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04070087 (2) CITY OF CUPEWHNOh'"'" BUILDING DIVISION PERMIT CON.TRACT.nR NFORMATTON ` BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITND04070087 10106 LAPLIGHTER SO OWNER'S NAME: PERMIT ISSUE DATE SAGDEO VIVEK DEANZA OAKS 14 ANI:: SANITARY NO, CONTROL N0, 408) 278-0330 ARCHITECT/ENGINEER: BUILDING PERMITBLDG ELECT PLUM LUMB MECH Op LICENSED CONTRACTOR'S DECLARATION �E 1 Hereby affirm that 1 em littnud under Provisions of Chaptar 9(commencing CT _T. `p�' _'affection lllfNpaf Divixion3nf NCRmineas and Prufcssinm Codc.end myliccnu is Cllr^rc=a^Je�D��J �' REROOF/PLYWOOD p. Liven Glu Le.M SEP � 2004 �—❑ Dam���/Yv_—�O—a+�_—Cunt �� AR(.HIIGCI'S D'CLE ION I undcrasan my Plans xM1all M used puhlie�i cords D rs rr�rr D��/\/\��\� ups6 U IILI� �/ Licensed Pmfcssimrsl OWNER-BUILDER from DEme ComrION N I hereby sfifrm shat I am exempt from Ne Conuacmr'a Liccnu Law for the 00 following Orion.(Section 71131.5,Business and Profession.Code:Any city m county K$ which requires a permit to consumer,diel,improve,demolish,or repair any structure us'r^ prior to its issuance,ales mquins the applicant for such permit to File a signed statement tF?'< that he is licensed pummana to the provisional nfthe Comadwr''sLiecnscLaw(Chapter 9 Sq. Ft. Floor Area Valuation C�'p (commencing with Section 7")of Division 3o the Business and Professions Cntk)ser y that he is amp(flumfrom end the basis for the alleged exemption.Any=of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of eT0 0 Occupancy Type not mote Nan five bundled dollars($500). r , ❑I.as Owner ofthe pruriently,or my employees with wages as their ale c an,smeation, will Ju she work.and the suucu d is nos awrldeJaroRered(.reale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply m an owner of Required Inspections proPeny who builds criterions thereon,and who doessucb work himself or Nmugh his own employees,provided Nat such improvements are not intended oraffered far sale.It, however,the building or improvement is sold within ane year of completion,the owner- builder will have[be burden of proving that he did not build or improve for porpose of sale.). ❑ 1,as owner of the prapeny,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves themon,and. who contracts for such projects wit a contractor(s)licensed pursuant to the Contractor's Liccnu Law. ❑I am exempt under See. ,B&P C for this¢axon Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of the following declarations: I have and will maintain a Cenifuam of Cnnunt m self-insure for Worker's Compere salter,as provided for by Section 3700 of the labor Cade,for the performance of the work for which this permit is issued. ❑1 ban and will maintain Workcfs Compensation Insurance,u required by Section 3700 of the Labor Code,for Ne Performance of the work for which this permit is issued. My Wohiker's Compensation Insurance carrier and Policy number : Canicr% ./)7�a�..A Polity No.: V ! � `' C RTIFI— CAAE (TION FROM WORK S' COMPENSATION INSURANCE ('this section rmad not bec^mpleud if tbe permit is forma hundred dollars(SI00) or list.) 1 unify that in the performance of the work for which this Permit is issued,l shell not employ any person in any manner an as to become subject o the Workers'Compensation Laws of Califorois.Dam Applicant NOTICE TO APPLICANT:If,after making this Camificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must .J O forthwith comply with such provisions or this Permit shall be m deeed revoked. Z C CONSTRUCTION LENDING AGENCY (r I hereby affirm that there is a construction lending agency for the performance of Dj r7 the work for which this permit is issued(Sec.3097,Civ.C.) (y 0 Larni 's Namc = z Lander's Address V C) 1 sanity that I have read this application and amus that the shove inf nu atiun is B. F coned.I agree to comply with all city and county ordinances and stale laws