03040033 (2) CITY OF CUPERTINO s ""'��"�"R"�'� "'t"'""'S "� Ln
BUILDING DIVISION PRRMIT h COONT1tATOR�INFRMrATION
BUILDING DDRESS: PERMIT NO.
29.71 LONGDOWN RD FOUR SEASONS ROOFING 03040033
OWNER NAME: o PERMITLSUEDATE
`6OMMUNITY MANAGEMENT SERVI ES645 HORNING ST 04/07/2003
E: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ERCT' PLUMB MECH
0 0 0 0
1186 LICENSED CONTRACTOR'S DECLARATION Job Description
Z 1 hereby AM,m that 1 am licensed under provisions of Chapter 9(commencing P
with Section l0(llq of Division Softho Bualnus and Pmfessines Code,andmliceuels
orce S<� ullse Cwnd ett Lica
n .
Dem Ctmmce r ✓ „a t REROOF
t7 .r y plant
shall .ukd As CLARATION - 9=0
0 p�p ALF,
p n p)—R3
65eu I undcrslend m Ices shall M ukd u LA recordsATION $�l/�'tiw IT—r7�
i c
Licensed Pmfrulontl
OWNER-BUILDER DECLARATION juN 1 0 2003
1 hereby Maso .(Sere o that i exempt from Jon Caroms Co Licence taw for 1W
p O following moon.(Saito 70313,strBusiness and vc,dcro ll Code:Any city or county
cure
$ which requires n penult re construct,else imProse,h Peri(fie.sig ed awmure
Fly,+
that
prior m its licensed
iissuance.ndporm nt to resthe the applicant of mnuch permit la fence La signed statement
ggg p
(commencing
cingwJPumtion7 )ofDislounithcConuincomittnsehoonsC.4mr9 Sq. Ft. Floor Area 1 uation
$ lan,he nettempth5atitns andtfOivision 3ctfor nfthe
eged euandom.Any
Code)or U00
Jut he V exempt Uemfrom and the buts for tie alleged tatmpJon.Any Httstlon of
Section 7851.5 by any applicant fm a permit WbJecu the appliunl to a civil penalty of AJI ,nb it 0 0 Occupancy Type
not mom than Rus hundred dollars($508).
❑1,u owner OftbepmPeny.omycmpoinso with wages u theUtoleeompenudan,
willd.the"AL and thesuuctum 1,not in¢nded or offered forsale(Sec.7044,13ualttw Required Inspections
and Prefeulotu Code:The Commences Licerum law does not apply m an owner of 305 — FRAME 9 ns P
property who builds.,Improves thermn,md who docsnah.1chimselforUwuglt his 307 - INSULATION
ownemploycet,provided that such improvements sse not Intended ooffMd for Asia IL
howcvu,the building M improvement is sold within one year nfwmpledoe,the owner 601 ROOF TEAR OFF
builder will haw;the burden of pmving that he did ant wild m improve for purpose of 602 - ROOF PLYWOOD NAIL
1,as Owner Of the property,am exclusively conlneting with licensed commema to 603 - ROOF BATTENS
construct the prOW(Sec.70N.Business and Professions Code:)The Contrsetm's u. 6O4 — ROOF IN-PROGRESS
come law does not apply m an owner of property who builds or improves theater,and,
who contracts for such projeM with aconoacmrp)licensed pursunt m the Conuannael
Licence
❑I am eaempl under Sec. .B R P C fm this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
have and will maintain a Cenlncam of Consent to selfduum for Workers Compere
11331YO(
n,As provided for by Section 3700 of the Labor Code,for the performance of the
work for which rob pctm;t is issued.
hove and will M.I.I.I.Worker's Compensation Imurutce,u enquired by Section
of the labor Cade.for the performance of the work for which this permit h blued.
% h Compensation Insurance carrier and Policy number see:
Polityo.• ylG D nG7 a7
CERTIFICATE OF EXEMPTION FFpR WORKERS'
COMPENSAnONINSUH' CE
This ration decd not he completed fifth Permit Is for one hundred dollars(SIM)
tor less.)
1 cenify that In Ne performance or Ne work for which this permit B issued,I shall not
employ any permn In any manners As to become subject to the Workrm'Compensation
Laws of C.Iirmoi..Dam
Applicent
NOricr TO APPLICAm:If.after making this Ccnlncem of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you most
.Ja forthwith comply with such provision or this Permit shall ted reacted invoked.
r� CONSTRUCTION LENDING AGENCY
j—t1herchyfice W
ofal then is a construction ction lending agency for the performance,of
a;> the work for which this permit ts issued(Sec.5097,Civ.C.)
94 lenders Name
0.nom. z Lenders Addecu
t.)0 I certify that 1 have mud this application and slam that the aboro Information 1,
W H
comet.l agree to comply with all city and county ordinances and slam laws mleting m
0U building COMMICtion,and hereby Audi reprexamillim of this city to enter upon the
W above-mentioned property for inspection purposes.
y (We)agree in save,indemnify and keep benches the City of Cupertino against
fA liabilities judgmenu,costs and esp.which may in soy any sector against said City
U 7 In consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS A�fD�1WWWLLL{{{���COMPLY WITH ALL NON-PO NT Issued by:qjtQ� Date
SOURCE REGULATIONS. //
�(/ Re-roofs
Ignuurt of AppllcaHA7A rade Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nr appllesm ser loom building occupml store or handle huallour mamnel
As defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safely
Codc'sookm355534? \- All roofs shall be inspected prior to any roofing material being installed.
EI Y. �n
Will thcapplicant car mom building Occupant use equipment or ucda,which If a roof is installed without first obtaining an inspection,I agree to remove
It haurdno air rontammants As deMcd by We Bay Am,Air Quality Management all new materials for inspection.
WriCt9
❑Yes tin
Ihaw mad the herSevii mamriats5533 requirements understand
imuithe Celi(on ��
nuHeslW&Safety Code.Sectio mmeria.35555 anJ35sun.lundcrsundlhuiite Wilding
dorm not cutmndy hese a tenant,that it mespomithills Identify u t of the
mquimments which must W met iuu of a Certificate of Occ
�(�/ 17_U3 . Signature of Applicant Date
Gunter or authorized agent Duce All roof coverings to be Class B"Or bC[[er
r
Community Development Department
Building Division
d City of Cupertino
'` 1L 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkT]NO
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: /J _19/a �� �
Job Site Address: ..��? !'� G.gA., �G�LeJN Cigasx/p. Q.
Roofing Company Name: ��/-n✓A, Sg<A�r A iv S /fle55 o
A plicariYs Signature: Ci-�� l Date:,�Z"�3
Greg eel
Building Official
Revised 1/30/03
_. Printed on Recycled Paper
CITY OF CUPERTINO v 3 e �-z,:ry 33
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# U.. fy Date:
Building Address: G�
Owner's Name: Phone #:
/it J
Contractor: IPhone#: License #:
ovG sow oO�- Lr— 8 03,20 „? OdK
Contact: hone #: Cupertino Business License #:
06'.S.S` l 9 7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 2' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
.0 Other(Specify)�- �oz:yl ❑ 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 Polic
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions:
Cost of Project: Type of Construction: Occupancy group:
.1!;— O U Oi
Qty. if
Applics0eFee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING