03090159 (2) CITY OF CUPERTINO :� ^�? «+�% Ac ere. fro �t sea a'
BUILDING DIVISION PERMIT 4CONTRAC,'TOR-INFORMATION .4
BU B.DING ADDRESS: ALL SEASONS ROOFING SERVIC ERMIr"x03090159
0940 14RRTRR QRt
OW NER'SNAME: 2640 PACER LN PERMITISSUEDATE
HE 4089724455 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
�op LICENSED CONTRACTOR'S DECLARATION
fz 1herebyaffirmthat1amfdmBdunder p r lessonsCode.Chapter9(commencing CcrJptJO��
SZ W with Sc li n)UM))nf Division3of the Business and VQfcssinns Codc.and mylicense is Ayb
+« in run eaodc c
q_ Lie I 9 Lid.is �So9/ REROOF
;moo Da Centracmr NOV 2 4
S� RCHITECI'S DE CLA ATION 2003
I>u 1 understand my plans shall he used as pup m records Al
su. LmcnmJ Professional
fcssil �ILDI,YG
eros OWNER BUILDER DECLARATION
a S I hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason,(Section 703 IS.Business and Professions Codc:Any city or county
m� which requires a Delimit n)construct,aper,improve,demolish,or repair any structure
_Zr
Poor o its issuance.alsu rcgmresthc applicant fofsrroh Permit to Olcasigncd statement
pZ< that he is licensed pursuant to the previsions(if the Contractor's License Law(Chirpier 9 Sq. Ft. Floor Area Valuation
x+l—O (commencing with Section 9000)of Division 3 of the Business and Profcssinn Codd)be
that he is exempt lbereffom and the bests for Ne alleged exemption.Any violation of 35628016 , 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty or .APN Number
ban roe than low hundred donaraUlM. - -- - - - - _ Occupancy.Type
❑ 1,as owner of the property,or my employees with wages as their sole compensation,
will da the work.and the structure is nos intended or Offered but sale(See.]044,Business
and Professions Code:The Conlvcton License Law doer not apply to an owner or — E Required Inspections
property who builds or improves waren,and who does such work himself or through his 307 — INSULATION
own employees.provided that uch improvements axe not intended or offered for aide,If. 601 — ROOF TEAR OFF
however,we building Or improvement r
is sold within one year of completion.thc owne
builder will have the burden of proving the he did not bund or improve for purpose of 602 — ROOF PLYWOOD NAIL
sale.).
❑I.as owner of use property,am exclusively contracting wild licensed contractors to 603 — ROOF BATTENS
COmI the project(Sec.?04A.emimeas and Profession Cade:)The Contractors Li. 604 — ROOF IN—PROGRESS
more Law due,not apply to an owner of property who builds or improves themur.and
who contracts for such projects with a contraaor(s)licensed pursuant to dte Contractor's
License law.
❑I am aentpl under Sec. ,B&P C for this
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one Of the following declarations:
1 haw and will maintain a CeniOcate of Consent m self-insure for Worker'sComper-
cation,as provided for by Section 390D or the Labor Code,for the performance of the
work for which this permit is issued,
❑I have and will maintain Worker's Compensation Insurance,u required by Section
3700 or we labor Code,for Ne performance of we work for which this Permit is issued.
My,'/Wooyrker's Compensation Insurance carrier and Policy number am:
CY LCERTIFICA OF EJ(EM Polis. :M OOKERS'
COMPENSATION INSURANCE
in less.)This=turn need not heeompdeteJ if thatPermit is for one hundred dollars(Slip)
I tend ry that in the performance of the work for which this Permit is issued,1 shall not
emPlny any Person In any nmrm,ao as In become subject to the Wnhcos COmpc ration
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ccmfi am of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�O fmMwith comply with such Provision or this Dam it shall lx deemed revoked.
L y CONSTRUCTION LENDING AGENCY
I hereby afore that were is a communion lending agency for The performance of
x we work for which this permit is issued(Sec.3097,Civ.C.)
1 Q Lender's Name
� Z Lender's Address
J C) 1¢nify that I haw read this application and sole that the soon information is
y F-' correct.1 agree 10 comply with all city and county ordinances and sate laws relating to
Z)U building convection.and hereby aotho6m represenatives of this city to enter upon the
W a consequence o Publicity
dn inspection
ofthis Pe purposes.
gy (Ws.)agree To saw,indemnify and k cp babood s the City of Cupertino against
rA
liabilities,judgments.costs and expenses which may in any way accrue against said C,LY
J z in consequence of the Framing of this Permit.
LICA NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
ERE S.
entre DlicanUContractor p,z Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will we applicant lir future building occupant store or handle ha ardours m 0amid
az defined by the Cupenin,Municipal Code,Chapter 9,12,and the Health and Safety
Codc,Scamn 25532(a)?
❑Ys., IQNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
it herardnus air conaminants az JcfncJ by the Bay Arca Air Quality Management all new materials for inspection.
e w
Ida?
Yea NNo ,
1 have read Use hasardrms materials requirements under Chap dr6.95 of the Califon
nice Health&Safety Ce,,Sedum 25N)5,25533 and 25534.1 undersand user if the Wilding
tido not curtcnJy have a tenant veer it is my rnponihility to noddy the occupant nr the z
revs not Orion k that
sofa Cc Ocateof Occupant
1 tureQ pplicant Dale
o fora iadagent m All roof coverings to be Class "B" or better
r Building Division
10300 Tom Avenue
{ Cupertino,CA 95014-3255
Telephone: (408)777-3228
C 0 Paz: (408)777-3333
* CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
Wand written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum um of'✓"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 of inspection.
We understand the above policy of eroofin and co ply wi policy.
Homeowners Name:
Address:
,
. Reroofing Com any Name:
Applicants Signa Date: "7-
• JJoe Antonucci
(Chief Building Official)
6/25/01
i
CITY OF CUPERTINO 0 ) ,>
S
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# J Date:
' 94- o
Building Address:
O D r
Owner's Name: Phone#:
V,",2 iQi y0 Z
Contractor: License ..l:
9s-sa
Contact: Phone#:
4wvi Sf—
ApplicanUContr tor: Fax#:
o Yob - 9 � -
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: r� Y
—' Residential: IC-
oe Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
12 00 7
Architect/Engine : Valuation:
Type of Consty4ction: Occupancy Group:
Qty. �(�Q
A 1'c 1 Fee ID Fee Description Fee Group
BPERMFEE BldgPermit Fees BUILIDNG
BENERGY Ener BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BU1i DNG
•
2