mlating to 0V building construction,and hereby authorize upresematives of this city to enter upon the Uabove-mendened propcny for insPccd^n purposes. C. (Wen)agree to save,indemnify and keep harmless the City of Cupertino against nF.a VI liabilides,judgmchal,rosts andexpenses which may in anyway acerae agamstuid City APt 'CgA�cufthc RSming of ND WILL COMPLY WITHILL NON-POINT Issued by: Date RatXILI —v Re-roofs Sigffftuf ApplicandContractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupanutom er banJlc hasallous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the licalth and Safety Code,Section 25532(x)? T`�� / All roofs shall be inspected prior to an roofing material being Installed. p Yes P P � Y b' g Will the applicant or future building Occupant agaipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove u hazardous air constituents as deFin ay Arca Ail Quality Management all new materials for i ection. District? ❑Yes ❑Nu I have o a l the haaaidne,materials n lmomorms outer Chapter 6.95 of the Iia llczlth&Sammy Com,Sccdons 255(15,25533 and 25534.1 understand thatifthe . leg \E-/fes Jtes not cunenJ,have a th it is my responsibility m notify the occupant of me myni cots wN -rte issuance ofac�cmwft=am oftxcupancy. Signature of Applicant Date red agent All roof coverings to be Class "B"or better w cr ser authoripart Community Development s 10300 Torre Avenue t� Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEDTIN® Building De a't'Il]Illent JOB ADDRESS: PERMIT # 010 �rrw % P� Q A�7rr A= OWNER'S NAME: PHONE # -Z -7 gz�,9?6 GENERAL CONTRACTOR: �s� S�sm s p�G FAX # I am not using any subcontractors —`�/L�y�� ��Signature 6Date 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 -Roofing 50p.5 ro�-� Septic Tank Ir Sheet Metal Sheet Rock Tile Owner/Contractor Signature Da e CITY OF CUPERTINO �m 1 of 3 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 34233001.00 DATE ISSUED. . . . . . . : 07/16/2004 RECEIPT #. . . . . . . . . : 26327 REFERENCE ID # . . . : 04070087 SITE ADDRESS . . . . . : 10106 LAMPLIGHTER SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SAGDEO VIVEK/DEANZA OAKS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2644 RECEIVED FROM . . . . : FOURS SEASONS ROOF CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323 COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING ADDRESS . . . . . . . . . . : 645 HORNING ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 278-0330 E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ______ _____________ __________ __________ __________ __________ __________ BPERMFEE VALUATION 8, 000.00 147.96 0.00 147.96 0.00 BSEISMICRE VALUATION 8, 000.00 0.80 0.00 0.80 0.00 __________ __________ __________ ---------- TOTAL PERMIT 148.76 0.00 148.76 0.00 CITY OF CUPERTINO REROOF ®CUPERTiNO PERMIT APPLICATION FORM APN # �.� Date: Building Address: / T Q O6, — Qnt / � �� Owner's Name: Phone #: l/t 1 llP-(� a �i � - 0 33 Contractor: Phone #: License#: Z7 —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 1) Wood Shingles Ute- Other(Specify) C42::O , ❑ Other(Specify) Number of existing coverings ❑ Provide LC.B.O.Report # ❑ To be Removed ❑ Provide Mfgr, Installation Specs. Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy: Job Description: Residential [D, Commercial ❑ Fire Zone: Yes ❑ No gj] w— Confirmed with Planning Dept. if there are anv restrictions: LJ Cost of Project: Type of Construction: Occupancy group: cX� e7vl� �S;1JC-w' Qty. if A 1' ale 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 Community Development Department Building Division ISI City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CFax: (408) 777-3333 CUPE'vINO 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: ::Jy .e 2 ° (fi7L Job Site Address: / U 0 6> Roofing Company Name: A phcant's Signature: ate: !/� 7/ja ✓� Greg teal Building Official Revised 1/30/03 Printed on Recycled Paper