06050034 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION"
BUILDING ADDRESS: s FOUR SEASONS ROOFING PERMITNO.06050034
22866 POPLAR GROVE
OWNER'S NAME: PERMIT ISSUE DATE
DE ANZA OAKS HOA 502 HORNING ST
ryE: SANITARY NO, CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too LICENSED CONTRACTOR'S DECLARATION L
wF 1 Iemby affirm that 1 am licensed under provisions of Chapter 9(commencing O IOn
?ZW with Sectimn701g0ofDiAmi.3ofthc Businwand P.I.M.Cade.and my license is
a"cN mfull face and erfee TEAR OFF SH V2" CDX AND GAF GRAND
juyz Lice�Lselausyy ue.g �- � SEQUOIA SHINGTTTT� SA'. J50 YE CLASS A.
Datz_ S —Convenor S ✓I
sf� ARCHITECT'S DECLARATIONJu LOOO
f e e I understand my plans atolle
be used as public co tit
,.0
C H LicensedPmfel
ssione
S OWNER-BUILDER DECLARATION nth dse,�
iC I Wrthy a(Sect Nal 1 em.Bump, s an J r Cssion of License Law for Ne I■ !0/ �nYv
p O following mumu. (anti t Wn Ls,Business and are.demmits Coot:Any city s roomy
<m which rtquimsapermit recorewcLaper.improve,h peraftt of mpsig anytatemen:
u i 6prior w its issuance.aisu requires the applicant for such permit W fiW a signed sutement
that he is licensed pursuant to the Provisions of the Comracwrs Lunn.Law(Chapter 9 Sq.F[. Floor Area Valua[i 15500
e�C (commencing with Section 7000)of Division 3 of On Business arta Pmfessions Code)or
i $ this he is eaemp,therefrom and de basis for the alleged eamnpuon Any violation of
Schon 7031.5 by any applicant for a permit subjccts the applicant to a civil penalty of ApN umber Occupancy Type
on,more Woo five hundred dollars(SNI 34 5 3 3019 . 0 0
0 L m owner of rhe pmpemy,ear my employees with wages a Weir sale compemadon,
will da the work and the structure u not mumded m offered roma,.(Sec.70th,Businw
and Professions Code:The Connaamor's Luxnx Law does not apply W an owner of Required Inspections
propeny who builds or improves theacon.and who doessuch work himselforNrough his
awn employees,provided War such improvements are mtinteMW woRerrd roan,.If.
however.Ne building or improvement is sold within one year ofcompletion,the owner,
builder will have On burden of proving that he did on,With or improve for purpose of
sok.).
❑1.as owner of the property.am exclusively convecting with licensed convatmor to
counteract the project(Sec.704x.Business and Prafrstio s Code:)The Cou¢acWrs U.
cense Law docs not apply W an owner of progeny who Wilds or improves thereon.and.
who contracts for such projects with a contractor(s)licensed pursuant to We Convectors
Lkeoee Law.
C]I am esempr under Sec B A P C for this reason
0. Dae
WORKERS COMPENSATION DECLARATION
40 I hereby aR under peaW ty of perjury me of the fallowing dcclaruions
❑Ihaveand will maintain aCerifseawof Cmuseniwself4mum for Wof esCompeo.
setion,is provided for by Sonion 3700 of On Labe Cade.far Ne performance of the
work for which this Permit is issued.
1 have and will maiourm Workers Campctuation Insurance,as required by Seeders
37W mf WC Labor Cade,far d e peffonnance of the work far which this permit Is issued
My Workers Compemafion Ms..carrier and Policy number are:
Carrier�gyy...a o.-.. W 6 1.v_o Polity Na.:I•1.e+4 ZU(I
CERTIPTCA OFEK PnONFROMWORKERS'
COMPENSATION INSURANCE
(rho section need not he completed if rhe permit is formic hundred ditham($100) v
or less.)
