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05060081 (2)
CITY OF CUPERTINO �-c�e!s��n5..s/-+�^ m�'+ ',A BUILDING DIVISION PERMIT o trot. , a, a,r, s�• .� vrrtxA BUILDING ADDRESS: FOUR SEASONS ROOFING PERMRNo05060081 ' 22825 POPLAR GROVE S OWNER'S NAME: PERMIT ISSUE DATE MARI HWANG 502 HORNING ST 06/13/2005 ONE: SANITARY NO, CONTROL NO. (408) 278-0330 ARCHITECTIENCINEER: BUILDING PERMIT INFO BLDG O PLUMB MOFFCH �I ti=p LICENSED CONTRACTOR'S DECLARATION Job Description r�u 1 hereby affirm that 1 am mman demo d under MaWmts of Chapter 9(mcing with Section 70110)of Division 3 of dre Business and Pmfessi0ns Code,and my license is ^'_ �nkdtl�fam`.un° , Lk.g REROOF W/SHINGLES . g Date ConmanorI fl . 211 1 WARCHITECTS DEC RATION iL—� kLicensed Pne W ypint that umssrecordsdpublierecordsIlli"' Il` •,11 �© he OWNER-BUILDER DECLARATION jUI W rehy.m.Not 1 am escmpt from the Cauacta's Lkeuo Law for the — �y 00 following mama ser don 7031.5.Busineas and Professions Cate:Any city err county S9 which requires a permit In convect,alter,W prove,demolish.or repair my structure $6500 prior b its issuance.also mquims she applicant for such permit in Ele a signed wtemeat ggFFF< that he I.licensed personal tothcpmvislonsofthe Contractors llmnmLaw(Chapter 9 Sq.Ft. Floor AreaC (fnn� ppp Valuation S$ (commencing with Section 70ue00)of Division 3 of the Business and Professions Code)a Cr lI 3 Net be 4 mpl Nemfsom and the bub for the alleged esempliun.Any Nolatlon of /I �fll Section 7031.5 by any applicant for a permit subjects me applicant in a civil Penalty of 3er - `Occupaficy,Type oat mom than five hundred dollars(650(r). wil❑Lasowneroftheaca nymmy.tin oeswith emdfa seal roteeompeoslan, and Professions ands:The C re boots Lim LAW dos Out apply o N,Budnhss Required Inspections and property wh bis Cade:The Comrcmn, rad who Law Oma set apply lf rt owner of q p propertywho b.IdsoNmprows himq andwhodoesouchWork himselfedmmugh M. awn a however, me Wiprovided that vin Impmsemmuue ne car fc a0msW fm uta IL . however,me WildingorImprovementg that edidraneSeoofcompletion,Neawmr- builder will have the burden of proving Nn ha did rust Wild or improve for purpose of uIC.). Cl 1,u owner of the Property am exclusively contracting wish licensed contractors to construct the project(See.7044,Business and Professions Cade:)The Cmtracur s Li. come law doss not apply in an owner of property who bullN or Improves thereon,and, wh,contncu for such projects with a cot actor(s)Handed pursuant m the Contractor's Lienee Law. ❑lam ea pt antler See. A Bkitcren tthis�mase, Owner $�,� ICe Dam Jp11(� WORKER'S COMP s ON DECl.50.AT10N 1 hereby affirm under really of perjury one of 0th following declwimu: I have end will maintain aCe tilleme of Cement m self-insure for Workers Compen- alien.u provided for by Section 3700 of the labor Code,for the pmformume of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,u m iulned by Section 37W of the Labor Code,for the pmfonnanm of the work for which this permit is hand. My Work�ees�CouniZnudan Insurers cartiv and Policy number am: Canner.1-Li¢,/,F -[O Poliry N.A(k'�7��OV T10R3V CERT•KATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Tib shim need nothecompleted If tine permit Is form hundred d.Han(SI0() or kat) I certify mat in the paiurmance of the work for which this permit is Issued,I Nall not employ any person in my manner an u in become subject in the Workers'Compecua0on Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making this Certificate of Eaempflon.you should become subject m she Worker's Compensation pm.dons of the Labor Cotle,you muss ,J z forthwith comply with such provisions or this permit hall be deemed mvaked. zy CONSTRUCTION LENDING AGENCY Fos Ihereby effrt that mem isaconsmuctinn Imilmligenry for the perfurmenceid LYi> the work for which this Permit it Issued(Sec.3097,Civ.C.) W Ise Lender's None Dz Landers Md. U Q 1 comfy that I have read this application and some that the ahave inform Won Is I,.- cormcL I erg.m comply wide all city and manly a dmism.and sum Ise rctsdmg m 0 Wilding construction,and hereby authonm representatives of this city to enter upon the W above-mondoned property for inspection purposes. gy (We)agree in save,indemnify and keep branches the City of Cupertino agaios, fn Imbildics.judgments,ensu and expenses which may to my way acerae against said City fJ 7 In consequence of the granting of this pcnnll. F7 APPLICANT UNDERST S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S REGULATIO o Re-roofs Ignmum of 'ImenVConuactar Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Il the applieam or future Wilds nesupotemre or handl.handed...materiel u de d by the Cupertino Municip ado.Chapter 9.17,and me Health and Safety cale.Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes o Will sen applican,or future Wading pard um equipment or dcviw which If a roof is installed without first obtaining an inspection,I agree to remove emit handNons air conteminanu as tic by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes o 1 have mad the Immo ous mmi fialsmquimmenu under Chapmr A95af the Califor- niaHealth k SafeiyCak,Suctions 25505,15533 and 25534.1 understood she,ifmc Wilding does set currently hast a mnane thin it b en�nmamaaponsiMlity m mdfy the caupmt of the f ! 99 mq.' m ,which must be met poor m doce0 ertificam of Reupanry. Sign of Applicant Date w er Z7rcc 3 All roof coverings to be Class"B"or better owner orwl and agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C 0 Fax(408)777-3333 UPERTINO� 2 aS Building Department JOB ADD S; PE©�#soe OWNER'S AME: WX PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: 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 Owner/Contractor Signature Date Community Development Department Building Division e City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 %UPEkTINO 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: Job Site Address: Qa 4.0 Roofing Company Naire: j s _ Applicants Signature: Date: j ' Greg Casteel Building Official Revised 11/2/04 Printed an Recycled Paper CITY OF CUPERTINO G REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: (a - Building Addre : 7-A 61LIPI- O er's N Phone#: Co ctor: Phone# License#: act: Phone Va8_) Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑/ Built-Up roof C3 � Asphalt Shingles n Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles Other(Specify)LI&Agyppe/ ❑ 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: b Description: J : Residential K Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type C ns tion: Occupancy group: D 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