03050046 (2) CITY OF CUPERTINO 77,70
BUILDING DIVISION PERMIT ICON"IrrZA.e"�.'C1R,Tr(F'a1�Mn' IUN .°
rF�.�r ,,•: 5 „ au. ^Y�4vn ,,del ,,.w ac�R a
Bu1LDINGADDRESS: FOUR SEASONS ROOFING PERMIT NO 03050046
964 LONr, T)OWIIJ RT)
OWNER'S NAME: 645 HORNING ST PERM "69) 12 2003
SSOTTI VICTOR Q ET AT,
NE: (408) 278-0330 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
yop LICENSED CONTRACTOR'S DECLARATION tion i Job \o
1 Wrtbestows Aram that I am nsed under pnvismm of Chapmr 9(commencing Jot3 I I'V A L E D
with SecyonJ OIMl7 afDiviaion Jaf thus Buurcsysv ata-Q-RafcssiaA Code,md my license is
in r it �`.naeR /" REROOF
�= D'aenseCks «arty MAY 2 7 2003
1q- ARCNITF.CI'SD ATION
'ysy 1undenunJ my plum Nellbecudu vi=and$
o'D
3 G Licensed Professional BUILDING
a'y5 OWNER-BUILDER DECLARATION
Ra I 1 mem am.Sa Sal 1a.1. ,Bumps from the r anwnCo License law for the
Ra O fallowing Rman.(Smit 7ID mu r.alter, Na sae.de ads Code:Any city or county
,turn
K$ which its isuap,mir aenmumLalley,Improve,dsermitt ora signed
igand arrant
Fid^ prior m its issuance.stabnqo the the applicant for nom Permit m Elio use,Luetl stanmcm
a
that hce cttnsoJpurstion7 d)ofDialomoftho flusiu r'sLtamclaw(Chapter 9 Sq. Ft. Floor Area $g){p�y1®tion
e�O thamm is ex with Section of Division uof ftse
Busineoand or.AnyansCode)fir
9
that W V esempt s""�fram and the bash for the a11egW esemption.Any violation of '
Section 7031.5 by any applicant for permit subjects the applicant m A,tall penalty of 3 442$IQdiI'7Eer0 0 Occupancy Type
not came than five hundred dollars($500).
❑I,As owner or the property,Or my employees with wages As their sole comperrmtion,
Will do the work and th,awctun is not inended or named for We(Sec.7044.Bmincas
and Prefestians Coca:The Conusewrs Lice.Law dom net apply to an owner of 307 — INSULAT 1-8N d Inspections
property who buildsor improves thermn.and who doesmth workhimself.m through his
ownemploy=.provided that such improvements fir,not intended croResed for sale.If. 601 — ROOF TEAR OFF
however.tie building at improvement is sold within aro year ofcompleim,the owner- ,
builder wi0 have the burden of proving that he did set Wild or improve for purpose of 602 — ROOF PLYWOOD NAIL
ak'). 603 — ROOF BATTENS
❑L As owner of the property,am exclusively contracting with[]ahead contratpn to 604 - ROOF IN-PROGRESS
construct the project(Sec.7044,Business and Profestians Code:)The Commute,Li-
anse law does not apply to an owner or pmpeny who Wilds or improves&man,and
who Comments for such projects with A anwmar(s)liaised pursuant to the ConVamofs
Liceae Law. '
❑ lamexemptunder Sac ,BAPCfmths ea en
Owue Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I han and will maintain a Certificate of Convent to self-[mum for Worker'sCompen-
scion,As prevalent for by Smdon 3700 alae Labor Code,for the perfamanct,of the
work for which this Permit is issued.
❑1 haus and will maintain Workefs Compensaaan Innrance.As nquired by Section
I3700 of the labor Cade.for the perfomance or the work far which thio Permit is issued,
My Worlxe. am/pp�ratiory
n Imum
rame lima and Pal' n WryLLe�
CERfIFlC COMPENSATION
NFR WORKERS'
COMPENSATION INSURANCE
man sation need not W completed if the permit Is for one hundred dmlars(SIM)
Or ksa)
I certify that in the performance of tie work for which this Permit u issued,I shall Out
employ any person in any manner an as to become subject to the Workeri Compensation
Laws of L'al[rarnla Date
Applicant
NOTICE TO APPLICANT:IL after making this CeAOcate of Exemption,you should
became nbjat to me Worker's Compensation provisions of the Labor Cotler,you most
,JO forthwith comply with such provisions or this perm115hall he deemed notal. .
Z2 CONSTRUCTION LENDINGAGENCY
[r 1hmebyairsm that mem isaeomwcdnn kralm,,,acy I'or the perrormannof
Ci> the work for which this permit is issued(Sec.3097,Civ.C.)
0 Under',Name
Z)z Icnd,es Address
V O 1 certify that I ban read this application and sum that that above infomatiun is
Iy F COMCL 1 Agra In amply with all city no county ordinances,and sue taws rotating m
O V wilding construction.And hereby authorm mirresmurtim of this city to enter upon ft
4k7 above-mentioned property far impation purposes.
ow (We)agree to save,indemnify and keep harmless the City of Cupcnino against
In liabilities,judgments,costs and expenses which may in any way seem,against said City
U Z in consrgueme of the granting of this permit _4
APPLICA NDERST AND WILL COMPLY WITH ALL NON-POINT Issued by:9102� Date
SOU CE O LAn1 d[e�,�
Re-roofs
S�ignaturtof Applics✓ ntnctor arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hassadous material
a defined by the Cupertino Municipal Code.Chapter 9.12.And the Health and Safety
Id-
ce,Section 25532(.)? 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 hasardous air contaminants a defined by me Bay Area Air Quality Management all new rials for ins e I
strict?
❑Yes
I have mad the haraNnusmanriolsacy3ard 55unser Chapter
eatual 5ofthe butidng
Health& cI Catic,Satiam2 ',4.5577 antl25534.1unacramnd lhelrthc Willing
ts not Cu ntly an a ten is my responsihllity m notify the acupanEnron
uinno whit must nlssuaaofaCcniricaeofoe pan �gnatureofAppicant Date
ncr or authorimtlagcm Dan All roof coverings to be Class aBa or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
/'� CITY OF Telephone: (408)777-3228
L U P E kT A 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: U rr
Job Site Address: a 5 y `0' d oc✓�1
Roofing Company Name: ^ems S e a -�, A°o eL 1
A plicariYs Signature: Date:_Z_ v2
\rlJr61NOW
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO o 30
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# � � �L Date:
Building Address:
Owner's Name: Phone#:
Contractor: t< hone#: License#:
Fot,r S s,s�1y ( ao a78 a3 W?Alov
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles &,Z Asphalt Shingles
,Q—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 Description:
Residential fz, ere al ❑
Fire Zone: Yes E] No ❑ Gam' Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of t: �D Type of Const o Occupancy group: ^�
Qty. if
A ble Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ene y BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING