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02070092 (2) CITY OF CUPERTINO BUILDING DIVISIONCONTRACTO.R`DWORMATION• 'i PERMIT �'; Ir e , .,: BUILDING ADDRESS: PERMITN . 22921 LONG DOWN RD FOUR SEASONS ROOFING 82070092 _`96M WILLIAM N AND JOAN K 645 HORNING ST APPLICAIOW. % T // '$2002 r !HONE: (408) 278-0330 SANITARYUNO/. l b/ CONTROL NO. Q o ARCHITECTENGINEER: BUILDING PERMIT INTO s w P BLDG ELECT PLUMB MECH a 1_1 C=1 L.7 I I i LICENSED CONTRACTOR'S DECLARATION Job Description ,Z!2, Ihe.byafrnnthnlamlicensed order prositimlChapter 9(commencing REROOF _Cu wiN Sccian9000)e(Divisioe3 of the Business and Pmfessives Code.engmy license m g is in full i.e.nQeffecq�j C 2 1�1t /j� L� 3 U Data Class _ LiatrContractor-J t=9NA a O ARCHITECT'S DECLARATI : < I undemm�d my,Plops shall M used as public records 3 12003 JANp O Licensed Professional OWNER.BUILDER DECLAR ATION 1 hereby,(fere on 1 ore emmp from the Conon,Co e:Any city Low for N< e ' p� y 530 ohc greesen.(ermitto03LS.Businessrntlave.deionsh,ormnycitysmacory B�/ILDI G BOOO F e equircs a permit m construct,oltee improve.demolish,or rtpen any slru<wm Int z fNl m E o which r - 'o to issuance,also rtq rtwM1e pplicom for permiuo NeecTgmd uammrnt Nat he u l ixhsetl pis sed iso the pro l ions of the Convecmra luttnse few(Chopter9 q r1c ]p N1cc�� -- — _ ..__ .__.._u (commencing.with Section 7")Of Division 3 of the Business and Pmfessions Code) ! (.:'s Valuation or Thal he is eiein 1 theiefioiri and the bass for the olle ed esem ren.An 1 P 8 P Any of an,arm/07 t ,t any dreddollfor opemut wbjmsshe applicam sou civil pcnairy" t arimkinara men Bve nnnarm dollars(s5oo) 309�PN I`hVl�@fE i.i,•::r :• Occupancy Type ❑1,di owner of she d the s,or to employees with wages fe ed f sole compemmion, 307 - INSULATION will"do"-the Prof and the is not intended ocice eeLaw does not apply t 14 n _ •Trome,of property Who Code:The Contractors,and w Law s;a not apply m an Ion$ '� '1' 4'-d 1 owner of property Ow Who Wilds or improves Merton,and who does such work himself 6 02 - ROOF PL of Nro{M1 ti n employees provided That suchimprovementissoa not intendedyear or o(fe d'f r lE I(howevo-,the Winding orimprovement is sold withinone yea 'of ""'"" "" 6 0 3ROOF"—BATTENS' .- •.,:• "complet on,the owner-builder will have the burden of proving that he did not build or ' improve for purpose. le.). 604 - ROOF IN-PROGRESS c - 0 L - - _ Owner of the peeuYam reclusively rwsinnmenou m amrixt he (Sec ]Iii,Business and Profusions Catlof no Conuemr'a +. r.,•l `fli F,. License Lowdoes no apply m an owner ffi.o a my who Wilde sed pmu,.... ..he i' ..mM.who.commne.fLawch.projects wiN.e conwctar(q IicensW-pumuem mahe. __......__... .... ......_.....____.. ^;' `. Cenwnori Lironu Law. .-:, ,._. ❑lemeecrept under Sec."" _ _ ,_BRPCfor this rtesaa . .- .•.. .i�•IIP.^. _. ._ Owner"" Dore " 'WORKER'S COMPENSATION DECLARATION 1 her,"affirm under Penalty of perjury one of the following dederesions:-' d ❑ I hive and will'maimein a Cenificam of Consent io'self-Town for Wor Compensation.as-provided-for by Section 37W of the Labor Code. for the Performance of toe work for which this permit is issued. ' ❑1 bars war will malnuih Workw'i Coad nimioo Insumme,•ei rigoirtd by Section 3700 Vrk for'which Thu Perri u Cesaer �O,.n,e carrier war bcY number we. .. C� 1, •. issuedM WCERTIFICATION OF EREMPf10N 0M W""17S.0 ate r r Ne Performa c e(Ne wo fk Y Y q..