I cemify Oat in do performance of We work for which this pennir is issued.l shall not
employ any person in any manner an as in Weomo subject in the Work<ri Compevsedon
Lawn of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you Would
become subject in the Workers Compenssuon provisions of de Labor Code,you mut
,z foMwith comply wit such provisions;or this permit shall be doomed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-+ 1Wreby affirm Jet dere is a construction lending agency for the performance of
7.> the wart for which this permit 4 issued(Sec.3097.Civ.C.)
Qfenders Name
Z fenders Address
U Q I certify that I have read this application aM sue that the above infamauun is
[4 P Co...1 agree w comply with all city and county mrdinames and sem laws relating w
�U building conswclion.and hereby authorise mpresenetives of Nle city in enter urine the
shove-mcnudgm rimPcny,Tor inspection por,riwhich may
F h (We)agree w save,indemnify and keep harmless the City of Cupertino against
to incoities.JWgmems.cow and esnsinfing of this Permit. may in try way acrneagaiuslaeid City
U APPLLIIC`gANI UNDEtionce,of do,RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOVR REGUS.
Re-roofs
Sigulume ol'App culuiCimmaim, Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupantsu m m handle havardous material
u de0ocd by Ne Cupenino Municipal Code.Chapter 9.12.and the Health and Safely
Code,Semen 25532(a)7 All roofs shall be inspected nor to an roofing material beim
❑Yes �Na P P Y g being installed.
40 Will the,applicant or future building occupant use equipment or devicest which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardru s air romissuo its u defined by the Bay Ara Air Quality Managcmcnt all new materials for inspection.
Dianne,'
p Yea —rZa
I have new the haraNnw\materials requirements under Chaprefd.95 of Ne Califor.
iia Health k Safc,y Codo.Sections 25505.25533 mJ 25534.1undtowed thatif Nc Wilding
duce ml currendy have a vnam,that it is my responsibility in testify the occupant of the
mquiremenu which mwpgt prior W issuance of a Certificate o(Occupancy.
YJ _ Signature of Applicant Date
lia
eL � All roof coverings to be Class"B"or better
Owner or mthom agent Dae' g
CITY OF CUPERTINO
Sm 1 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34533019 . 00
DATE ISSUED. . . . . . . : 05/04/2006
RECEIPT # . . . . . . . . . : 34240
REFERENCE ID # . . . : 06050034
SITE ADDRESS . . . . . : 22866 POPLAR GROVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DE ANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY : . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPERTINO
Building Department
JOB ADDRESS: PERMIT #
c-r C m d 0/' a() Y
OWNER'S N PHONE #
GENERAL CONTRACTO FAX #
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and lete the followmi information:
21 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
r
er/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408) 777-3228
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.
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: z//�/_ Qn7� t /c�CISI, b A
Job Site Address:r2 Q 'sUL'o :a �--1y
0
Roofing Company Name:
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
utoC60054
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
l - O Gi Z O(o
Building Address:
o / C-t
Owner's Name: Phone #:
.3 .
Contractor: License#:
SI?CIO 271Z
Contact: Cupertino Bgsiness License #:
.�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles V —Asphalt Shingles
Af— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) __ ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report N
1B To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will ComI With Cu ertino's Tear Off Policy: El
• Job Description: "nokF- C£ 5�3 1 iN3k�_k\, f Ztt CDxI cy. („a G(an guo,
0 C I6,s
Residential S._ Commercial ❑
Fire Zone: Yes ❑ Nom Confirmed with Planning DAVt. if
there are anv restrictions: Ll
Cost of Project aoType Construction: Occupancy groT
S Soo — o Cy rL
Qty. if
7NBUSLIC
Fee ID Fee Descri tion Fee GrouPERMF=Edit Fees BUILDING
ENERGBUILDING
SEISMIee Res BUILDING
SEISMIommercial BUILDING
PLANCk Fee BUILDING
License BUILDING
•