05060080 (2) CITY OF CUPERTINOs �-.^w@*+
BUILDING DIVISION PERMIT
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNO05060080
2224c; POPLAR rpni7p. q()
OWNER'S NAME: PERMIT'ISSUE DATE
ROBERT
ONE: SANITARY NO. CONTROL NO.
08 27 8-
ARCHITECTIENGINEER: BUILDING PERMIT INFO
nBLDG, ELECT PLUMB MECH
�86 LICENSED CONTRACTOR'S DECLARATION 90b!Desc11ri tion
YI I homey afOrm that 1 am licensed under provision of Chapter 9(cammancing P y�,
U� with Section 70(10)or Division Softhe Business and Professions Code.and my licensee
^ in full form and
Lkene"c , ns o REROOF W/SHINGLES . `j �•/ nU�
a Dam Contnmor T
ARCHITECTS DECLARATION
1 undersand my plans shall be used as public records p j{
Licensed Pmfaelnnal �� r. � \
OWNER-BUILDER exempt
DER DE Ce Contr ON r v
a y 1 booby+(Sec o n 1 a1.exempt from the GOnuacloo License Law for de .
p o following u amu.(Section 703 L4 B.abor. and Improve.
4cm ns Cade:Any city or county
$ which rtqubea a permit re cones iW alar,improve,h permit
er W,fi mpNr mmy swctum
ZSQ
prior mits issusdpurml�olte lWiosapplicant for Cmucrmi a o as Law(Catemcnt
thwromminnwit pursuant to the of Division
of the Conuinss and Prase Law(Chapter9 Sq. Ft. Floor Area Valuation
zC (comm is exempt
Section a and t f Diviaiof r of al egad Business and m.Any
laganComof
3$
that he a uempt Nem(rom and the bile for Jur alleged taempJan,Any vlalNon a(
Section 7031.5 by any applicant for a permit subjects de applicant m a civil penalty of 3 44TB13DdJ1r* '0 0 Occupancy Type
not more dam ase hundred dollars($510).
❑1,as owner of the property,or my employes with wages as their min compensation,
will do thework,and the stanctum is not Intended oroffmcd(mask,(Sm.70M,Business Required Inspections
and Pmfessiona Cade:The Communes Llcause law docs not apply m e an owner of q P
property who builds or improves Neuron.end who does such work himself or through his
Own employes,provided thatkueh improvements are not Intended oraRered forsate.IL
however,the building or improvement Is mid within oro year of complWon.the owwr-
builder ,will lave the burden of proving that k did nm Wild m improve fm purpose of
axle.).
0 1,as owner of the progeny,am exclusively contracting with Iimnsed contractors or
construct the project(Sec.7014.Business and Professions Code:)The Comractors U.
raw Law does not apply to an owner of property.who Wilds or improve thereon,and
who contracts for such projects with a contractor(s)licensed pursuant in the Communes
Lkmse Law.
❑I am exempt under See .B&P C for this msson
Owner Dam
WORKER'S COMPENSATION DECLARATION
7 kreby alRsm under penalty of perjury arc of de following declaruions:
1 have and will msintsin a CCnlOate of Cansenl m wif-haum fmwwkcesCampen-
tylion,as provided for by Section 3700.1'the Labor Cade.for the partalmmm of the
wok for which this permit is issued.
❑1 haves and will maintain Workers Compensation Insurance,as mquired by Section
3700 of the Labor Code,far the performance of the work for which this permit a Issued.
My Workers Compensation Insurance carrier and Policy number art:
Cmwn&i6AC a .4uilF�v Policy No.:ie.YV-!M/OY¢IOnY
CERTIFI TEOI7 EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(The section need not k completed If the p urnh Is(mane hundred dollars(x,100)
or ICs+)
1 certify that in the performance of the work for which this permit a Wood.I shall not
employ anymaxon in my semantic as to become subject to the Workerf Compewdon
IA.of Califomia.Dae
Applicant
NOTICE TO APPLICANT:IL after making the CeniOcate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
OZ forthwith amply with such provision or this Knelt shed k deemed revoked.
Z rn CONSTRUCTION LENDING AGENCY
[r Ikreby m.the there is ac...umwn lending agency far Ne performantceaf
E
.�.v the work for which this permit Is issued(Sea.3097,Cn.C.)
W�Q Landers Name ,
z Lenders Add.
U O 1 cattily dot I hive read the application and sum the the above information is
DO correct.l Lame to comply with all city and county on Innen and saw laws relating in
0 Wilding construction,and kreby authorise representatives of this city m enter upon the
W above-mentioned prapeny for Inspection puquws
gL (We)agree to save.indemnify and keep harmless the City of Cupertino against
y liabilities,judgments,cents and expense which may In any way accrue against said City
In consequence of the gaveling of this penult.
APPLICANT UNDERSTAN ND WILL COMPLY WITH ALL NON-POINT Issued by: Date jS�l 3-r Q ,2(r
SO,,�pRR/��E REGULATIONS. /�
3Z2=;zign pvncanoc "" — ���oa�� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupanumro arhandle haamom material
M defined by the Cupertino Municipal Code.Charm,9.13,arta the Health and Safely
ade.Section 255324» / All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or(elute Wilding occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
atoll hsvandaus air contaminants as Jc0 thy`Ik Bay Area Air Quality Management all new materials for inspection.
anv .
District?
❑Yes u
I have mW the haasrMw materials requirements;under Ckpter 6.95 of ft Califar- -
nrsHealth&Safety Cade,Seen=24505.25533 aNA534,l understand thattrue Wilding
does peirwar 4 ly have a tenmt,WI It e m e mibilhymsBdfy t amupmt of the
requircart ichmusabometpdarm lga eL'i�aw of mpaney. _ Signator fApplicant Date
-� All roof coverings to be Class "B"or better
wile,or anthariv ecnl Dae
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C 0 Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS- PERMIT#
S- G QSa G oo,&�q
OWNER'S NAME:X1E PHONE # '
GENERAL CONTRACTO FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' o tion:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass/ Glazing
Heating
Insulation
Landscaping
a
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
Telephone: (408)777-3228
CITY OF
UPE�TINO
Building Department Fax: (408)777-3333
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: 40
Roofing Company Name: a `
Applicant's Signature: Dater "-
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINOaw
REROOF �q S
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
13 yj
Building Addr s:
0 er's Phone# Yob/
C actor: J Phone #:i/08 License
ct: Phone �Qyq Cupertino Business License#:
7U
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 1�4 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles / ❑ Wood Shingles
Other(Specify)__-Z' oo ❑ Other(Specify)
umber of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and ill Comply With .Cu ertino's Tear Off Policy:
b Description: r`
.t c Cb
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: T f tion: Occupancy group:
5
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
� "24
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