03040035 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT . CdNTRACTQR TNFOXtMATIUN a:
Nz >^+ �.alRaN.r h •3i^&4
BUIL "9083s LONG DOWN RD FOUR SEASONS ROOFING PERMITNO.03040035
OWNER' AME PERMIT ISSUE DAM
CI�MMUNITY MANAGEMENT SERVIC S645 HORNING ST 04/07/2003
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT(SNGINEER: BUILDING PERMIT INFO
' BLDG ELECr PLUMB MECH
_ 0 0
0 0 1 Mraby affirm LICENSED
S1D CONTRACTOR DECLARATION
Dof LTaptcr 9(rommendng Job Descrip n 0 '
ftLJ
MIlh Sullon7 )of Divillon Sof Ne Businua dProfculnu Code.entl mylicenss is
in full fano frac o
5� LIanmGl Con, REROOF MAY 2 1 2003
n Date Contractor /
ARCHITECTS DEC AVON
lundcutand my plana shall he used seep lie rtmrda
BUILDING
3 c� Licenacci Pmfadioml
OatNEm exempt
DECLARATION
�.�i f 1 naso ,(Sam that 1 1. eaempl tram the Contractors Cc :Any c Law for Nc
foll00
which
reason,a permit
7lommuct5. ueineu and W, oli demolish,Of orth ay or county
$ pd.t requires a permit na .l. b 1,a@r,improv, ermittm repair any atmetore
F•ZSee primmits Iensedpalso rt to Me,theappbcant for auhpermitto file adgna(atatemanl
F <
(commencing
that he commecce withSemen7W)of vialomnftftheBuutosWcenuUna(Code)9 Sq.Ft, Floor Area Valuation
(cat W Is exempt herfom and of basis f B the al eged ens and Profeson.An vi Cade)of $5000
a.. Nat he Ice exempt therefrom end Ne nub for the alleged excerption.Any violation of
Section 7031.5 by any applicant for a permit wbjeets Ne applicant M a civil penally of 3� I� � 0 0 Occupancy Type
net more N 5001
an five hundred dollars(5 .
❑1,as owou of the property,or my employee.with wages as their ok compatudm,
will do tee wank and Ne mucome 1.not intended or offered for aak(SM.7044,Business Required Inspections
and Professions Code:The Contractor's License Law don nut apply to an owner of 305 - FRAME q p
prapeny who Wildaar Improves themen.and whodue..uch work himsslfmJuough his307 - INSULATION
ownemployees,provided Natauch Improvements ere not Intended orolfered formic.IL
however.the building or improvement ismld within one yew Ofcompletion,Ne owner. 601 - ROOF TEAR OFF
buulider will have the burden of praying that he did not Wild m improve for impacts of 602 - ROOF PLYWOOD NAIL
❑1,as Owner of the property,am exclusively contracting with Iterated contractors to 603 - ROOF BATTENS '
convect the project(Sec.7Wd,Bustnw and Professions Code:)The Contractor's L6 604 - ROOF IN-PROGRESS
cense law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with acontrsstorfs)limmed pursuant ro the Contrmtoeg
LIcen.Law.
❑I am exempt under SM .B@PC for this mason
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under putridly of pe jury one of Ole following declarations
have end will maintain sCenincateof Cmumt towlf-uure for Warmer Compere
1301.01
n,u Provided for by Section 7700 of the Inbar Code,(m doe performance of the
k for which this permit is Issued.
hew and will maintain Worker's Compensation Insures,m acquired by Section
of the Labor Cade.for the performance of the work for which this permit la lSamd.
Workces CampewBon Insrance artier aad Policy number art:
'Lpt''° CERTIFICATE OF EXEMPIOPL OM WORKERS'
COMPENSATION INSURANCE
(This sermon mad nothecompleted little Permit Isfmone hundred dallantSIDD)
or Ime)
1 Sentry that In the performance of Ne work for which this Permit is Issued,I shall nest
employ any penin In any mmmrm IS u become Subject to Ne Wof WCompewilon
Laws of Glifomia.Data
Affluent
NOTICE TO APPLICANT:If.after making this Certificate of Eumption.you should
become subjm't m the Workers Compensation provisions of the labor Cada you mut
.,0 foMwith comply with such provide.of this Permit total[W Simmons revoked.
CONSTRUCTION LENDING AGENCY
j-t I hereby alarm that them IS a coutmcuon lending Remy for the lerfurmanm of
Ci;> the work for which this permit is issued(Sec.5097,Civ.C.) .
W bender's Name
z
Lender'sAddtua
U Q 1 really Nat 1 haw read this application JIM state Nat the above Information la
PyF
career.l agree to comply with all city and county ordinances;and sub Is"misting to
0 C.) building convection,and hereby auflodrz representatives of this city to enter upon Ne
ILl aMve-mentioned pmperty for lurecuou purpossl. 07/
od (Wc)agree to an,indemnify and keep h urn ess the City of Cupertino against
it rv0 Ilabllidne.judgmenu.cams and expenses which may In my way acerae against Said City
F/,?A
in
() APPLICANTS of the UNDERSTANDS ANDof WILLWILL COMPLY WITH ALL NDN-POINT Issued by: Date
SOURC EGULATION
l� 5 ?
Re-roofs
S' cart of Applic.nVContncto, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will The applicant or future building recupral!tore or handle hanwdous material
u dented by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code
. Dye. sS:ta)7 X / All roofs shall be inspected prior to any roofing material being installed.
❑res �Na
Will the applicant or future building Occupant use equipment m device!which If a roof is installed without first obtaining an inspection,I agree to remove
It hevamous air mroarommts u dxfmcd by the Bay Area Air Quality Management all new materials for inspection.
amici?
❑Yea kNa
I have mad the huxa dous matoriab requirements under Chapter 6.95 of the Cattle
niaHul"SafetyCod0.Secumts255115,2555Jud2555C.1u mndNUlf Ns building r -1�
does not currently have a enm4 N a my rapmuMillly b no the asuPmt of Ile '
mquim" 'u witch mud dormX umaor'C ' Eamor Occupmey, ignature of Applicant Date
L ?O?
Own
of mthod cd.ant nam All roof coverings to be Class"B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
/'� CITY OF Telephone: (408)777-3228 777
L U PE�TI N Fax; (408) -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 i/a" 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.
Homeowners Name: 17� �A✓ 2
job Site Address: 3 Gni., �o,v �%c A-
Roofing Company Name: // d,Q �c3A��OtiJs ,I
A plicant s Signature: �%1 1/� / Date: 7- O 3\�1Ir61h1DC X1
r
Greg eel '
Building Official
Revised 1/30/03
- - - ---- _-- - _ Printed on Recvcled Paper _
r
r
CITY OF CUPERTINO
v3v � v 3�
REROOF
OnCEkTIT -1
CU PERMIT APPLICATION FORM
APN# d Date:
Y ?v3
Building Address: q
.2.24 '.3 �o c�otunJ �iv ' � .vo
Owner's Name: Phone#:
Contractor: Phone#:"Y"o 7� 03 O License#:
Sf?A O.VS oo >
Contact: Pflone#: Cupertino Business License#:
Gell, S L ng S-Sr 9 7
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles
b Wood Shakes ❑ Wood Shakes
❑ Wood Shingles � ❑ Wood Shingles
Other(Specify) /.d'M -92riew ❑ 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 21 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: lJ
Cost of Project: OU o+ E D Type of Construction: Occupancy g ups
Qty
A ica le Fee 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
•