02070052 (2) I CITY OF CUPERTINO - -
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
a 22903 LONG DOWN RD FOUR SEASONS ROOFING 02070052
OWNER'S NAME: APPLICATION S}�B DATA
REED CHERYLAN 645 HORNING ST 07/ 09/2002
PHONE: (408) 278-0330 SANITARY NO. CONTROL NO.
❑ ARCHTTECT/ENGINEER: BUILDING PERMIT INFO
00
m 4 BLDG ELECT PLUMB MECH
Z w= LICENSED CONTRACTOR'S DECLARATION lob Description
0 —O I hereby ulRrm mm 1 am IicensW under provisions of Chap¢r 9(commencing
r':Fu, wit S5 tian1000)o(Di nn IheBusinexsandPmfe,,ionsCMe.andmylianu REROOF p �L®
-d<xs, ixmrmlremeane�r�r� 2. OOP- 9-
o 'Licenu CI s Lie.N
D
or non's'
O
%—fARCHITECT'SCor �� .r eyQo9
am 1 undasmnd my plans shall be used as public records 1 L J
Lmorked Professional
g R - OUDER DECLARATION BUILDIN
u� I hereby olT:m shats,I..am exempt from IM1e Commcmr i License Isw for the G
t•Z< following reamn.(Seetion 70315,Business and Professions Code:Any city or county, $8000
Y F o wh' h req 'rt a pe t i consume'
'her,:burow"demolish or repo r any swcwre
i❑$ prior to ns ssuatw 1 requ sth applicant for such perminofdeaugtud vammem
3— math ' leaned pun u th p loons of the Contmcmrs L¢enu Law lChapmr9 C a 1 V31nah00
qcb me I Bwnh Sem 1000) fD'vlsion 3 of the,dic ..and ppmkxs ons Cade) 1, �,a p'r !� f3 YT7;�VUsUTi.yVV,I'.,L�l=��i 4.S v'
.........
r that he is exempt therefrom and the bas s fur the alleged exemphlm.Any vudmian
."Section 7031.5 by any applicant fur a permit aibjmts the appllcam m n civil penalty
armat mare man Eee Hundred eah'is(,sail' 3 0 5APN lji'1�fplME - Occupancy Type
❑Los ownerof the progeny,ser my employ.,with wages as meir,cd,emn,rsmmet, Q 7 -
--Brawill do the work,and the strucoak::Th C not intended License
offered for telt apply
7044,- - - . - --- -
' nod and Professions Code:The Contractor's.and w Law docs not apply to an 601 - ROOF TEA12gIfsl�'d'a[nspeetions' "
owner ugh his ow em Wilds or improves thereon,end who does such wink himself
or througM1 his own employs.provided that such improvements are not intended or 602 - ROOF PLYWOOD NAIL
ceyed for sale.If,however,me building or improvement is sold within one year of - -"- -"" — ---'- '-
ompletion,the owner-builder will have the burden of proving mot he did nut build or 603 - — ROOF BATTENS t''` '
improve farpmrp::xeafxale.l 604 - ROOF IN-PROGRESS
m . ivel
°L
as owner jhrpmpen$am exclusively contracting with licensed contractors. - - "- - --- -
construct
o one, the project(Sec.]Oe Y,Business and property
who
CW e:)The Ces them
and-we Law does not apply man owner of p cl ny who Wilds or improves thereon,
-and xho commcla for such prolecu,wim a cammcmr(s)licensed pursuant m the
tracmdx License Law,
0 1 amxemec
1 ept undec
mile,S .'' �,B&P C fnnhis reason '
Own :D.m
WORKER'S COMPENSATION DECLARATION
n Thereby elfin.under penalty of perjury one of the following daPwtiuns:
❑ 1 have and will maintain a Cenilicate of Consent to self-insum I'or Worker's
Compensation, as providW for by Section 37N of the Labor Code, for the
performance of the work for which mix permit is issued.
1:11 have and will maintain Worker:x Cumpcasmion Insurance,as required by Section
9700 ofthe'Labor Gafe,for the performance blithe work for which his Permit is
i5ord.My Worker's Compensation Insurance caner and Policy number are
' Cem r Nr'"`r�^�1 1 ,)f'�Pohcy No W C'iU 41$4 62 t., _ .....' _ ., ..�...�__.__ .....
r v CERTIFICATION OF EXEMPTION FROM WORKERS". 1, r„, C ,x, '4 A�'� c5. 1' ,,,r!. 1 ill
_ COMPENSATION INSURANCE
a r'IGINs section need nm be complcmd if the permit is for one hundred dollen -
($100)orlesx.)
.. .. Ic of thin the ationanccurn kf which this .s
'shall not em to Pe { rte f s sued,1 t
impy any pe son in any manner so as,m became pyN.1 m the Workers'
Applicant on Laws nl'Cal il'nmia.Date
. 1
NfrfICE TO APPLICANT:IL after making this Certificate itionsof m Exemption,you a must ..
Q 0 bccbme subject m me Workefs Compensduon Drovisions of me labor Cale,you nun
fnnhwi h room ply with such provision war his permit shall W deemed revoked.
4 "”'"" "�'CONSTRUCTION LENDING AGENCY - f
`�' °' 1 hereby nfhmi thm mere is a conswnion lending agency fur the performance' y,
W'. of the work for which this 'issued d(Sea 307Civ C)
, . '
Lender's Name - . ' a `
zl Q Lencerx Addre.s,•
V'0 r.I.mfy that 1 have mol this application and xmm Na the above inrunnsumn is -
:>:'F. ainece 1 agree to comply with all city and county ordinances and state laws relating
V w Wilding comuuction.and hereby autboriu representatives of this city to enter upon
W theabove-memioned progeny for inspection prmpnu..
r0..' (we)all to wve.indemnify and keep harmless the City of Qiperiinoagaiast
fn liabilities,judgments,costs and expenses which m:qin any way seene against said V V
V.� City in consequce of the Rmming of this penn'u,
- APP,IIIICANTI' ❑L'R' SANDWILLCOMpLY,N'ITHALLNON.POINT ! /
sf�GPy�;RT �L'ATI .,'I'', �_� Issued by: Date
Stgnat set Appl:caMContrdcwr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
• "511 the applicant or future Wilding occupant store or handle hazardous material. _.. Type of Roof. .. .. . ...
iV dehnW by th Cupemn M ni iPa1.Code Clr pl, 9.12 and the Heahh and Safety -
CoRi.Section 2551 (a) •I '71 i? striY
eyes, All roofs shall bm
e speeted prior to any rgofing,mat_erial being Ingtall_ed. ,.-
wh m p{c' to f t b Ie ngM I t ,�gmpnn t rid vnex when If a roof is installed without first obtaining an inspection, I agree to'remove
emit bars d ani in�nn as definW by the Pay AF.'.,9 r Q el ty Management
District' all new materials for inspection. Applicant understands and will comply with
..y °vest _./ •• ' - all non-point once re lotions. "
L1 Ease mad ma hazardous materials requirements under Chapter 695 of the
Calif..ia Hwlth,FSafety Code,Sections 25503,25533 and 25534.1 understand that
iilding duesnot cunendy have a mnam.mat it is my responibilit mnmif the
nrofheqummucts which must be mei prior to iss once of u CeniOcme of
ney. Sign ser of Applicant Date
incuriredagcm Date All roof coverings to be Class"B"or'betfer
OFFICE
I ;
Building Division
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTINO
Building Department
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 VV 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 comp�l/y with this policy.
Homeowners Name: 0,,J—,;>
Address: a(7 J �,4 a.,'
Reroofing Company Name: S c� 9
Applicants Signature: Date: 7- 'G
• Joee AntonucciY��
(Chief Building Official)
6/25/01