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04070088 (2) clTv OF carEeTlr o „CONTRACTOR4NE IRMA�ION 77777777 BUILDING DIVISION PERMIT BUILDING ADDRESS: FOUR SEASONS ROOFING PBRMITN004070088 10096 OWNERS NAME: PERMIT ISSUE DATE A Ek DONNA L RUTH NE: SANITARY NO. CONTROL NO. (408) 278-0330 ARCHITECT/ENGINEER: BUILDING PERMIT BLDG ELECT PLUMB PLUMB MEC11 Z, LICENSED CONTRACTOR'S DECLARATION m C 1 hercM1y affirm at I am licensed under previsions of Chapter 9(commencing u wire Scaion7 fDivisi.n3of the Businessand Pmfcssions Code.and mylicense is Hz rc^Imreess� a j ua.x REROOF/PLYWOOD n^p Dam Commcm SEP Zz- 2004 �W i A CHITECTS DECLARATR)N7 Xt; I Plolusn my puns shall he uscJ as public rcairJ.( D r, 3 n U U 1\/I\/`-�V/l o F`n LicenreJ Professional OW HER-BUILDER DECLARATION <Y I hereby affirm mat I am exempt Imre But Contractor's License Law for the i p O following rearm.(Section 7031.5,Business and Pmfcssions Code:Any city or county K:� which m mfires a permit to consumer.alter,improve,demolish,or repair any structure nnn prior m its issuance,also mquims the applicant forsuch permit to rile a signed statement h�a that he is licensed pumuam to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation �F$ (commencing with Section 7")of Division 3 of the B usiness and Professions Code)or that he is exempt dmrefrom and the thesis far the alleged ex=ception.Any vialatian of Section 7031.5 by any applicant for a p.rmit subjects me applicant to a civil penalty of 3 9A21N3ti2aer0 0 Occupancy Type not more man five hundred dollars($500). 0 1,a owner of the property,or my employees with wages as;their mole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7W,Business and Professions Code:Tho Contractor's License Law docs not apply to an Owner of Required Inspections property who builds or Intimates Hereon,and who dmessuch work himself or through his own employees,provided that such improvements are not intended oroRered formic.If, however,me building or improvement is sold within one year of completion,the owner, builder will have the burden of proving mat he did not build or improve for purpose of I.I.J. 0 I,es owner of the pmpeny,am exclusively convecting with licensed emu em.m constmct the pmject(Sec.7094,Business and Professions Cade:)The Contractor's Li cense Law does not apply to an owner of property who Wilds or improves thereon,and who contracts for such pmjecu with a comm ecru)licensed pumuan0o thc Contractor's License Law. 0 I am exempt under Sec. .B&P C far this recon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of pe jury one of the following decimations: 1 have and will maintain a Cenibcam of Consent to self-insum for Worker's Camper. potion,as provided for by Section 37W of One Labor Code,for me performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,an reyvited by Section 37W of the labor Code.for the performance of to work for which this permit is issued. My We kc, Compensation Insure Cartier and Polity nu�m�ber�ale�:��y CarlerL Policy No.:_&So p C) �j0 CERTIFICATE OF FJ(EMPTION FROM WIR„KEIfS' , COMPENSATION INSURANCE (This section need nm W complemJ if the permit is for one hundred dollars(EI W) nr less.) 1 certify that in the performance of the work for which this permit is Issued,I shall net employ any person in any manner so a in become subjeeuo the Workers'Compensation Laws of California.Dale Applicant NOTICE TO APPLICANT:IL after making oris Certificate of Exemption,you should become subject to the Workers Compenution previsions of the Labor Code,you must ,z forthwi lh comply with such provisions or this Nomilsholl W deemed revoked. ZO CONSTRUCTION LENDING AGENCY [r 14 1 hereby.11irm that mem is a coramnoo m l.ndirit.1acy fine the pert nnam c of Cls> But work fur which this permit is issued(Sec.3(197,Civ.C.) ALender's Name z Lender's Address U O I certify that I han mad this