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03050103 (2) • CITY OF CUPERTINO , BUILDING DIVISION PERMIT eco? t INFORMATION., Bath DINCADDRESs: FOUR SEASONS ROOFING PE MrrNo.0307�5,0103 OWNER'S NAME: 645 HORNING ST PERMITIsle7G,2/2003 ANZA OAKS HOA NE: (408) 278-0330 SANITARY NO. / L CONTROL NO. ARCHITECTMNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB 0MECH t� jC is LICENSED CONTRACTOR'S DECLARATION Job Description 1 I bcreby affirm Nal I un lieensop ed under pmvisiom of Chapter 9(commencing m with Seexcar1111)ar roiNnon3orthe BuslnwW Profcui OOCr and my license is FMJAL®® a`N in full fora and eReryt _3 D/ IOrGs iiti License Clans Lie.M I REROOF a W Date V Contracts, ARCHITECTS DECLARATION JUN 0 2 2003 1 I understand my plans Mall be used a public records 3y G Licensed Pnafeuionsl p R-BUER DECLARATION I hereby anion�H am exempt from the Contractor's License Law for On BUILDING a0 following reamn.(Section IID IS,Business and Profeaurns Cade:Any city Or county 3$N which requires a mmil or construct,alar.Improve,demolish,a repair my structure Z< prior N its Issuance,aim requires the applicant forsuch permit to rile a signed statement e that he is licensed POSIOMcothe Provisions Often Contractors LicenseLaw(Chapter 9 Sq. Ft. Floor Area $4V(5 I6ion di S (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ., Nat he is exempt therefrom and dte basis for On alleged exemption.Any violation of Section 7031.5 by Ary applicant for a permit subjects the applicant to a civil penalty of 3 42N Mtbiler 0 0 Occupancy Type not mom Nan It.hundred dollars(5300). ❑I,a owner ofthe property,or my cmploycea with wages as their sole compensation. will do the work,and themorcmte i.not intended or offered raraak(Sec.7044,Beat. JU5 - -FRAMERequired Inspections and Pmfessims Cade:The Contactor'.License Law dos not appy m an owner of 307 - INSULATION p property who bunds or improves re theon.sntl who doo.uch work himselfor duoagh his own employee.,provided thauach lmprowmats ate not intended or offered forala If. 601 - ROOF TEAR OFF however,the building or improvement Is sold within one year of completion,the owner. builder will have the borders of proving that he did on,build or Improve for purpose of 602 - ROOF PLYWOOD NAIL ale')' 603 - ROOF BATTENS ❑I,as Owner of the property,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS convect the ec pmject(S .7044,Business and Professions Cade:)The Communes Li- mine Law does not apply to an owner of progeny,who bunds or improves thereon,and who concocts for such projects with a contractor(s)licensed pursuant to the Contractor's License La- ❑lamexempt under Sec B B P C for this mason iOwner Date WORKERS COMPENSATION DECLARATION 1 hereby Nine under peaty of perjuryone ar the wi follong d larstians: 1 haw and will maintain a Certificate of Consent m self-insure for WarkelsCompen- ashon,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 71 baa and will maintain Worker's Compensation Insurance,a required by Section 00 of the Labor Cade,for the performance of the work for which this permit is Issued. My Worker(a,�)°mperaradc lu ton lne artier antl Policy nu bet am: Carrier. N 4.`��+-�+ Iii�e Policy No.: �• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mix secdum need not M completed if the permit ts for onab undyed dollva(5100) or leu.) I certify Nat in to performmec of dte work for which Nis permit Is issued.I shall not employ any Parson in any manor an a he become subject to the Workeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Curie,you must ,J O foMwilh comply with such provisions or this permit shall he deemed revoked. 'z ► CONSTRUCTION LENDING AGENCY [-i I fur whihOus Permit ,C h,agcneyfor dte perfurmervx of �i da work fur which thts permit is ndnetl(Ste.7(197,Civ.C.) for nds Nuns U z IsneoeeYS Address U Q 1 Modify that 1 have mad this application and mute Out the near.infmnadom is II. F cortex I agree to comply with all city and county ordinances and stale laws relating to OV building convection,and hereby auNaa drepresentatives of this city m enter upon the U movmmcniened property for inspection purposes. (We)agree to ave,indemnify and keep harmless the City of Cuperlino against IA liabilities,judgments.costs and expeao which may in any way name against aid City U 7 In conwgwnec of the grating of this permit. A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Si{rause of ApplinDa HAZARDOUS le US MATERIALS DISCLOSURE Type of Roof Will the a Cupar ter furore banding occupant no.ter handle Health and a tle,Sed by the Cupertino Municipal Cade.Chapter 9.1],and the Health and Safety I de,Section 25533(4)? h All roofs shall be inspected prior to any roofing material being installed. ❑Yu Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hoarenua air conaninan u defined by the Bay Area Air Quality Mmagcmenl all new materials for inspection. strict? C]Yes 10 /3�. Ihowmalthcbe. r maadalamquim M53ndcr Clapter6 ifthc Glding Law t does hal YCaec,Srcdonshat'l t my resndrumla 1 understand Noir..b,or On ,vJ-\/_ /_ _4/. cs Iwt ndy have Wt it u my mmponsiMlitY m notify the aecupant of than �7 ui c re which Ipoor toissuance ofaCertfuatofOccup ry. Signature of Applicant Date au,' MiQ3 Ow eroreuthadaedagent one All roof coverings to be Class"B" or better Community Development Department Building Division City of Cupertino YV 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 U P E IST 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. 1 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 t1on re-roofing. Homeowner's Name: O-e r ranA Z cti ©A l�5 l� Job Site Address: a1O 1 0,4 (11"')A Dur S P< S kS Roofing Company Name: ' '?reg Signature: Date: • GregJteel Building Official Revised 1/30/03 Printed on Recycled Paper , CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # Q Date: S D i Building Address: as 5S�( �� Clow / Owner's Name:' Phone#: &P Atzc.%_ Da,k5 904 Contractor: /1 Phone#: License#: .Se.:. c�'t-S r�oo '(�` a>3_�3,3a Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles .® Asphalt Shingles 0- Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ 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 Descri on: Residential Commercial ❑ Fire Zone: Yes ❑ Noc�L Confirmed with Planning Dept. if there are any restrictions: L1 Cost of Project: Type of Construction: Occupancy group: Qty. if A li ble Fee ID Fee Description Fee Group BPERMFEE Bldg Perniit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 2 