04080190 (2) CITY OF CUPERTINO p.3•'.. .,, �. �s1 m ;, 'x ,;,
t BUILDING DIVISION PERMIT CONTRACTORFINFORMATIQN a�
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BUILDING ADDRESS: PERMIT NO
r
FOUR SEASONS ROOFING 04080190
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY 0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
toZ, LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am lim,lsed under provisions of Chapter 9(commencing Job e rept] n�
—iw with Se
on]�p(N17 of D ivision Jo(Oc Rusineupnil Prufessiam Cndc,coil myFormse is
r7� infallto�iy
-grd Jeff n. s./A�/
^5„yz L+anuaGlessn �- Lie.g a1'72.toQ REROOF SEPI 2004
�tiFp Date Contractor Cess agfoJ
- ARCHITECTS DEQLARAT—100thN ^--�
�iU Iunticr¢IanJ my plans shellMus,J aspuTJi �G ��D�
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Dsay UccnmJ l'ntfcssmnal 1V\\\V'I'I
S OW NGR-BUILDER DECLARATION O
.�<x 1 hereby alfmm Nat 1 R exempt from the RATION License Law for the
S o o following mason.(Section 703 1,3,Businass and indications Code:Any city or county
u m tai which requires a permit to construct,alter,improve,dcmolixh,or repair any structure
Fly, prior tit its issuance.also oquins the applicant(orsuch permit to fie a signed statement
��C that he is licensed pursuant to the pmvixionsofthe Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Scninn]fk1U)of DivixionJ of the Business and Profnsinns Cndc)ar
Nn he is Condi therefrom and Om basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty es f
N
not mom an five hundred dollars(S50E. 34S;T$T2,pt7nber00 Occupancy Type
❑ I,nowner of the pmpcny,or my cmployms wish wegaalhcir sole compensation,
will Ju the work,and Ne swnum is not intended mriffend for aale(Sec.7094,11manev
and Prorefsions Code:The Conuanors License Law does not apply,o an owner of Required Inspections
Pratt who builds or harrows themon,and who does such work himself or through his
Own employees,provided that such improvement ve not intended or offend for sale.If,
however,the building or improvement is sold within one year of completion.Ne owner-
builder will have Ne burden orproving Nat he did not build or improve for purpose of
sale.).
❑1,as owner of gm Prolany,am exclusively contracting with licensed contractors to
common the project(Sec.7044,Business and Professions Code:7 The Comracmr's U.
cone law docs not apply to an owner of propeny who builds or improves Thereon,and.
who contracts for such projects with a con Melo hd licensed pursuant to me Contmemrs
License law.
❑I am exempt under Sec. ,B&PC for Nis mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Com finite of Convent to self-insure for Workch Comrcm
sarion,n provided for by Section 3700 of the labor Code,for the perfarmance of the
work for which Nis permit is issued.
❑1 have and will maintain worker's Compensation Insurance,as required by Section
37M of the labor Code,far the performance of the work for which Nis Permit is issued.
My WorrkJer's Compensation Insurance carica and Policy number am:
C.rdb � ,e..fl Q'kw4i cWllry No.�9J cml O0 10)cow 0
CERTIFICATE OF EXEMPTION FRAM WORKERS'
COMPENSATION INSURANCE
Or ll(This section need not be complem
mJ from permit is for ,hundred dollars(SIM)
1 cenlfy No,in the pertinent of the work In which this permit is issued,I shall no,
employ any person in any manner 0u N becomeu
subject the Workersm
Copensation
laws of California.Dale
Applicant
NOTICE TO APPLICANT.If.arm,making this Cenificn,rr Exemption,you should
become subject to the Worker'Compensation provisions of the Labor Code,you must
., z fuMwith comply with such prnviaiom or this Permit shall M deemed revoked.
'Zq CONSTRUCTION LENDING AGENCY
(~ l hereby affirm that there is wmtslruninr lending agency for he Performance of
x Nc work for which this permit is issued(Sce.3(197,Cii,C.)
