' All roofs shall be inspected prior to any roofing material being installed.
Tea
Will the applicantor foam Wilding occupant use,equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
/ nit harardnus air contaminants a defined b the Ba Arca Air alit Management Quality s all new materials for inspection.
District]
O Yet
I have mvl the hva nuld smaterials requirements under Chapter 6.95 of the Califor.
ria Health&Safety Cods,Secdum25N)5.25533 and25534.1 understand Nap if lk Wilding
deer not currently h moan it' pOmthilipy t0 nodl'y Ne occupant of the sJJ
reyuimmcni whjpp must m r�ui.e. /ofa Ccou con.17 c parser. Signatur Of IiC Date
!/� 6� 6a All roof coverings to be Class"B"or better
Owner tar amhorimd apcm am
s,,,,,t Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT b�—b
OWNER'S NAME: / e PHONE #
GENERAL CONTRACTOR ,Q�pso /FAX #
I am not using any subcontractors.(/ �(2 �,..z , .�,.c ..sem--- -o S'
Signature Date
Please check applicable subcontractors and complete the following information:
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
i
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
Q10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
OUPEkTINO
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 comply with the above stated policy on re-roofing.
Homeowner's Name: U/�.F6
Job Site Address: t� l FPKloo
Roofing Company Name: U
Applicant's Signature: Date: pJ�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF /
�CUPEICTINO PERMIT APPLICATION FORM
APN # Date:
3 z 376 9, � - —Q-5—
Building
Building Address:
Owner's Name: // Phone#:
Q k1A.1
Ctractor: Phone y°B License #:
A m ti X78=0�?0
=t Phone Cupertino Business License #:
Z79-0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ��yyC3Wood Shingles
Other(Specify)A""mwao�/ ❑ 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:
ob Descripiion: �o i �/ YOB SAF
Residential Commercial ❑
Fire Zone: Yes ❑ No JK_ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost f Project: T o o ction: Occupancy group:
1p Oo0
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
3c)t9-7