05010172 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT a,CONTRAC`TORff ORMATIQN
BU ILDING ADDRESS: _ FOUR SEASONS ROOFING PERMR N'05010172
OWNER'S NAME: FERMrf ISSUE DATE
ONE: SANITARY NO, CONTROL NO,
(408) 278-0330
ARCHITECEENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (� l=
+00 LICENSED CONTRACTOR'S DECLARATION ma
w I batch,affirm mat I am licensed under pro.Woro or Chapter 9 crammancing b Y c rpUo�� r.
withScetion 7000)of Division 3 ofthe Box. it Profcsimu Cade,and in,he rase is -
5n,d i"`°II`oro "d� 9 La.. �171/O.F _ REROOF W/ COMP.
$= trisect
Data Contracts, "�c
DECLARATION MAR 2005
',' ARCNTTECTS
I understand my plans shall he used is public records
3 U. 1I II I}Q /I,�''
0:1 y LKCRYd Pm(fIDOnal 11 t1 II \} a y
DWNERBOILDER DECLARATION I11'vjllf L`RIS:3`'HI rs yyAA,� siren
F 1 hereby affirm that 1 am exempt from the Conga-tors License Law for the i
D o following recon.(Section 7031.5.Business and Professions Cads:Any city or county
$ which mquims a Permit to construct,eller,improve,demolish.or repair any structure
f m y prior to its issuance,also rquiru me applicant for such permit to file a signed suument
Edo that he is licensed pungent a the provisions of the Characters U..law(Chapter 9 Sq.F[. Floor Area Valuation
a( $ (commencing with Section 7000)ofDivision J of me Business and Profeuiom CMe)in
that he u exempt thomfram and me basis for me alleged exemption.Any violation of
Scedon 7031.5 by any applicant for a permit objects the applicam tu a civil penalty of 31rbY3v8191fr19Jet0 0 Occupancy
not mom man Rw hundred dollars(SS()[)). P y Type
❑I.Mowner of me propmy,ormy employcu wim wagesu their sole compensation,
willd.the work and the structure u rot intended¢offered rental.(Sec.7014,Bus ..
and Patricia.
icia.Cade:The C.mmmraw mat apply m am s License Ldoes owner of Required Inspections
propenywho builds orimprove,meroon,and who doessuch work himselforthmugh his
awn employees,provided thatsuch improvements are not intended oroffeud forsale.If.
hawewr,me Wilding or impmvemem is sold within arc year of completion.me owner.
builder will have circ Widen of proving mal he did not Wild or improve for purpose of
salt.).
❑1.as owner of de pmpeny,am exclusively contracting with licensed convxemrs in
construct the project(Sec.7061,Business and professions Code:)The Contractors Li.
cense law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such piasters wim a c°mractor(s)licensed pursuant to de Contractors
License Law.
0 lamcxemptunder See ,BIsPCforthis¢ason
Owner Data
WORKERS COMPENSATIONDEC RATION
I hereby affirm under penalty,of perjury arc of me fallowing declarations,
I have and will maintain a Cen ficate of Consent msclf--insure forWofter Camper.
sermon,as provided for by section 3700 of me labor Code,for the p.rfmmana of de
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance.as required by Sccuon
3700 of me labor Code.for me pmformancc of me work for which this permit is issued. '
My Word�yg)esC°mpensadan lnwrancj{arier and Policy number am:
Cartier F,11 Pt, aa✓e6 u Polity Nixfr-C 0 M/C)Y 60 00030
Q F CERTIFICATE OF EXEMPTION FROM WORKERS'
.4 ^w-r I Cia, COMPENSATION INSURANCE
(Thu action need nombe completed if de permit is for one hundred dollars($1 W)
or Icss.)
I-coif"mot i"me perform anex.f the work for which oris Permit u issued,I shall rad
employ any person in any manner in as in become subsecuo tae Workers'Compentrumn
Laws of Califomi..Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifeave of Exemption,you should
become subject to the Wodmr's Compensation provisions of me Labor Coda you mug
.J,'Z forthwith comply with such Pravi ions or mu Permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(-+ I hcmby affirm that them its corouunion lending agency for Jia perfurmana of
a the wark for which this permit u issued(Sec.3(197,Civ.C.)
