05060148 (2) CITY OF CUPERTINO �=.+ .r
BUILDING DIVISION PERMIT CONTkkC"TORiINFORMATIIO
BUIIDINGADDROS: FOUR SEASONS ROOFING 1FRM11NO050 E 0148
- 22836
OWNER'S NAME: PERMIT ISSUE DATE
DAVID CHUNG 502 HORNING
NE: SANITARY NO. CONTROL NO.
408) 278-0330
A0.CHRECTR3NGINEER: BUILDING PERMIT INFO
ELECT
BLDG LECT PLUMB MECH
u
o LICENSED CONTRACTOR'S DECLARATION It I' r, y i (✓
Job script on
r�iJ I herebya.70 affirm Nal I am fthe Bu under previsions of Chapter 9(commenting
with Section 7g10)of Division Sof NC Business Met Professions Code,end mylinertu is
LL
ain full forceand I Air Zfo - REROOF W� COMP.
Z Lkense C m - Lac.4
Dam Comrcmr /— /71
ARCHITECTS DECLARATION • by.v
O 1 undersand my pluu shall bo used u public mnrds
Licensed Preform anal t�
1 OWNER-BUILDER DECLARATION BE a
3 1 hereby Affiliate that I am exempt from the Comamars License Lew for[ant� r\�V
fallowing mason.(Section 703 1.5,Business and Professions Code:Any city or county
v�$ which requires a permit to construct.eller.impawn.damnliah,or repair any structure 51,6000
Z Z?n prior to its intention.aen requires Me applicant for each permit to file a signed commem
Na he is licensed pursuant to the pmvisiou of the Contractors Leman Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of Ne Business and Professions Code)a,
.. Nae he m exempt therefrom And de basis fm the alleged ea umption.My Attlason of
Section
e mart Nan fibve p�ReHdom.f:r a per it subjects Ne applicant to a civil penalty of er0 0 Occupancy Type
❑I,ae owner of the property,or my employee with wages u their sole compensation,
will do the work,and to struclum is natimmuded moRend for W.(Sec.7044,Bminbnt Required Inspections
And Professions Code:The Contsactore s Licenue Law donot apply in an ns an owner of q p
property who builds orimprows tiureon,and who doessuch workhimulf ortiunugh his
own employees.provided that such Improwmanu ase nminmnded ucoRernE fesale.H.
however,the building or Improvement IA said within oro your of complex ion,the owmr-
Wimtr will have the burden of proving Nal le did net Wild At improve far purpose of
sato.).
❑1.As owner,of de property.am exclusively contracting with licensed cantramon to
construct the pmjem(Sec.7014,Business and Professions Cade:)The Commences LI-
ccme Law doe not apply in an owner of propertywhe Wilda or Improve Merton.And
who contracts for such prokeu with A eonmcloKtl licensed pursuant in the Contractors
License Law.
❑I amexemptunder Sen .B&PCfor Niswaaon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declarmionae -
I haus end will maraud.AceNfinm or cAnow nt to self-Wort for warieracmnpan-
salon,As provided far by Section 37M of On Labor Cade,for the parformams of Ne
work for which this permit is Issued.
❑I have And will maintain Wakees Compensation Insurance,As required by Section
370(of the Labor Code,far the performance of the work fmwhich an.permit is intend.
My Worke Compemadon Inwnnce c 'er and Polity number are:
Comer
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need notbecampleed ddc permit Is two=hundmAdoBan(SIM)
or lass)
I certify that in the performance of the work for which Nin permit is Wood,I shall not
employ any person In any manner an As in become subject o the Workers'Compensadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,After making this Certificate of Eiemption.you should
become subject in Ne Workers Componsation provisions of Ne Labor Coda you muss
.,Q foMwith comply with such prmawas or this permit Nall An domed rtwkW.
by CONSTRUCTION LENDING AGENCY
[-v I heahy mon the Nereis a construction rending agency for the performance of
Ne work for which this,Permit Is issued(Sec.307,Civ.Cd
W�Q Undeh Name ,
Z)Z Lender's Md.
V0 I certify Nat 1 have read this application sod sum Nal Ne.bow information is
Uy!". contact.l agree m comply with all city and county ordlmncea and sou laws totaling m
rV^ Wilding construction,and hereby maintains upesenotim of this ity w enter upon Nc
[11 above-mentione4 property for inspection purposes
(We)agree to saw.indemnify and keep hamleas Ute City of Cupertino against
,..r W liabilitie,judgments.emu and expenses wbich may in any my Accrue against said City
V Aconsequence
PLE NTPof the RTA A
gof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATIO
Zo,}' Re-roofs
sign 55
ofApplicantle,iffroctor Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or(curt balding occupant sw e m handle herardom material
as dented by the Cupertino Municipal Code.Chapter 9.13.Aral the Health and Safety
17-1
de. 0Yes35532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye ON.
Will the applicant or future building a MMM me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hmondom air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
trim7
❑Year 0 N
I haw Medina,haardms Ma nials requirements under Chapter 6.95 of Ne Califor. /
HuWg.Safel'Cadc,Satiau 355115.355 aW 7S53d.l unMeoM NaiftW Wiming / �� Z Q
eano cumcn ly haw a mnane Net int ts ibllity m nndfy Ne ocoupant of tiro _-.���^JJJ
e
r. be
err aarsceAOeamafOccapancy. ignature Applicant Date
2 o s pp roof coverings to be Class"B" or better
Owner eutharimd agent Dae
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
coo Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMrr#
�� Q el
M
OWNEk 3 N ' PHONE #
GENERAL CONTRACTOW(ie-�--,A-cokiieaebt2uC FAX #
I am not using any subcontractors: tol,2D-O
Signatur 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
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E TIN 0 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.
. 1* 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: ICI ObUAi
Job Site Address: (Q 9012 IAB Geo✓L
Roofing Company Name: t
Applicant's Signature: Date: O O S�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
G REROOF l�
CUPER-TINO PERMIT APPLICATION FORM
APN# Date:
20 _015
,2 -
Building... ddres
O 's I,Na e: IPhone#:
A✓/
Contractor: Phone License #:
# � Cupertino Business License#:
Contact: Phone
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )< Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify)CEM W ❑ 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,0 Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No FX Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost f Project: Type of Con ction: 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