05070037 (2) PERMIT
OF CUPERTINO :� s . 3T
BUILDING DIVISION PFRT CONTRACTOR�INF®RMATION:
BUILDING AOOREss: FOUR SEASONS ROOFING PERMIT
N%5070037
10151 V
OWNER'SNAME: PERMTTLSUEDATE
JOHN E MASEGIAN 502 HORNING ST 07/06/200r,
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECTXNGINEER: BUTT ING PERMITINFO
BLDGma
f ELECT PLUMB MECH
�Oo LICENSED CONTRACTOR'S DECLARATION I'. _ f I�-. I F�
m❑ I krmy affirm Nat 1 ren licensed under provisions of Chapter 9(commencing Job Desc'r'ipti'o'n' �.�- _
IW with Sation 7(Mquf Division 3 of NC Busincot and Profession Codc,and mylimnu is ...n s-_a
Min full forte and en _ x -721 GX REROOF W/SHINGLES _
Lare Clav LiL N 4 `�.�/
nF� Dhow CO.".., NG 7 2U05
ARCHITECTS DECLARATION
-r 1 understand my plans shall W used u public records '`ry'
%03 Licensed Professional LJ s�� LC.L�V��q
M G
v't
OWNER-BUILDER DECLARATION
I hreaso affirm that 1 I. ucmpl from dr Cantramoo License law for the
p0O
following reason.Permit
1(131.5,Buimr. and Pmfrsvions Code:Any cry or moody
K LL wnl,M1tits a.es ae..k.to construct.alllicutt forsum.dcm.if1.Ne.sig my edsWemm
Lmi priormia issuance.also uquiru the applicant for such permiuo filcasigruJsaumem
< that he is licensed pursuant mdue provisions ofthe Contractors Lianselaw(CheperY Sq. Ft. Floor Area Valuation
y (commencing with Section 7")of Division 3 of the B usiness and Profusions Code)or
y $
that he IS exempt therefrom and the basis for lk alleged exemption.Any vlohdon of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of 3 WITRa3Fl 0 Occupancy Type
not more Nan five hundred dollars(55001.
❑Luownerofdepropray, mss mtiploycnsor offs oa rWe(s .7W.Busirusts
will do Newark end Ne swmum is not intended or a w do far sale(Sec.1064,Business
and property
who bis Codc:The Improves
durmts red who law data oat apply lf an owner of Required Inspections
properly who builds or improvesch improvements
and who am not intended
nt work or offered
his -
hOwnow cmployeuiprovided that such improvements see not imn Of completion,
m leered for tale.If.
however,Nebuildingor err of pntemivat within one year ofcompletion,Neowner-
builder will haw Uw WMen of proving that k did rot Wild or improve fm purpose of _
sola.).
❑I.as Owner of dte propcny.am exclusively conuecting with licensed contractors to
construct One project(Sce 10ae,Business and Pmfessiou Code:)The Conf acurh U
cense law docs not apply to an owner of property who Wilds or improve thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Conactale
License law.
❑1 am exempt antler Sec. .B&P C for this recon
Owner Dal
WORKER'S COMPENSATION DECLARATION
1 hereby milon under penahy of perjury one of the following declarations:
7:.L,k
have and will maintain a Certificate of Consent a self-insure for WorkefaCompen-
n,u provided for by Seedon 3700 of the labor Codc,fm the performance of the
for which Nis permit u issued.have and will maintain Worker's Compcnsauon Insurance.u rryuired by Section
of Ne tabor Code,for the performance of Ne work for which Nis pemtit is issued.
Wthcrs Cnmpensauon lnsumnce ca cr antl Policy numheram:
cr: ./xlwav ee s-apolicy No:�C��I — 02 U00�
CERTIFICATE OF EKEM MON FROM WORKERS'
O a�f;L^COMPENSATION INSURANCE
gOlussection need not k completed lithe permit is for one hundred dollars(SIM) _
or less.)
1 certify thm in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so u to become subject to the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making Nis CcniOcatc of Esemplion,you should
bttome subject In the Worker's Compensation provisions of the labor Coda you mum
.JO fodviN comply with such provision or this permit mail W deemed revoked.
Z— CONSTRUCTION LENDING AGENCY
'[•s I hereby alarm that utero is a construction lending agency for the Performance of
a 5do,work for which this permit is issued(Sec.3197,Co.C.)
0. a Lender's Name ,
Z Lender's Addreas ,
U C 1 certify Onto I have road Nis application arta show that Ne above information is
D.f"' correct.I agree to comply with all city and county ordinances and sou laws relating to
pU building construction.and hereby authorise representatives of this city to enter upon de
�W akve-mentioned properly for iupecuon s
purpose
0. (We)agree to save,indemnify and keep harmless the City of Cupertino against
H rn liabilities.judgmcros,casts and expenses which may in any way ascruc against said City
U Z to conam,nam of the granting of Nis rmik
APPLICANT UNDERSTANDS COMPLY WITH ALL NON-POINT Issued by: Date 7—G- , -
SOURCEREGU MONS.
Re-roofs t~
Signature of Appl anUConuoctor Data
HAZARDOUS h rXTdIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupanumm or handle hmallous material
u defined by the Cupenirw Municipal Cork,Chapter 9.12.and the Health and Safety
,giCodc,Seaton 2ss32(a)? All roofs shall be inspected prior to any roofing material being installed.
,ca
Will the applicant or future Willing Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it lu mous it Ionamin Is u dcfiood by the Bay Area Air Quality Management all new materials for inspection.
isuict7
❑Yes
Ihave wadthol,See usmaurialsmy and25hums unuc ndmated thatithe Califon-
nice Noalth&Svfct!theta See 1r �d25s under hapurthaz011e Wilding Ckl
uses not curet sun Na smy ronhifIIy to and ly the oacupent of the
myuimmc wnichmu mctpri rwissuanccor.CeruficateofOccu ancy. Signa[ pplicant Date
-lar All roof&erings to be Class "B" or better
Ownm or amhomed agent Date
_ Community Development
10300 Torre Avenue
S Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
UPEI�TINO
Building Department
JOB AD S: / PERMIT # n �G 03-?_1015 he 1A A0
OWNER'S NAME: &/ `& 191 — PHONE # V
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: ,
Signature Date
Please check applicable subcontractor and com Tete the followin 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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF 773
Telephone: (408)'777-3228
U��k—'�O Fax: (408)7333
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 witfiout first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspectiion•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: zA Ll
Job Site Address: �Jr� I ✓
Roofing Company Name: t!.
Applicant's Signature: Date: OS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
«�- REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Y 336 z 74 -6s--
Building Ad ss:
A91 / u 2 .
Owner's Name: Phone #:
„/ e S,6Z
Co ctor: Phone #: License #:
terg < L /O
Contact: Phon Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
q.—Wood Shingles ❑ Wood Shingles
¢?Other(Specify) e< o ❑ 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:
W' Iqb Descriptio
E o .. — sfrr�/.t/�uJ 6® ,
Residential Zommercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Prc j' : nl Typ of Cos ction: 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