QLenders Name
v7- z Lender's Addm..
J 0 1 crstify that 1 hats read this application and suis that 0e above informauun is
D. H
correct.I gree in comply with all city and countympmx rontiwnm and tau laws relating e '
V
buildingconstruction,on.and(inin euthonp rtprcsenutivos of this teener upon 0u
Fyahavcmenudgm nts.coy fan inspection purposes 6�/—_�J
(We)all.to gave,indemnify and lies,harmless me City Of Cupertino against
rn inconsequencecnrs,-suend of this psraft. may in anyway accrue egging aid City
[)z in consequence of Uta granting of this permik /61:;�_l�� `
" APPLICANT U STAND ND. L COMPLY WITH ALL NON-POINT Issued by: 'O
SOURCE R ONS. / Y Date
\�•— 28�Of Re-roofs
sgnar p r-anUCa ar Date
HAZARDO ATERIALS DISCLOSURE Type of Roof
Will me applicant or future building acupani gore orhati is hamelous manna
C defined by the ClI mh a Municipal Cade.Chapter 9.13,and de Health and Safety
cads. 0 es zss3z(.>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future Wi ing aeca,rata... a; If a roof is installed without first obtaining an inspection,I agree to remove
p y pment or devices which g
it haeardous air comeminums find by the Bay Area Air Quality Management all new materials for inspection.
Diavi-n P
❑Yea
Ihave re+dMe codit. nus maurials.2553requirements U53ndcrdcba a ngafore Califon-
nuao md:$a ry Code.Sc rex 25 Y respe15534.i undersfM accurp Wilding (/ ✓X`/i \J`_� / yrs��
]acs tet togap haw ,ly a( ,that it y rrsp.mibilitY b notify tic occupant of the ! 6
myui cn-yv0liich f cm sortoissaanaofaCerdfcauafoccupanry. Signature of Applicant
/ • - Date
amhosu .g-nt Date All roof coverings to be Class "B"or better
Community Development
e f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
UPEI�TINO CITY OF Fax(408)777-3333
�
Building De artment
JOB ADDRESS: .)-(n O� S PERMPERMIT # 0 STO/ O
� Or1i,y�4� d'a9
OWNER'S NAME: Pin 3 - k4 a i r -Se" PHONE # I.X-7$-o 330
GENERAL CONTRACTOR: 77,,r gec4,,,j FAX # 278'-0333
I am not using any subcontractors: / • 2 8. 6.r-
Si a Date
Please check applicable subcontractors and com 1 e the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing I H'7a o
Septic Tank
Sheet Metal
Sheet Rock
Tile
1 -2k • 6Sr
O-wner/Cont4W6r Signature Date
Community Development Department
Building Division
k J�p City of Cupertino
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. ff 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:
Job Site Address: A020-? N ,Or+L b r k S c -
Roofing Company Name: / Fou/ Se.G.SonS P—oo-Pr,lq
A plicant's Signature: < l�C Date: / '37—o
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY OF
CUPEf�TINO PERMIT APPLICATION FORM
APN# 3 1 C 3 9 0 G 5 Date:
Building Address:
x030-} NoAl,bcoo K
Owner's Name: Phone M.Pin - Havr Ten Phone
Contractor: Phone#: License#:
Fi,;vr $eu.So✓wr Poofin x-78'-0330 g7A /08'
Contact: AIfrcclo CazareS �--78-0330
IJ Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles e-W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Jaq Other(Specify) cAL—,S t4iA (,E— ❑ 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:
—TIO cqt_,—SWAY- ,Lt 304* f`c�T A-PPLAI G,AFCira.%d C&
Residential Commercial ❑ C.o►M
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project Type of Construction: Occupancy group:
Qty. if
Applicable 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
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