01070010 (2) CI upEOND
BUILDING SSINI'FRMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10138 RIDGEWAY DR FOUR SEASONS ROOFING 010700TION810
VANDATE
IYA SUSAN P 645 HORNING ST 0705/2001
PHONE: (408) 278-0330 SANITARY NO. CONTROL N0.
O n ARCHITEC(ENGINEER; BUILDING PERMIT INFO
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k p, BLDG ELECT PLUMB h1ECtl
a z CI I=1 "_I GJ
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LICENSED CONrRACfOR'S DECLARATION
Z 5"„ Ihereby alrirmthat l am licensed under provisions of Chapter 9(commencing Job Description
FrZi-,f- with Section 7000)of Division 3 of Me B avian,and Professions Cale.and my license RE-ROOF
a Y g is in full(lace and
tY z 0 Lice Dole Connector
u-3 Lie.a �`-
Cnnlmor l�tT✓L !/
3 u A C 'S DECLARATION
'_=0 I Pace tan m Is t am,ed as public record, /
e.i p Licensed Professional
e N H map,from
DECLARATION
1 lhereb,actso aif,.that I L exempt from the rontracrCad License law fa the ,
r_'? following reason.(Season 703L5.Business antl Profusions h, Any city or county $8000
Z LF D which requirca a permit In umchuc,,abet impnrve,JemPIL M1,or repmr any Slmcmrc
� toes is a - ..
,hath ii iatp '. annoWcp vi fm t tract L La fChpmf9 , 34�441jtOFllgorValuation
Icor t heir a.em Senefromion 0)ofD vi 3 the Bneidc aphnd .AnyvsCWc) - '.).11 S ., V. t,.�., ,rat 1�• ,
,f Sec he is 31.5 b,rhercfmm and the basis fm the alleges ezEmpnon.Any l plution
of tom ma]OJ n by any applicant for a permit subjects,he applicant m a civil penalty
of tut,mar.than fiv<nundrm dollar,ls500). 305APN;aI tpA¢gE Occupancy Type
❑I.a,owneroftheproperry.ormyemployeeswithwagesastheirotecompensation. 307 INSULATION
'will do the work:and the xtmmure is am intended or offered for sale(Sec.7044, 11 RU m
Hu.(iness and Professions Cate:The Contractor's License Law does not apply to an 601 - ROOF TE T&cIGInspections''• -'
owner of property Who wild,or improve,thereon and who d«,such work himsalf 602 - ROOF PLYWOOD NAIL
a through his own employee, provided that such improvements art not intended or _ _ .. __
offered for sale.If,howevedthe building or improvement sold within-ore year of 603 - ROOF BATTENS 1.
Iompletifnnrthe owderfwiider will have the Barden ofpfoving that he did not wild or 604 - ROOF IN-PROGRESS
mprove purpose o
❑Las owner ofthe pmpcn%em<usibivclycomrofeir,wsins Coucenscdcommc,om,o
Gunman the does
Ian.]Bran owder o and Proeny who
CW<y ra,improves
nes thereon, I ,
- rniCs
License Low duet not apply mon owner of a com who build,or imprournt.pa the
..and who contracts fLow. projects with a contracmrts)licenmd.punuani.m dte - - - -
El I an of,License ISW..
O 1 am exempt under Sec. � .B&PC fanhis mason ' 1
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby ami ffirm under penally of perjuq.onc of N<following declarations:
�h5ve and will minin a Certi herd¢ n
of Comenr ,,el6
i name far Worker's
_ Compenvtion, as provided for by Senion-J]00 of the Labor Cale, for the
Performance of the work for which this permit is issued.
❑1 have and will maintain Worker's Compedsntion Insturance,as rcquimd bj Section
.- 3700 of the Labor Cade,forrm
,the perfosrc a of the work fell r
r which this pemit is
iss d.My Wsk lvis C pa i n Inca and Poliy M arc:
Carr AW N/v LclA pedcy No '
CERTIFICATION OF EXEMPTION FROM WORKERS)" '•
COMPENSATION INSURANCE" ' "; .. ._.,.. .. ...
m r
(This senlnn need not Se evann ied if the permit is for mic handled dollars
(SIW)or less.) -
,l I'nnily that in the performance of the work for which this permit i issued,1 p ,
shall nm eulaid,am,penon in any manner su as to become sahi m be Wmkerk ,
Compensation Laws of California.Date
Applicant _. _ _.. .. . . ._ ... .. . . . ... . ... . ..
NOTICE TO APPLICANT:If.atter making ihls C-llrmme of Exemption,you should
become zobject m the Worker s Compensation provisions of he LaWr Cale,you most
Q forthwith comply with such provisions or this permit shall b<deemed revoked.
� ^ CONSTRUCTION LENDING AGENCY,' i..
a , 1 hereby oRnn that them is S construction lending agency for,the fieffomnance t
W Qnf,M work far which this penal,is is.add(Sec.3097.Civ,C:I
..Lender's Name'
Lender's Address'
U 1 c<nity,h u I have head this.,plication and sae that the above information is
cont I agree to comply with all city and county ordinances and state laws reining
. Q U to building construction.and hereby authorize representatives of this city to enter upon
LJ the abovcmenlinned property for inspection p rpn,es.
(...L (we)agree to save.adcmnlfy and keep wrmles,the City of Cupertino against
'5G liabilities,judgment%.i costs and expense,which may in any way accrue against said
C''LI In eons< f the gran 'g of is penult �J—
APYI.ICAM ERSTA, A OMPLY WITH ALL NON-POINT' Issued b \L / !/��c_!-/ _ .. DnIO
SOUREE RE�UL`TIOas Y•
ff�� /
Sigfm are o Applicantlveto Date Re-roofs
Hd RDOUS MATERIALS DISCLOSURE -
Baia be 1 M s t o,frouric baso g overran, ohe or handle b u-mated,). . .Type of Roof,
. - _ ...
as tl t d by the Cupertino M n,,pal CW Charter 9,12,and the Health and Safety
0Yes .. .
CWe. an 35].14)' :;I'
�.,.., .r a
• ;� -: _ _ .) .L� ....,. , . ...._._All.roofs.shall be.inspec[ed_prior.to any.roofing material being installed. .....-
Willtheapplicantorfuturebuildingncupmuseisuipment or device,which If a root'is installed without first obtaining an inspection, 1 puree to remove
emit hvurtim,air cantaminum,a,defined by,he Bay Area Air Quality Management
District"
_ all new materials for inspection. Applicant understands and will comply.with
one." NP - " all non-point source regulations.
I
I have led the baiardou.s materials repuirem<na under Chapter 6,95 of the,
California ealthd Safery CWC Scnions 25505.255]1 and 335]4.1 unJemanJ that
'f,herb d as no,`unready here u a Ith n,is my -pun.-tiltymnohfy tb<
uc P LII Gana e w,hlC e m ardor f Cenit cam of
o p'
" p Signature of Applicant Date
Owner m twd.<a g , Date .Ali roof coverings to be Class,"B" or
$etter
OFFICE -
Building Division
10300 Torre Avenue
� y Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 2 A.n 7-u
Address:
Reroofing Company Name: (-�rjr `S eats cx45 ka)
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01