application and sum that the above information is {L F Corton.I agree to Comply with all City and county ordinances and sum laws relating to �U building construction.and hereby amhorim representatives of Otis city to enter upon the W above mentioned property for inspection purposes. LL (We)agree to save,indemnify and may harmless the City Of Cupertino against y liabilities,judgments,costs and expenses which may in any way accom againstsaid City U Z APPLICANTeUNDERSgranting of this permit. WILL OMPLY WITH ALL NON-POINT Issued by: Date IA Re-roofs Signature pli anusCommalor am HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hav Oc sus material a defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cole,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. Dyes Will the applicant or future building occupant raw.quipm.nl or devices which If a roof is installed without first obtaining an inspection,I agree to remove nit hazardous air conuminarm as defined by the Ba ca Air Quality Management all new materials for inspection. Doone" O Ycs [-I No (have maJ me hvallo ra reyuiremcnm under Chapter 6.95 of me Califor- / niaHeald&Safety COdc, ons 255(1 , undcmmnddatifda Foil �lw dean notIce my responsibOc ility to Willy the cupant of dtc whi. met !: ml enc.OraC. Bcamc'oicpancy, Signature of Applicant Date Owner at suffmixed spent Dm. All roof coverings to be Class "B"or better Community Development 10300 Torte Avenue 6e Cupertino CA 95014 ' '��` ' Telephone(408) 777-3228 CRYOi Fax(408)777-3333 4JUPEI��'INE) ID ilding Dartm ent JOB ADDRESS: PERMIT # OWNER'S NAME: l{ PHONE # Z7 r-—0 3 GENERAL CONTRACTOR: r-wr Sa,L-9-.,8 /LoF FAX # I am not using any subcontractors: I� I Signature Date Please check applicable subcontractors and complete the following 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 7f f caner/Contractor Signature Datel CITY OF CUPERTINO S® 2 of 3 PERMIT RECEIPT OPERATOR: suem COPY $ 3 Sec: Twp: Rng: Sub: Blk: Lot: APN 34233002.00 DATE ISSUED. . . . . . . : 07/16/2004 RECEIPT #. . . . . . . . . : 26327 REFERENCE ID 9 . . . : 04070088 SITE ADDRESS . . . . . : 10096 LAMPLIGHTER SQ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DONNA L RUTH ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2644 RECEIVED FROM . . . . : FOURS SEASONS ROOF CONTRACTOR DIAZ, ALFRED LIC k 21323 COMPANY FOUR SEASONS ROOFING ADDRESS 645 HORNING ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 ® TELEPHONE (408)278-0330 �E'E ID UNIT - -- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL _____ _________ __________ __________ __________ __________ ____ _ BPERMFEE VALUATION 81000.00 147.96 0.00 147.96 0.00 BSEISMICRE VALUATION 81000.00 0.80 0.00 0.80 0.00 __________ __________ __________ ---------- TOTAL PERMIT 148.76 0.00 148.76 0.00 CITY OF CUPERTINO REROOF �U�QQS OF CUPEPTIN0 PERMIT APPLICATION FORM APN # ql--- Building Address: Owner's Name: Phone #: Contractor: Phone #: License#: 7 7,? — q ?"z. 16 Contact: Phone#: Cupertino Business License#: 5i;�O9 elv / Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles rX Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. is Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy: Job Description: ✓l�t�-cr f; ..«„�,� ,- Pel -&, Residential R;s Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construeti Occupancy group: cX> c�c�l� �S;/Jt✓'�l Qty, if A c4 ble Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development Department Building Division City of Cupertino 10300 Torre Avenue ® CI OF Telephone: (408) 777-3228 C U P E kT I N O 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 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 eejabove stated policy on re-roofing.! Homeowner's Name: $- 0 / i Job Site Address: �U O �� 4 12 Roofing Company Name: A plicanYs Signature: ate: j/6 Y \.t/r61l�SDLX1 l ® Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper