04070171 (2) CITY OF CUPERTINO �'�' �"" "� `•• ' '� ttk-�r �' +a"
BUILDING DIVISION PERMIT CONTRACT(5R INka4RMATINO
�.
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT" 4070171
10076 LAMPLIGHTER S
OWNER'S NAME: PERMIT ISSUE DATE
DE ANZA OAKS HOA 645 HORNING ST 07/27/2004
ZONE:
SANITARY NO. CONTROL N0.
(408) 278-0330
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
useC LICENSED CONTRACTOR'S DECLARATION /
i w b hereby affirm that 1 am licensed under pmvisio of Chapter 9(commencing "tion
b wiN7ealion]WB)af0iviuon3of NC Buvnus and c ions COJe,andmylieenxis
�'n inffi 'kne °-3S REROOF
,g= DoenseGlm, Lie.« SEP 2z.,1004
=t-a Date �z—>'�—+ CI camrenar
gg� ARCHITI.CI'S DECLARATION
n 2 1 undcrsunJ lasush+ll M used n public records pp pp pp
x If
UDI
n 0� Licensed P somal
g OWNERBUILDER DECLARATION UN
nyI hereby affirm that 1 am exempt from to Curvatures License Law for the
i o O following rector.(Secuun 703 1.3,Business and Profheiors Code:Any city or counly
K$ which requirh a permit to cnnawct,eller,impmus,dcomfl ah,or repair any aremum $8000
Fiy prior Or its issuance,also requires the applicant forsuch permiuo File asigneJ statement
s< that he is licensed pursuant to the provisions of the Continuum's License hw(Chapter 9 Sq.Ft. Floor Area Valuation
zt$ (commmming with Section 7000)of Division J of the B usirm and Professions Code)or
3_
that he u exempt thcmfrom and the basis for Ne alleged exemption.Any vlolaion of
Section 7031.5 by any applicant for a permit subjects Ne appheam to a civil penalty of Occupancy Type
not mom than Bas hundred dollars($500). r
❑ do
othe work.
the pmpcny,or is omplende with r.ff..dpro prosaic
IC. 04A.Business
will Pr the work end the hn Conantruc is no,un intended Lta,do Cal a(See.t oan,..nt
arta PrVreSamm code:The Contvcmrs License of tach nos apply to,i ..net If Required inspections
p'n Iho whobuildsorimprovesthereon,andwho dohsuchwork himselfedNmugh his
ownever.m ebuiprovided Nat such improvements as not intended mpledo.for tale,r-
however.Ne building or den of pmena is sold within one year of mprove bar
the .of
builder will have Nc burden of proving Nat M Oltl nor buil)Or improve for puryos of
nk.).
❑1,as owner of Nc proper,sm exclusively ccouearin,with licensed conuamors ao
consumer the prole.(Set 7044,Business and Professions Cuda:)The Cmuncsor's Li-
came Law dock not apply to an Owner of property who Wilds or improves theson,and
who conducts for such prejec r with a canuach rl.)licensed pursues m Ne Comracmes
License Law,
❑ l son exempt under See .B A P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury on of Ne following deabomons:
❑1 haus and will maintain eCeNficam of Comem Code.
for
fur Workch fire
Iworkf r troubled bo for by Section 3700 of the labor Cole,far Nc performance of Ne
I
for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance,Is required by section
37M of Ne Labor Code.for the performance a(Ne.ret for which Nis permit is issued.
My Workers ACCmi.sauan Immence carrier and Policy number art:
Carri �wY�cw„a�Policy No HERS' t/ojd 3(;J
CERTIFICATE OF EMPnON FR ORKERS'
s COMPENSATION INSURANCE
(This eootion need nm W cmmpleteJ if the pc(mir is fn(one hundred dollars($11«11
or less.)
1 coni fy do,in to performance of the work for which this Permit is issued,1 shall ms
employ any Person in any manner so as to become subject o the Warkeri Compennuan
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cur ifrcme of Exemption,you should
Mcome suhjek,to On Worker's Compensation provision,of We Labor Calc,you mum
Z fmMwith comply with each poveismor or this permit shall be doomed revoked.
Z Q CONSTRUCTION LENDING AGENCY
[r Iherehy affirm Out there its construed..knding agency for Ne performance of
!Yi
be work for which this permit is issued(Sec.3097,Civ,C.)
f$7 0 Lenders Name
0. Landers Add.
U 0 1 certify Nat 1 have had Nis application and sou;that the above information is
W F correct.1 agree N comply with all city and county oNinanas and mete laws relating ur
0 U building construction.and hereby authorise ra,mroe utircu of this city lonnter upon tW
r ilwm-mentioned property for i e,kord n of rpass
(We)agree to save,indemnify and keep harmless On City of Cupenina against
o-Fi fa'q Imbilities.jud,ouns,e.warmd expenses which may in any way accmc agnhtsaid City
U z icanseLgAucncc of Ne N e LAND WILL COMPLY WITH ALL NON-POINT Issued by: D
CER L-
'� Re-roofs
Sigmwre of
HAZARDOUS
aur Dam
DOUS MATE RIALS DISCLOSURE Type of Roof
Will applicant tarformbuilding aapt mom or handle N
eauus material
as defined byytax rti
Cupeno MMunicipal Code.Chapter 9.12,and NH
e Health and Safety
Code,Scene.255320)? All roofs shall be inspected prior to any roof.g material beim Installed.❑Yes �x�Will tale applicant or future Wilding Occupant as,equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit harardnvs aircmtaminants as dCrOcd by Uto Bay Air Quality Management all new materials for inspection.
District?
0 Ycs
I have mal the hvaNaus materials requirements under Chapter 6.95 of the Califor-
iafail"Safety Code.Scions25 l3 and 25534.1 un_J_crsund Nan the Wil
dyyes+ l tune rceponsilbiliky ur nadfy Ne a upant m ube 7
kyuimments ich us{:6n pdorwi anccofaCenlgcacofOccmancy. Sig ureofApplicant Date
/ — �7 All roof coverings to be Class "B"or better
Owen,or a thonud agent Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
SIUPEkTINO
Bu]1ldII.ICII De a1CtIl]meIllit
JOB ADDRESS: PERMIT #
0076 �a. �' �/ei SQ, � C 07 ( 2
OWNER'S NAME: /j moKs PHONE # 7i7
GENERAL CONTRACTOR: yn SeQ� s tc FAX #
I am not using any subcontractors: 7—
Signature Date l
Please check applicable subcontractors and complete 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
oofing _
Septic Tank
Sheet Metal
Sheet Rock
Tile —
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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 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: sok S
Job Site Address: �� rJ
Roofing Company Name:
A plicant s Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
"ROOF v 7
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: /D076
a
Owner's Name: Phone#:
Contractor: Phone #: License#:
q??-
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof, ❑ Built-Up roof
❑ Asphalt Shingles ' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) �'cr'»�c c tx�� ❑ 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:
1z `SCS
Residential I;, Commercial ❑
Fire Zone: Yes ❑ No L❑—� Confirmed with Planning Dept if�
there are any restrictions: lUd
Cost of Project. Type of Construt"os Occupancy group:/
Qty. .
A cabl 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