05060079 (2) CITY OF CUPERTINO a
BUILDING DIVISION PERMIT
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNO05060079
OWNER'S AOP! A.R GRGVB Se
M . PERMIT ISSUE DATA
]NE: SANITARY OL NO.
ARCHITECT/ENGINEBR: BUILDING PERMIr INFO
BLDG EO PLUMB MECH
O
n00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby a(IUm Nn 1 am licensed under prevoof Chains,9(commencing
I. Section]0111)a(Dlviaion 3 of Ne Budrra4 W Pro(esdons Cade.W mylittnse b �r �1
in fu11 forte and9f(e51.�
z Lnenm Clgst_L.t'L_Uc.« REROOF W/SHINGLES`� �IA%�E®
Dam � (A -or ComrmWr ova
ARCHITECTS DECLARATION
l 1 understand my plats sNB le rad u public wordsieu
i G� Licensed Pafesaianal
` 2005
OWNER-BUILDER DECLARATION
I mA,so rm Nn 1 a1.uumpt from the C aloes Code:Licensey.Law for the
O O following union.(Section 7031.5,Business and n.damns n,oAny dq or county cture ) 'nl II I� Y 1\ l/\/
. $ which uirm a Permit w coon,dic tlee harpoon.dPermit,or a sire scan., - __ -V V v
prior W its iuusrec,eluant to the tie applicant the Cork Permit W wosw Law chamem
q�< that(commencing
end gwt pursuant la 0)previsions of the Conuamr'aUttnmlaw(Chapmr9 Sq.Ft. Floor Area Valuat on
S
AgoI.eaccuit wiction70ndth basis n3ofthe.SeBusiness md Prafmions Cade)car
Wt k b wmpt Dertlrom and the bub far the allegred vmptian.Any violation of
Section 7031.5 by any Applicant for a permit subjects the appl Want W a civil penalty of3 gq�P�I�•bjgy�lerp p Occupancy Type
not mom than R.hundred dollars(5300). -
❑I,As owner ofthe property,m my employees with wages As Nen mlc compensation,
will do the work.and theswctu.bnoUmmnded confined funic(Sm.7034,Bminiaa Required Inspections
and Pmfessians Code:TIM,ConvmWrs Liwue Law does not apply W an owner of q P
property who builds car improws thereon,and who does such warkhimsal f or through his
awn employees,provided that such improvements art not Intended oraRered forMle.If. -
hem,cr,the Wilding or improwmmt is mid within one you of completion.the owner-
builder will haw tie burden of proving that he did ret Wild or Improve for purpose of
sale.).
❑1,as owner of Ne property,am exclusively connecting with licensed connmtors to
construct Ne pmject(Sec.7044,Business and Professions Code:)That ConusuWri U-
cense law dor not apply W an owner of property who Wilds or Impmws women.and,
who contracts for such pmjec,wish aeonwcwr(s)licensed pursuant W due Contractors
Lice.Law.
❑1 am mompt under8cc. .B 8 P C far Nb mason
Owner Dem
WORKER'S COMPENSATION DECLARATION
1 hemby Amon under penalty of perjury ane of to following fluctuations:
I haw and will maintain•Collocate of Consent W self-iuurt far Worker4Compen-
ndon.u provided for by Section 3700 of tie labra Code,for the performance of the
wing for which this Permit is issued.
❑I haw and will maintain Workers Compensation Insurance.u mquirtd by Section
3700 of the Labor Code.for the Performance of the work for which Nis permit is Issued.
My Workers Compensation Insmance curiar and Policy number an:
filer:fa/F L.,«F-N(ate Policy No.:/�.YM7D/DlL12Dnuo/
CERTIFICATE EXEMPTIONFROMWORKERT
COMPENSATION INSURANCE
(This when=it not In completed if ik permit Is foram hundnA dollar($IN)
or rasa)
1 airy that in Ne performance of the work for which this permit is issued,l shall not
employ any person In my Answer an as W become subject W tin Wargen'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making N4 CertiOmm of Ewaption,you should
become subject W the Worker's Compensation previsions of an,Labor Code.you most
,J O foMwish comply with such provisions or this permit shall Ate deemed rowan.
,zs v~N.nCONSTRUCTION LENDING AGENCY
(r Ikreby aEm NU Bert is a coneruction lending agency for Oe performance of
�i the.,it for which Nb permit is issued(Sec.3097,Civ.C.)
WQ Lenders Name
M
.7 z Lender's Address
V Q I carfify that 1 haw mad this application W gain that the show information Is
Is,E correct.I agree W comply with all city W county ordinances and sue lam relating W
Q V Wilding construction,and hemby authada represanwim of this city Wanler upon shat
W above-mentioned property for inspection purposes.
(We)agree to saw,indemnify and keep humlm she City of Cupertino against
y liabilities,judgments,costs and expenses which may In my my accrte against Mid City
C)7 inconmqucnceofthe graining of omit.
r7 APP ANT UNDERSTAN D WILL COMPLY WITH ALL NO Issued by: Date Ca—_r a_''Y\
S E REGULATIONS _
Re-roofs
ignesurea Ppliww Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
/111 the applicant or future Wilding Occupant gone orhendle haardous memrial
AsRoed by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(4)1 All roofs shall be inspected prior to any roofing material being installed.
applicant oru
Will she applicant future building occupant me equipment Of devise which If a roof is installed without first obtaining an inspection,I agree to remove
milt hannicns air contaminants As defined by the Day Area Air Quality Management all new materials for inspec
Dimic4
0Yes
u
Ikwmadthelb. mese WmqulroommatxlerChapmr6.95a1gshe Calilb,. /
nia HcalNdSalcly Cale,S=4ou25N15,25533W25334.lunwnwdthitiftie Wilding
dem not currently how a unsart.31agpi,is my AtEgandleflity W notify she occupent of the
ro is which mug is, nfAMikemofOccuparuy, ignature Applicant Date
-azo All roof coverings to be Class"B"or better
Giinucomijk6rined,gant Wm
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aCOF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDR S: PERMIT#
OWNER'S NAMEjffAePHONE#
GENERAL CONTRACTO FAX#
I am not using any subcontractors:/,//b�r.,�l�� r.Z—
—�Signature Date
Please check applicable subcontractors and complete 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
qW
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPER,TINO
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: (n,P/f4S� /o�Pl//i�
Job Site Address: Z 1 . �na/n�P Leo✓l/
Roofing Company Name: i,Q c[t eJ A r
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
�8 - CITY OF CUPERTINO S� G
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
- r
BuinAddreOwPhone#:
Ccrtor: Phone Yu6 License#:
o
c XM-(3130 '172 IDFJ
tact: Phone `W) Cupertino Business License#:
0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '4 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
X Other(Specify)ism./g, ❑ 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:
J b Descriptio :
i /2q A&,Wl4az 40
Residential K , Commercial ❑
Fire Zone: Yes ❑ No uf Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Projec S Type Cons ion: 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
563
72 .