02070051 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
,I.
BUILDING ADDRESS: PERMIT NO.
22901 T-QNQ N RD FOUR SEASONS ROOFING 02070051
OWNER'S NAME:
APPLICATION SUR DATE
DILTS CATHERINE J 645 HORNING ST 07/09/2002
PHONE:
(408) 278-0330 SANITARY NO. CONTROL NO.
c ARCHITECf/ENGINEER: -
O_ BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
y a
Z y Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_ I hereby uffrm that I am licensed under provisions of Chapter 9(commencing p
9E2 wi.mSmtion7OOO)ofDivision3ofthe BusiKssand Professi�'oda.m>dsnylicenu REROOF
i6 y y< is in lull forte and cffcar 1 CCVVJJ
ca i U License Class-� l�`_ Lic.N_ 6
t'i 3a.� Date _ s01MLto� �Q�����
t s,0i g 1 unders bad my plans shall be used u publiiccAreccoid.s
d o o Licensed Professional JAN '3 1 2003
so
OWNER-BUILDERptfrom he Connector's
onn ION
_ a 1 greasy affiw than 11. cBusin from the Cession,Cur License law for my.
__a following reason.(Section]OJ 15, t,alter, and Professions Code:Any city or county, $8000
G
which q p t r c est t Iter,improve.for such
demolish.n psi any swcturc
e.3 Prior to its e I requires the applicant far such perrmu file g Isutememof DMIG
nae sMpurwm.70W)rovsiosion3 a n,Business
ust a an Lo fCWper9 .C}Q LAE, OC ear n,,.! .,., Valuation
( tent e'with 5 coon can'il of Div... 3 of the Buses s and Pr9fes ns Codes i,j>'Ny 13 4, 4�u V. s I (t 14 it 1.A.1 I J y
r r Sens hes 1.5 b Inercfrolt send the sues for Sea alleged exemyt on,Any v tLa on
of Section]OJLS byeny epplicam[me permit subjects the nppnicam m a civil pcnahy�'
of not more than live hundred douam(s500). 3 0 5 ApN� Occupancy Type
01,as owner of the property,or my employees with wages as their sole ornpenwitor, ;
-will do the work:and the imitation (SINSUT
it not Inunded'oroffered for sale ]044, - - _ ...
Business and Professions Code:The Conwctar's License law does not apply to as 601 - ROOF TEAftetpgeld Inspections'
owner of proprny,Who Wilda or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or 6 0 2.,._ ROOF PLYWOOD NAIL
"off ed f ale.IL h' ei Ih "building or improvement is sold within one Ycar of - - - - -- _......_ .. ............
curipled.m.the ownerWllderwill have the burden ofprovingthat hedid not Wild or 603 - ROOF BATTENS -
improve for purposeofsale.), s 604 - ROOF IN-PROGRESS
❑I as nwawi3 the m 't,am esclus el co i fn- "" "' "-
conswe the P(Sec ]B14,Buvness and ProRxslgomtCode:)The Cmaricmr's 'k' "l
_ License Law does note I man owner of s
PP Y pmpeny wW builds or improves thertan. •
_
ad who commas for.such projects with,a Contruemr(s)licensed pursaantto the
r - Contractor's Lot"' Law. -. _• .- ... .- .. -_... ..... . . ....._. -.._ _..
❑I am esempt under see' ,'If&P C rorthis reason
- Ow Date
t ,per" WORKERS COMPENSATION DECLARATION
-Y Ihereby affirm under Nulty of perjury cantor the following declarations:
❑ I nave and will maintain a Certificate of Consent an self insurer for Worker.
Compensation, as,provided for by Section 3700 of the Labor Code, for the
perform arse of the won,for which this permit is homiest.