�l'�1T 11� c No r t" . Y e d '1.. t WORKERS.•� ` - ITh,canton pled not be nom lead if NSURANCE or' ' COMPENSATION I -d,. ... ...._____ .__ __...__.............._...._.._.._.._._._._.... W doss... r completed the permit is for one hundred dollen ($1007 or(esti ' Ieathis. of _..—....,_.._ .........w._- ...._- _..1..........-...._.-......_ Ts vl s lo in the perform,m of the work far which this Permit is issued,l i.] Ties. !' c ,'ll'011„)• _._,._._..._.__,__,__._.._. hell ena.employ Laws f rwn r any madncr,w m m bedome svbJett m the,Workeri ' Compe anon Wws of California Data itr •becoICE TOAPPLICANT-If Compenking N C niOcue h Esempbon.you should z Qbecome subject to the WorkeYaCompersobon pmvtdoiu of the IaWr Code,you must forthwith complj'wilti such provision or this permit shell be dttmuus revoked. - a 1 hereby'R N t N r Is o consmaon le d ng agency f the perfo ono. T r W fNe wokfa;hch tors permins s"d(See J097 CT C) �-- U ....... . Zfenders Add •r,. ,T, _ `_ 't __ _ __ .. - ._ _ _ .;__ T C ' t- _ ,•r -0 1 endy shot I he a ed Ih s applicet on d mote shu the above informaban is Tess[~' correbl.1 agree w comply wish ail city 0hd county ordinances ontl sum(ewe ter upon�.�)', mWilding ronswmion.mtl ficrttiy auNoriie rtprcseniauvu of chis airy so corer upon [g] NeeWvomemidnW property,(or inspersion Puryous. y-� f We)agree m wve,indemriify.and keep hertnlcas the Ciiy of Cupertino ejainst rr=f/2 Habil t eq judgmems,cam e d expenses wh eh req m any wry acme against aid V Z! ChY m conseghenee of N gra t ng of Nis Peron t APPCICANTC )ER5TANv5 AID WRL COMPLY NTTH ALL NONPOINT"c Issued by: Date SiFP1 HnAZARDOUS MATERIALS DISCLOSURE dcontractor Dan.-` Re-LOOPS as d Will'he.a licant or;burden Wlldi" me or handle haaaadoos minimal, PP n8 Wcupant n Type Of ROOF: _ _ ermed by The Capacious Municipal Code Chapin 9 12 and the Health and Safety - '-"h' Code 5 et o 25532(a11 t *; ' All.roofs shall.be inspected prior-to any roofing material.being installed... ............... n Will do,a pplicion,or IINeepplcantor m acquitsdingts,, quip mardal!ceewhich If a roof is installed without first obtainin an'ins ecnon,4 agree to(iemove emit haurtl i a conumm s es defined by the Bay Arta Au Qudily Management g p g District r _ h area T­. ❑Nn all new materials for inspection. Applicant understands and will comply with i rt , all non-point ice iegulahons . --..-._ 1 have rend the safety Co ui materiels 503,2 533 an 255 4,1 understand 97 0(the �g 7 California lyHeeho k Safety Code Sections 25505 t itis and 25534 1 and uund Net (uta Wlldugda urtently haeuenenl Nanus my rupom btpty To notify the a' Ni q f ' menu whmh must be met prior to aluenn ifa Certificate of ' oRmpe ��6 Z + ignatur_of Applicant Date Ow_ No dogcm '1S t Dn5All roof coverings to be Class B or'better TI:v . n p, -OFFICE-- - --- — . _.. . Building Division 10300 Tom Avenue Cupertino,CA 95014.3255 ` Telephone: (408)777-3228 CI Fax: (408)777-3333 CUPERTiNO 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 YV 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 policy policon reroofing and will comply with this policy. Homeowners Name: �- 1 02 Address: Reroofing Company Name: Y,- S�S6 ✓tS O F!' Applicants Signature: Date: 7-/6 -� Joe Antonucci �~ (Chief Building Official) 60101