02070094 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT `CO
PERMIT
BUILDING ADDRESS: PERMITN .
22991 LONG DOWN RD FOUR SEASONS ROOFING 82070094
WALKER SANDRA A 645 HORNING ST APPLICA`61s�19972002
PHONE:
q (4 0 8) 2 7 8-0 3 3 0 SANITARY N0. CONTROL N0.
{v 0 z ARCHITECTIENGINEER: BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
�?i U C.I L '7 Li
Z_S2= LICEN5ED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under EEm,sion,of Chapter 9(commencing REROOF P
Iw1:1 with Section 7000)of Division 3oflhe11.6atssend Professions Code..nd my license I
'i A, � Lcense force end tlkSl, 'y/o P FIN AL
O o h License Class ` Lic.N / IJ F
3 O Date Commmor
LL O(r ARCHITECT'S DECLARATIGIN
L r s ate o d my plans shall be used as Public records JAN 3 1.2003
ip O Licensed PmOu,wul
OWNER-BUILDER DECLARATION A p�
1 hereby a?nn shat 11. aurin from the Commcmr',License law far the BUILDING
C?< following reason.(Semon]031.3,Business and Professions Code:Any city or county us 8 0 0 0
F F C which requires a Permit A. re comtwes.Quer,in mve,demolish. file
repair arty t.m.e
t°J 3C$-prior ro iu iuusnn.efwrquirts the Ikantf«suchpenniuofienseLow(Cnemcm
q - . .. ..... . _
dwth.issing aepmwiottoihe Purvis sof the the Busiam AndPelaw lChapter) n'• ',3d¢4�V,�IDIDcfQ@ara. ValUflllOn — -
(commepcine,wit[t,$enion TfJ(�0)of Division 3 of the Business end Profcesians Code? - ..r.s• l h.l.i,5,',,,.% c.3 s.l a!,\.•i„':sat..,'• :
at that he N ceempf theiefrdm and the basis for the alleged eRnnpsiofi.Any violation
of Section 7031:5 by any applicant for a permit subjects the applicant roe civil penalty
'!of not fimiclhen Ove hundred dollars(SSW). 30%PN AULME _. TQI'' Occupancy Type
01.a......frhe proprny.mmy,.pl.,,.with wages.,their sale compensation, 307 - INSULATION
will clothe work;ono the strita. ie mi imeudea or-offered for.].'(Sm:7664;' q-_•,
'Business and Professions Code:The Contractor's License Law does not apply m 601 _an 6 0 2 - ROOF PLYW u QC[IO71S -
owner of property Who builds or improves rherton,and who does such work himself .1.L
or throw h his own employees.provided that such improvements an not intended or
;q. reale.If,Wweve the Wildmi r Improvemmr is sola within our year of ' 603--'`ROOF 'BATTENS '�'” - -'--'
Rcred
smmr�ova for to o%ner-Wider will have the burden of proving that hedid not Wild or 604 - ROOF IN-PROGRESS
P PrP
n n:mownerpmjcc p(SmrtYam eusiniss and mmnisions Wenud Contractor',
- -�;U^J;'>".i --
_ - - License the does
n (Sm.7044,Business and Pmfahons Code:)The ws t eaor's I`
[;_ Liana Lew car mar apply m mj owner of property who Wilds or impmsua thto be
+.;.. wrd.wctor. wcte.for wch Prof«u wim.a.contmctw(s)licensed pursuant to be .-__.__. ..._-_._.. ...,_._ _. _ ......_.,.. ,...-..r
_r License Lmv.
❑tealexempt under Sec "..., " '"I B&P C for this reason �•.)l: ft Il�rll
Owner r''Daie''
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pnnahy of i ecrury one Of the following declarations: -
7 ❑ 1 have and will'inunuin'e Cenificsie of Consent m self-insure for Worker's
l{, j_ Cnmpensmion. as-provided for by Section 3700 of the Labor Code, for the
perfonnece of the work for which this permit is issued.
°1 have•and will Wdiniaie Wotkar i Compensaiion Insurtnce,As mxgmred by Section
-=
3700 of the labor Code.for the p6fomre,«e of the work for which this Permit is
Issued My W rke,s is pe]]]ggg...rrruuu��tt�on���I���niun«e nat/e�r a�nd Policy' mbar arc: -
Corti lley N �lJ C� /' Z
llll����
"` 'CERTIFICATION OF EXEMPTION FROMWORKERS" �. .64It.GI' . % ff , r, r h.?E.:IL',T!i r. s •' :11'
COMPENSATION INSURANCE', "�
mlis'Rfll6n A
ttd not E<'rompleied If the permit is for o«hundred dollen
,shl Ian,loy.y I 6inmi A in
eof the as,to become11.
to is iseded,l ;It, : pr;p.1'•,fil'�"' �• `
shall not employ Ws.f rwn in'Iny'manner w 1 m become wbjen m"Ne Workers' '
Compensation Ws.f fabfomra De..
..AppLcani '�•. 'r � .
'NOTICE TO APPLICANT If.Workers
Comkingpensation
n OTC Lnsnsof of Lempton.y you mulct '.r-
becomeh comfy thewith
such
Colons or this proriaani I the dLGWr Code,you must
00 _forthwith comply wiN each pmvi,ions w this pemsit elull W domed revoked.
CONSTRUCTION LENDING AGENCY _. _._ ._ _._ J 1 �sr• _-_' _
thereby willom that the 'is a construction lending egencyfo� perfo
W-,Q ofrh sk fur hrch N ape t Isivad leer 309]Cs C.)
LendNam .. ... .,. I u.... . ...___ _, .._._...._ _- ._...... _ ..._
Lend Add' r c .._..
v' '..b,
0 1 certify Nat I have rtW this application and nate that the above information Is
tq correct.l agree In comply with all city and county ons inanm and nate laws relating
0"E to Wilding mosWction,and herttiy authorise rcprtumaiiJes of this city to enter upon
the aWvemcmioncd pmpcnyfr inspection purpose, „
G.r'p,t ' IWe)epreemube indetlln fy and Jeep hennless the'Clry fCupenrno El.rat
Fr V] cit
liabilities,c Judgmen0 f 1h and expenses may,n any way a«rve against said
C.J aZ City m consaaqqu, f Ire go ting of Nis PA.Y "- /VL
APPLICANT STA.\ AND WILL COMPLY K ITH ALL NON.POBJT I''a
so RE nD� �,1C�� Issued by:
ate
SI ppl HA2,nvacmr Det Re-roof Roof
HAZARDOUS MATERIALS DISCLOSURE .
Wll tea eppllcam orfatare Wilding 6cc pwtarae o hwdle hazardous ten V .Type O OOf --
u defined by m Cupertino M nrctp.1 cede Ch pre 9 12 end the Health and S.f.ty - - ` "' --
Cade S«uon 25532(elo Ts I ,i t I 5 's .,f. s 1 e a t s 1 - -.
°Y" °i,: t P" All roofs shaD be inspected pnorto.any roofing,matenal being installed,_,-,_._.__.-
. . Will die applicant TaalonWlldln`«cap.I uequipm nt rdevl aWhich If a roof is installed without first obtainingani ins ectio'tFa Tee to remove
ithe dbytheBeyArce it alnyMinagetnens P g
D' all new materials f r inspection Applicant understands and will comply_wlth
`i _.- -
em t haxudous ser conumsmnts u define
4 ` Wnam and mw rtnte I ;' all non-point so a regulations
°Yrs
Cat Vs requirements under Chepier 693 of tha
fo a HeeIIA k Safny Code Sections 23505 23533 and 25534 1 u denund that
f th 8 y nimt that t is my rceponslbduy to notify the
AeE t of die quisenunuWhich must be met pnorr m Waimea of a Certificate of
Oce •
" p'7 Si attire f Applican[, Date
r uthom ed sent Date, „ All roof coverings to be Class"B"or better
Building Division
y 410
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
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 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 above
policy on reroofing and will comply
/wiith this policy. .
Homeowners Name:
Address: / O✓�Q�JLpcJ�
Reroofing Company Name: (nytC) �,c c
Applicants Signature: 1,2 Date:
Joe Antonucci
(Chief Building Official)
6/25/01