07060168 CITY OF CUPERTINO
BUILDING DIVISIGN PERMIT +Clk�' Rc�GTt� I ' } N�1�'IUAi�`
PERMIT NO.
BUILq�rgRPzEsNORTHGLEN SQ FOUR SEF.SONS ROOFING 07060168
L PERMIT ISSUE DATE
OWNER'S NAME:
PML MANAGEMENT P 0 BOX 1210 06/20/2007
SANITARY NO. CONTROL NO.
,NE:
(408) 27f�-0330
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
�p LICENSED CONTRACTOR'S DECLARATION Job Description
%vF I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z 8 with Section 7000)of Division 3 of thc Business and Professions Code,and my license is REMOVE EXISTING ROOF AND REPLACE WITH NEW GAF
? y in full force and r t Lic n W:2 7( C GRAND CIMON ROOF SYSTEM W/30 # FELT
? License Class
p Dam A 1.2-t-v ContractorS 12
a w ARCHITECTS DECLARATION UNDERLA`.'MENT.
5 w< 1 understand my plans shall he used as public records CLASS A
)yU
u.y Licensed Professional
O a OWNER-BUILDER DECLARATION
ja 1 herebyaffirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
o m prior to its issuance,also requires the applicant for such permit to rile a signed statementc;q Ft.Floor Area Valuation
"?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $15000
(commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316 410 4:3 Aff Number Occupancy Type
not more than five hundred dollars($500).
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's u-
cerise Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License La
Q I am exempt under Sec. B R P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
LJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrierg C._./-\ Policy No.:W42\
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,JZ forthwith comply with such provisions or this permit shall be deemed revoked.
z O- CONSTRUCTION LENDING AGENCY
Fr r-+ I hereby affirm that there is a construction lending agency for the performance of -
> the work for which this permit is issued(See.3097,Civ.C.)
Gra A Lender's Name
2 Lender's Address
U C-) I certify that I have read this application and state that the above information is
�L r correct.I agree to comply with all city and county ordinances and state laws relating to
C building construction,and hereby authorise representatives of this city to enter upon the
shove-mentioned property for inspection purposes-
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
HV) liabilities,judgments,costs and expenses which may in any way accrue against said City
U ,Z in consequence of the granting of this permit. Date G `�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURC EGULAjiQNSX
;
(( 133-2 Re-roofs G
Signature of pli t/ tract Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
'
If a roof i 3 installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices w ch
emit hazardous air contaminants as defined by the Bay Area Air Quality Manage cot all new rr aterials for' ection.
District? /
❑Yes o --
1 have read the hazardous materials rcunder c Cal
niaHcalth&SafetyCodc,Scctions25505,25533and25534.Iunderstandthatifhcbuilding
fJIY/—�-
does not currently have a tenant,that it is my responsibility to notify the occupant of the
quire is which m t rior to issuance of a Ccrtifirate of Occupancy. Signature Of calIC t Date
17'o All roof coverings to be Class"B"or better
Owner or autho ircd gent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B11_: Lot:
APN . . . . . . . . . 31(41048.00
DATE ISSUED. . . . . . . : 06/ 20/2007
RECEIPT #. . . . . . . . . . BS(100001712
REFERENCE ID # . . . : 07060168
SITE ADDRESS . . . . . : 20274 NORTHGLEN SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER PMI, MANAGEMENT
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : SAN JOSE CA, 95120-2702
RECEIVED FROM . . . . : FOUR SEASONS
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS P 0 BOX 1210
CITY/STATE/ZIP . . . : ALAMO, CA 95407
TELEPHONE (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPERMFEE VALUATION 15, 000. 00 223 .56 0. 00 223 . 56 0. 00
BSEISMICRE VALUATION 15, 000. 00 1.50 0. 00 1 .50 0. 00
TOTAL PERMIT 225 . 06 0. 00 225. 06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 225. 06 AMEX
---------------
TOTAL RECEIPT 225 . 06
06/20/2007 10:44 4082780333 FOUR SEASONS ROOFING PAGE
( PAGE 02
C I —ol l�
CITY OF.C'UPERTINO
- 4
REROOP
uPr�Tli�io PERMIT PPL ICA'�ION FORM
C R
APN
3 (0q
Buildin¢ Address:
-26514/
Phone#:
Owner's Name: 2 53
Z�L e� � License#:
Contractor: Y��/4
Cupertino Business License
Conta
Type of x oof Covering:
Pr.oposed:
Existing:
❑ Built-Up Rood [3 ]Built-Up roof
Asphalt Shingles
* Aspbalt Shingles c3Wood Shakes
❑ Wood Shakes ❑ Wood Shingles
❑ Wood Shingles �� � L3 other(Specify)
lOther(Specify) c3 Provide I.C.B.O.Report#
umber of existing coverings ❑ Providc Mfgr.Installation Specs-
0 To be Removed
I Have Read,Understand and Will COm 1 With Clertino'S Tear Off Polac :
e e��St� t Ct�t•_.....e.� tic•X Q..tiel 0
00/
Job Description:�r.� - 1 d ,� U.r / ~e f
04
Residential [ Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Phanniug D t. if
there are an restrictions:
C st of Project: ype of Construction: OcctxpanC 57
1:
Qty.if Fee Description Fee ou
,A. licable Fee IA BUIL G
BPEYt1v1FEE Bldg Permit Fees
$ENERGY Ever R G
BSEISMICRE Seismic Fee Res Bim' G
BSEISWCOM Seismic Commercial BUIL G
13PLANCHK Plan Check Fee BUIL G
BUSLIC Business License BUILT ING
06/20/2007 10:44 4082780333 FOUR SEASONS ROOFING PAGE 03
Community Development Deparent
Building Di ion
City of Cup tino'
i o3o0'Torre A nue
Telephone: (408)777 3228
Fax: (40S)77 3333
Building ]Department
Subject: Reroofing policy for the ('-ity of Cupertino
1. Prior to permit issuance,you must agr�e to comply with 1997 UBC Standards
and manufacturers specifications on rf-roofing.
2. New roof coverings shall,not be applie d 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 Cit. ,the following steps are
required:
1) Pre-inspection and/or tear off apps-oval.
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.
IMPOR'T'ANT:
1. Flat roofs must have a minimum of y " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be o:1 the job site at the time on inspection.
I understand and will comply with the above stated policy o/re-roofing.
Homeowner's Name: ""`' Yc 171U�
Z�Z
job Site Address: 2<)z
Roofing Company Name:
�� 14�o�s- �10�
Applicant's Signature. -Date:
Greg Casteel
Building Official
Rc-rised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRES PERMIT #
"'( b
OWNER'S NAME: "n PHONE # _ ) O
GENERAL CONTRACTOR: 'S, FAX #
es
�3) _
I am not using any subcontractors: two
Sig nature Date
Please check applicable subcontractors and com lete 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
er/Contractor Signature Date