03060057 (2) CITY OF CUPERTINO a " ^' ���• �a�% �yaz
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UILDING DIVISION PERMIT *CONTRAGTOI2INFOItMe1.TION�„
NG ADDRESS: FOUR SEASONS ROOFING PERRMITNo'03060057
'S NAME: 645 HORNING ST PERMIT' `1RAP06/2003
: �4OS� 27S-O33OSANRARY NO. CONTROL NO.
ECTIENGINEER: BUILDING PERMIT INFO
BLDG EIEL7 PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION1,whereby afBfm Wt I am licensed uMer provisimu of Chapter 9(commencing Job Description
uon7000)of Division 3 of NC Busies and Profcssioru Code.and my license is
rce and cream, p��,gg �f�, ® 1�' clIauyr Lic.g ag REROOF aB�l�n:la E3� bl Conoactar-= ARCHITECTSDECLARI understand my plana ANTI he trod m public rtmNs J U L 0 3 2003
s'� Licensed Professional
S OWNER-BUILDER DECLARATION
1 hcrchy affirm that I am exempt from did Contractors License Law for use BUILDING
0O following Mason.(Sccuon 7(13 1.5,Business and Professions Code:Any city or county
COO
which requires a permit to construct,alter,improve,demolish,or repair any structure
uziprior to its issuance.also requires the applicant for such permit in fie a signed statement
< thuheislicensed pursuant totheprovisionsofthe C.rt.mr'sLimn.Law(chapter 9 Sq. Ft. Floor Area $,y09,Vion
X (commencing with Seetion 7000)of Division J of the Busineds and Professions Code)or
- that M is esempt therefrom and the buss for the slleged exemption.My violation of
Section 7031.5 by airy applicant for s permit subjects the Applicant to a civil penalty of 3 AEH NQiRl&r O O Occupancy Type
not more man live hundred dollars P Y YP
1,m owner of the property,m my employcm with wages u dteir tale mmpenudon,
Mild.due.,k..nd theawctum is not Intended woffercd fmmxh(Sec.7066,Buunen 11�C�,
and Prefestlons Code:The Contrarmrs Licosa law don tmt apply min owner of 307 - I NSULH 1�p��{ vNd Inspections
m
property who builds orimproves efoon,and who doessuch work himselfor through his
Own employ=.provided dolman improvements arc not umM or offered formic.If. 601 — ROOF TEAR OFF
however.the building or improvement issold within one year of mmpietion,the owner-
bullder will have the burden of proving that be did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
Asia 603 - ROOF BATTENS
❑L m owner of the propony.am exclusively contracting with licensed contractors in
emotmct the project(Sec.]066,But..Add I'Micaiom Cade:)The Contractor's Lt. 604 - ROOF IN-PROGRESS
corm law docs not pply to an owner of property,who builds or improves 0¢rce ,and.
who contracts for such projecis with a conuattor(s)licensed pursuant An the Contractors
Lice..Law.
0 Iammemptunder See ,B&PCforthistemon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following doolmomm:
I have and will munuin sCor iBmte of Consent in sel6imum for Workers Cooped.
Aides,m provided for by Section 3700 of the labor Cade,for the performance of the
work for which this permit is issmd.
(191 haw and will maintain Workers Compeuaion hcsmanee,m momm l by section
37W of the labor Code,for the performance of the work for which this permit is issued.
My WorkerLComoeasauonajf�uraocc�carrier and Policy nu6"b" ^� �Q o
Carrier. •K//le T I-s/ Polity No.: s✓ aA-bt
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section..door becomplmed If me permit isforone hundred dollars(Sl W)
M km)
I cenify that in me perfnmurce of the work for which this permit is issued.1 Nall not
employ any po m r. csubjmua tMWorkers'Compcnmdon
Laws of Califopt'+g TET
ApplicE VC�d'`
NOTICE TO APPUCAM:If.after making this CeniOnte of Exemption.
� forthwith
Workers E You
u
become subject the Comp provisions of Ido LAW Codeyou most
OfaMwihComply With such provisions Or this permit shall be deemed¢oiced.
z
y CONSTRUCTION LENDING AGENCY
I hereby afEtm that more is•comtrocto n lending agency for the performance of
x the work for which this permit us issued(Sec.3 .Civ.C.)
YQ lenders Name
3. z Lenders Address
:)C) 1 certify that 1 have read this application and state that the show information is
i P cart¢.I agree.comply with all city and county ordinanm and slam laws relating to
�U building construction.And hereby authonx representatives of this city to enter upon the
N D] above-menumrWpmpertyst for and inspection purposes
(We)agree m mw,indemnify And keep harmless the City of Cupertino against
h in'.ine;jude or th. osusnd expensesrnit. may in any way Attrvc agaimtmid City
U z A APPLICANT
of the UNDERSTANDS
of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of APPhcaMCantrumr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future building occupant seem arhandlc hazardous material
Ac defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
oda Scarian zssu(')7 All roofs shall be inspected nor to an roofing material beim
�Y. P P Y g g installed.
Will the applicant Of future banding moupaal use equipment of deam whim If a roof is installed without first obtaining an inspection,I agree to remove
.alt,CBllalam air eonuumnanJts m defined by the Bay Atm Air Quality M...gemmt all new ma .cels for inspeeti
❑Yea 1p Nu a�
Ihavc maJthehvaNnusm 141117,y3and2514.1uChapmr6.95ofthe Gelding
nuF Aclth& a tyCadc.Savo 5 nSJJ anJ 755Jd.1mderstaM thaziftite Wilding
does rest c of how a y responsibility to notify the occupant of me
equiremmsw chmt i n toiss.a.mof.CenificateofCco.panry. Signature of Applicant Dat
Owner or aunadrcd rut Date All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P E D 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 Y4" 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: N-C '0,4 2 k (_9 r,(-((5 l+ 1)
job Site Address:
Roofing Company Name: row'^ S c',�g o-LS ►2o0 4—)\-ty .pct C
A plicanYs Signature: -Gi Date: U3
,ego
Building Official
Revised 1/30/03
CITY OF CUPERTINO
) _3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
3 q�L --3 S- vaD
Building Address: 1
Owner's Name: Phone#:
R -e C..--,L TV"LlS +-
Contractor: Phone#: License#:
a�4- (33' 1 4�alo�
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _ W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Q-4 -w0�_ ❑ 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: 19 '
Job Description: _ (zQ F
c
1 t—r o ��:5 .1� le-t A[ 30L 6 �ret+
Residential Commercial ❑
Fire Zone: Yes ❑ No ®- Confirmed with Planning D if
there are any restrictio
Cost of �Projft: Type of Construction: p cy grou
`tb p'
Qty. if
A lica e 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
2 S�3