05010169 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFURMATION.`'
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMRNc05010169
QR-PWqRAT PQ
OWNER'S NAME: PERMIT ISSUE DATE
NTRO
ONE: SANITARY NO. COL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
Y 0 0 LICENSED CONIAACnder provisions DECLARATION Oe tea O O
iwF 1Wmbyaffirm Nat1am if tluaB under radPlessof CWPter9(commencing Job E N/I,YL q�R ttpf�n"vF@Y'�y
ts with Section]IX1U)OfDiviaim Sof Um Budnw eM Proftsdan Cock.and my license is
<a in full tome end en a°
t)MZ Licen claw ?9 » S/7�/O� REROOF W/ COMP.
Z~� Dam / Comraclar RSaPA
ARCHITECTS DECLARATION MAR 1-0 2005
i w� I understand my plans shall be used as public records
DU
''0 3 Licensed Professional I�r() 11 U".4)
ry� I}
OWNER-BUILDER DECLARATION I'LI7✓l!(1 U tllll�1tL{i�9°bA'
<I 1 Wmhy affirm that I em exempt from the Cnnvecmrs License Law for the k1
i O O following mason.(Section 7031.5,Business and PoIcWon Calc:Any city or county ll
K$V which myuires a permit to construct,alter,improv.demuliN,at mpair any suunure
Fie prior w its issmnaa,also requires the applicant for such permit to file a signed statement
Fx0 that he a licensed pursuant to the provision ofthc Conuacnrs Liceve Law(Chapmr9 Sq.Ft. Floor Area Valuation
mom$ (Commencing with Section 7000)M Division 3 ofthe Business and Professions Cods)or
Nat he is exempt doorman and de,basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant on a civil penalty of 3 7PH�1CIQlftt®et0 0 Occupancy not more than live hundred dollar(5500). p cy Type
❑1,as Owncr of dm proputy,or my emplayees with wagesas dmu sole compeusadon,
will do dm work
.end theswcwre u rat intended car oRered forsde(Sec.]Ota,Besiness
and Profession Cade:The Comuacteri License law does an,apply w an owner of Required Inspections_
propenywhe Wilds or improvesdamem.and whoulmsuch work himeelfor through his
Own employees•provided that such improvements are not intended oraffered for We.If.
however,the building or improvement is sold within ane year of completion,the owner-
Wilder will have the Wrda of proving Wt he did not Wild or improve far purpose of
sale.).
❑1,as Owner of the propeny am uelusively contracting with licensed mnvenon w
construct dm project(Sec.7014,Business and Professions CMc:)The Conmmor's Li-
cene law dose not apply to an owner of property who Wilds or improve Merton,and
who contracts for such projects with a conuacwr(s)licensed pursuant m the Convenors
License law.
❑I Me exempt under See. ,B&P C for this reason
Owner Dem
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of ate following declarations:
I haw and will maimuin•Cctificate of Consent to self inure far WOdees Compeer
svinn,as Provided for by Section 37x0 Of the labor Code,for the performance of the
work her which this permit is issued.
❑1 have and will maintain War1{er a Compensation Inurance,as required by Section
3700.1 0.labor Code,for cite performance of the work far which this permit is issued.
My WorWs Compensation Insurance carrier and Policy number art:
Carrier. ,flrver/~?QeCCFOIicyNa.:WGO�e)(a0S0 OC30SQ
CERTIFICATE OF EXEMPTION FROM WORKERS
aaM.vn 1 d2 jc6WOMPENSADON INSURANCE
(Thu unim recd not he completed if the permit is for one hundred dollars IS IIXO
or less.)
1 eenify talo in the performance of 1W wad for which this Permit a issued.1 shall not
--play..,,..many manner as WCome sobjecu.the Workeri Compenauon m
Laws of California Data
Applicant
NOTICE TO APPLICANT:If.after making this CCMFICMC of Exemption,you should
baome subject as the Wod u'a Compemvoion provision of the labor Cade,you most
.J O foMwith comply with such provision or this permit shall he domed revoked.
Z Vy CONMUC'nON LENDING AGENCY
Fw IWreby aflen Nat then is a Constrortion lending agency for the Performance or
Ca> the work for which thin permit is issued(Sec.3097.civ.C.)
Qlenders Name
Z)Z lender's Address
U O I anify that 1 have read this application and all this cite there information is
ly caret.1 agra w comply with all city and county on inarces and state laws relating to
C U building construction,and hereby euthorim mpreunmune;of Nu city to carer upon the
above-mcnudgm property far impaction pugmus
F y (We)agree w save,indemnify and kap harmless the City of Cupertino against
pq incoisequM gmcnts.cmmand expenses; may in any way accrue against City
U z in eonsegmncc of the rating of this permit. '����
APPLICA N STANDyRNp WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU TIONS. /
\1�!_� -2.,3 roofs
Signzture of AyplmcanvCOn o Data Re-
HAZAMOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or forum Wilding oceupanbwm or haadle hvallous material
as carload by the Cupertino Municipal Code.Chapter 9.12.and the Hcalth and Safe,,
Code,Section 25532(a)7
❑Yes e�uo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant me equipment or dcvicw which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air cmumimut car mood by the Bay Area Air Quality Managcmem all new materials for inspection.
DWi icr7
0 Yes
I have mad the havrdousmamrials mquimmmnts under Chapmr6.95of the Calder.
nia Hulth&SafotyCodc,ScdomMM5.M533am12553a.lwmdcrmaq ifthc holding
does ncnrly have at it my responsibility wary occupant or N
o cote u w the
scquircmeA. hic m urn orwisuanaar.couReamafoccupancy. Signature of Applicant Date
owner or.utherindagcrC� Date All e0of coverings to be Class"B"or better
Community Development
J10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
/p99,T' Nar'f1.s�.-1 .S _ oS,-6/O/4-9'
OWNER'S NAME: IPHONE # 27g-o3gp
GENERAL CONTRACTOR Ra&P„� FAX # k-o333
I am not using any subcontractors: 1—,2-e-
S�
Signature 61 Date
Please check applicable subcontractors and complete the following information
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Ah Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing o n r y7 ylo�
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contract r Signature Date
/ Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U��_^I�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.
e 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: F-o ak d A . �Z"do tDLn
Job Site Address: /O /Var-lln S-,�/ S9 -
Roofing Company Name:�Fo/r S r_o s o n.3 ?—oo-�J..y
4gAicant' Date: I-17o
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFOn OF
CUPERTINO PERMIT APPLICATION FORM
APN# 3( 6 ljO O O Ooc Date:
a7-oS
Building Address:
/O q `t T Na f't1l Seu j Sq .
Owner's Name: O ri a d Ru d o k Phone
Contractor: Phone#: License#:
F'o„r Se-c"o^S in .)-'78 -033o q72/ OP
Contact: A Wrcdo Ga2sres hone#: 2.1 _033 o Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles eW Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
'4W Other(Specify) GA V—S N e K L ❑ 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:
T10 c4I sl^,zK•r. I^S+ill 3 o* 44 , e I G.hF Cfo�d Cam o.. CcI.+P
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
6, ooc> '?.00'F
Qty. if
A licable 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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