CQ Lender's Name
0. z Lender's Address
U Q 1,edify that 1 have mad this application and stem The,Ne above informuiun is
CL F cored.1 agree to comply with all city and county ardimanees and nam laws relating to
C)U buildingcrnsWCtian,and hereby auNmim«presentarves or Nis city to enter upon On
¢hove-mentioned pro Try(an ins P ruseschon which may
F�„ C (We)agree m save,indemnify and k,oP harmless the City of Cupertino again,
h in
equnce of ts,the grassing ea pis prem it. may in anyway accrue against said City
A PLICAcncc of the graining of This permit. rs
U z SOPPLICA E �GONS3fpS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Dp�2 6y Re-roofs
Signa rc of ApPbc ppcmr Dem
iA7MlDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or rumre building uccupen,soon or handl,hine doses mucrial
as defined by the Cupertino Municipal Cade,Chapter 9.12,end the Health and Safety
,dMLCode,Section 25532(¢)?
❑res JN.
All roofs shall be inspected prior to any roofing material being installed.
will the apPlicam ormtam wilding accupam use,yuipmcm m Jcviccs which
If a roof is installed without first obtaining an inspection,I agree to remove
emit harartlnus air eonuminan deform by rbc Bay Arca Air Quality Mana,cmcnt all new materials for inspection.
District?
[D Yen 0 N
I have mail the hazardous materials mquimmcros under Chapter 6.95 of the Cali for
ria Health&Safely Cale,Sectors 25505.25577 and 25534.1 undersand Nu,if We building r,
Jos no ly ha a ten at i,is my himensihility m notify Nc uecupan,of Nc a 23 •Q
nyui ems Asch tial metp tit uanm ora CCNfsam of Occupancy.8-23-0y Sig atur o ApplicanL4rocove7ing,
Date
owner ufarm r a ant Do1e to be Class "B" or better
Community Development
y, v 10300 Torre Avenue
�<, Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTIN®
Building Department
ent
JOB ADDRESS: PERMIT #
10126 1„2li to+er Sq . 0,-10ir01 `iO
OWNER'S NAME: �-% �. -smPHONE # o g
GENERAL CONTRACTOR: r-owr
/•�o ,n FAX#
I am not using any subcontractors: L .,�X� ��.,.._ g. �3 •o y
SignatuW 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 FoL%c Seoaar%c, a ca
Septic Tank
Sheet Metal
Sheet Rock
Tile
•a3-OK
Owner/Contr r Signature Date
Community Development Department
Building Division
City of Cupertino
r -
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
U P E RT 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 above stated policy on re-roofing.
Homeowner's Name: A f\,,.e
Job Site Address: hl9L6 (,amol ahl2c Sa Glad
Roofing Company Name: Ra d,_ Seas wjr, R.a.p.N 5
A plicant'sSignatirre: (2�2n� Date: 45 23 0`t
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
aCITY OF CUPERTINO o
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 "1 2,H 2 d c ( Date:
4S"a3- oy
Building Address:
I0IZ6 Lata 1. h}er Sq. Skid .
Owner's Name: Phone #:
DEAwZA AILS - Fko^ WAlV.9.R kr4rt6 C ,-to$) 2l$-0�30
Contractor: Phone#: License#:
u SE 5 0 a - 0 �t 12108
Contact: Phone#: Cupertino Business License#:
s CAZAa Fs C%Aosl 0-0
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
r4 Other(Specify) Qmwomo 0 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: a.n (j 6"OVG Gy_ sTINg ooF, ( ,srA« Ys neLl Appk4
Residential rO Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dr t. if
there are any restrictions: fJ
Cost of Project: Type of Construction: Occupancy group:
000 g eg-00 C, P
Qty. if )
Appliqable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
i BENERGY Energy BUILDING
f BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
� 77
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