❑1 have and hill maintain Worker's Caarpcnimihin Insurance,as--required by Section
37M of the Luba Code,for the performance of the work(or which this permit is
/
issued.May Worker's Cc Boat on Insurance cancer
and P 1lieyc numb,crare:
came.n_(�=_.... ,,�.mpolcy NoWC7 ) 101 2 _ --
_..-
L ,¢CBRTIPICATIONOF,B%EMPTIGN I"ROM ORK—� ERrSli - i �,d� s �t,fts, (fy ,� 1- x 'j,gjs lS R.t�-ai N
COMPENSATION INSURANCE•" "
.. .... .-..__,-. ._ .. . .. _.. .__ . .. -......._. . .�._. .-.. __._.....-_._. _�..
" (Throe lection neon nm he comPlctd if Ne permit is frn one hundrtd dollars :.'d.- . 1 ,, d�"L•'.'`__ --�_-_-' - •-
(gl00j or less.)
.. .._ -_..._.,a . ..
1 Carl,f5 than in er Person romancenn the work(ser ons h u ct to t e issued,IshaI
C Ilpertsutionl awsyoaliumu in Dmenner so as to become Subject to the Workers' � � " "
Applicant'
NterimuOs,1.the W.ri If,Compensation
this Cemncmf the
Labor od.youmuld
zZ become subjecty the R'ocker's Compemutiis revisionsllbcdonWr Cale,you must
Q fdnhwiih comply with such provisions m this permit shall W Aeemed revoked.
E_sCONSTRUCTION LENDING AGENCY
} 1 harabY tiffirso this there is ailwauuSer. lending agency for the performSnca
r'
cf,h
Leaeweak for whicM1 pews '
Le der s Address N s tis issued(See lrq].Civ.C,I, • -
.0 �
sailic
t the
a read1s ant an information t I no,
,t comply with.1city amymidinane,and acto laws onadnganblJg r-ootou,liu.and h by itaffimir,rcP coves at N'scty ment,,uPon
tin
;} A. the aWse nmagree to Property fur ify and keep
purposes.
-` W) nt,mdgree to save,Indemnify and keep harmless the City of Cupertino against
Z liabilities,jadgmenis.etsyc,and upends which eny in any way accme uguinst said i6��
C.1 City a q cesfth B Ing of ih pc 'n.
APPLICANT n' UERSTAVDS VD RILL CO'sll'Ll'lv'HALL NON-P �T �!
SOUR ril ULATIONS -' '� Issued by: Date
21=
si f Appl lwo/C mrocmrIJmc Re-roofs '
.HAZARDOUS MATERIALS DISCLOSURE -
Wiilltheapplicautorfuturebuildingaccountstoreorhandlehamidnuatnatatial _ .Type of Roof
as ddned by nheC Ern Mundpal Code.Charlie,9,12,and the Health and s f ty -_. .. _ _.-,_ ,-_ ..
CdA Section 255121st ' i .. t. 7, •z �.` w+ �� k'I•i�1�.) b
❑Y N I I, \
All roofs shall be inspected prior to any,roofing material being installed.
Rill loo appbca l rfpts Ing occupant use equipmentordevi«awmen
Bay Aia�Yir Qualiry Munagemem If a roof is installed without first obtaining an inspection;I agree to remove
emn ha<allous eircnmaminunsdelined by the ..
D1tnC all new materials for inspection. Applicant understands and will comply with
❑Yeso .
/ all non-points 'rce regulations.
I have read the hard marcrml,regi vemenm under Chapter 695 of the
Califs 'a Health&Sat ry Cale,Sicum,25505 25533 end 25534,1 code...and that 7 9 0
if the Wilding does not currently have a tenant.that in it my responsibility to notify the - / �'(- '�
occupdm of the require a on must be met prior m issuance of a Ciamfica t of
Occupant y,/[ -
(// SignaueofApplicant Date
owner :w ad agent Data All roof coverings to be Class "B'• or better
OFFICE -
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
BuildingDepartment
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
and 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 of Y4"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 on reroofing and will comply with this policy.
Homeowners Name: cJJ 6I J 7,A/,I--
Address:
NkAddress:
Reroofing Company Name:
Applicants Signature: eZ- Date: ]7 u
' Joe Antonucci
(Chief Building Official)
6/25/01