05060225 (2) I CITY OF CUPERTINO zr ,,., a• .a z�`: .w x +^.
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,;
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT14%5060225
- 10141 FIRWOOD DR
W NER'S NAME: PERMIT ISSUE DATE
SIMA DUTT 502 HORNING ST 06/30/2005
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED COhn RACTOWS DECLARATION t�
M C 1 hemby affirm that I am licensed under provisions of Chapter 9(commencing lob Des"c�iptionl Fl r
$p+ with Section 70X1())ofDivision 3 ordse Business and Professions Code.and my license is
iafI]f all (f �y REROOF W/SHINGLES U
LicenxClu LIc.M U �;�- AIT'LL-�
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Dam
O O
EnDECLARATION
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ARCHITECTS DECLARATION !-( •'77/ ZDandmy planashall W usedas public records rrJ
re ,1 undersa �
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u LiLC11SCJ PNfCttinnal t�7 ry
o
3 OWNER-BUIIDE0.DECLARATION II + r 1
.�00 1 hereby.Rent Nal 1 1. exempt from sbe Contractors rte License Law for the rl „i I
p 0O following aazon.(Section]In 1.5,Busincs and Rofetio+ts COJc:Any city or county L'
NO! which mgYlrei a pCmdt to cons+met,abet,Improw,dmnOl Lfh,or repair my aWCWm $6000
prior to its issuance,also acquires the applicant for such mamilto file a signed sotcmcnt
0� that he is licensed pursuant to tire provisions of the Contractors License Law(Chapter9 Sq.Ft. Floor Area Valuation
,rn (commencing with Section 7IX)0)of Division 3 of the Business and Professi�nsCMe)ur
E. $ that he u exempt therefrom and Ne bssu for the alleged exemption.Any violation o!
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of er Occupancy Type
not more than five hundred dollars(5500). P Y YP
O I,as owner of the pmpeny,or my employees with wages as Jets sale compensation,
will do the wortand the swemm is not in+mwad ormTetw longue(Scc.Toa,Business Required Inspections
and PmAssaz
iov Code:The Canuarestse
,LicLaw does tro
ot apply in a owner or q P
Property who Wilds orimpara s Ihemon,and whodaa such work himself or drought his
Own employees,provided that such improvements..at intended mo0emd forvle.IL
however,the Wilding or improvement i,sold within one year of completion,Ne owner-
builder will have Ne burden of proving that he did not Wild or improve for pu,pose of
aalc.).
❑has owner of the property,Ma exclusively emou ne ing with licensed cavus cums to
consumer the pmjcct(Sec.7(04,Business and Professions Code)The Catornm nies Li-
cense Law does not apply w an owner of property who lou da or impmws thereon,and
who contracts for such pmjecm with aconuactor(s)licensed pursuant in the Conuacmrs
Liecom LE
❑l am Exempt nder Sce .B&P C for this+eawn
Owner base
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury me of the following declarations:
s I have and will maintain a Ccoifcale of Cement to sel6insm,for Workers Conifer.
sation,as pravided for by Section 37W of the LSWr Code,for the performance of the
work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance.as equired by Section
37W of NC lobar Code,for the pearro mec of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy nu Wr am:vi
Cartier. Q' V —_ Wicyrw: co-r61dAO OOl
CEWMI ( TEOFMEMPTIONFROMWORKERS'
•— COMPENSATION INSURANCE
�M T,-t
section need not Mcompleted if tie permit is for one hundred dollars($I00)
or Icsa.)
I cenify ON in she Performance of the work for which this permit is issued,l shall not
employ any person in any mannersn as to become subject o the Workers'Compensation
Isws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject to NC Worker'a Commosasion provisions of are ISWr Cade,you mug'
=IO foMwith comply with such provisions or Nsh
Cars Permit all be domed iewbed.
z� CONSTRUCTION LENDING AGENCY
[r Ihereby affirm that thele is a construction lending agency for the performance of
tai
the work far which this permit is issued(Sec.3097,Civ,C.)
W 0 Lenders Name
lY ICom,s Address
az
U Q 1 cenify Nal 1 have read this application and stsm that she above information is
It, P correct.I agree to comply with all city and county on inartaa and sole laws relating in
0U building construction,and hereby amhoria mprexmgises dithis city to enler upon Ne
above-mentioned propony for inspection purposes
f, py (We)agree to save,indemnify and keep harmless the City of Cupenino against
Ig liabilidea,judgments,costs and expenses which may in any way accrue against acid City
U z sAnPPLLICANT of Or OEgrantrng Ofthis
A+ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE IS
_ G/�a 4-r' Re-roofs
Sign of AppmanV nus or Dale
OUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future Wilding cmcup,nt store or handle ha mous material
EELu defined by the Cupertino Municipal Cade,Chapter 9.12,and the Hcalth and Safety
Dile,arion25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Ye
Will the applicant ha.um,.,OngOccupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus airconcominants Jcfncdbytho Bay Area Air Quality Managnmenr all new materials for inspection.
Vicl7
❑Yes -
I have read the hero us materials requirements under Chapter 695 oftheCalifor-
niaHcalth&Sales CodC,SCCJ 33and25534.1 undersand thazlrthc WilJin
does nos cu y ave a that it u my respomihility m nosily Je occupant of the O J a/ `b/�+
reyuimor awh' Ipriormissuance ofaCcrtifcaeaftkcup,ncy. Slg eofApplican Date
v - Owncrorauthorircdagcn( ate roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
L Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building Department
JOB ADDRESS: / PERMIT # G G a —Z
O/� / FlAIL/OOC� G�
OWNER'S NAME: c5nit PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors.'/
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
t Building Division
f1111VVV\ City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
LU P E_ Fax: (408) 777-3333
,'j\�! 'N 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 withthe
/above stated policy on re-roofing.
Homeowner's Name: i3iAAAf//
Job Site Address: /0/`// Fleklooc!
Roofing Company Name: cle &_F4 ,/ leo 64"-r Z,C.
rr Applicant's Signature: Date: 61,-46-0s.—
l�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
C��, CITY OF CUPERTINO s
dr- REX OOF tscS
CUPERTINO PERMIT APPLICATION FORM 4o-!/
APN # Date:
5 Yz 336 ZF, - ,2
-OS-
Building Address:
o. (c/
Owner's Name: Phone#:
3,�nA4 '011116
C tractor: Phone #:,Y40 License #:L17Z1 o8
sLZ; (i9So.✓s it o o 7_7 6 -0?3 m
Co aqt Phone#:`AP Cupertino Business License #:
0 2 78-o3�a
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Ell Wood Shingles El Wood Shingles
Other(Specify)6 X! ❑ 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:
Residential-67 Commercial ❑
Fire Zone: Y7es ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type 9f Consttytption: Occupancy group:
6,006) e3
Qty. if
Applicable Fee ID Fee Description Fee Group
I 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 BliILDING