07060010 CITY OF CUPERTINO
BUILDING DIVISION PERMITPERMIT NO.
. '
BUILD(It[(i�pJX,tESS:ONG DOWN RD FOUR SE1,SONS ROOFING 07060010
G G L 3 Lr PERMIT ISSUE DATE
OWNER'S NAME:
DEANZA OAKS HOA P 0 BOX 1210 06/04/2007
)NE: (408) 278-0330SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
0 0 a o
00 LICENSED CONTRACTOR'S DECLARATION Job Description
U- I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3ofthcBusiness and Professions Codc,andmyliccnseis REMOVE EXISTING SHAKE AND INSTALL ASPHALT
y in full force a f q
License Class ` Lic.0 SHINGLE:i
F p Date 1� �+—�, Contractor
1^' AR HTTECPS DECLARATION
i a< I understand my plans shall be used as public records
>0.
U.f Licensed Professional
y OWNER-BUILDER DECLARATION
> I hereby alTirm that 1 am exempt from the Contractors License Law for the
:no 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
- prior to its issuance,also requires the applicant for such permit to rile a signed statement ,,
that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 ,q.Ft.Floor Area $8000
Valuation
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 342 4 0 00 f 3 Number Occupancy Type
not more than five hundred dollars(5500).
Q 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 sae(Sec.7044,Business Required Inspections
and Professions Code:The Contractors License Law does.not apply to an owner of q p
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 Li-
cense 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 Contractors
License taw.
❑1 am exempt under Sec B&P C for this mason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑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.
❑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 Wo 's Compe sation I rance carrier and Policy
tnumber are:
Carrier: / Policy No.:
CERTIFI ATE 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.1 shall not
employ any person in any manner so as to become subject to the Workcrs'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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z r"' CONSTRUCTION LENDING AGENCY
F~-r I hereby affirm that there is a construction lending agency for the performance of -
Q! the work for which this permit is issued(Set:.3097,Civ.C.)
aQ Lender's Name
Z Lenders Address
U Q 1 certify that I have read this application and state that the above information is
U. r- correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,Fy C/) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. eJ {�
Date
APPLICANT UNDERST ANWILL COMPLY WITH ALL NO INT Issued by:
int GULATION!
t o
Y- �`'t Re-roofs
Signature of Applican ontracl r DateType of R sof
HAZARDOUS MA 1ALS DISCLOSURE
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(x)? All roofs:hall be inspected prior to any roofing material being installed.
❑Yes �o
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
Q Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cote,Sections 25505,25533 and 25534.I undcrsivtd that if the building lCf
does not currently have a tenant,thabit is y responsibility to notify the occupant of the
must be met r to i cc of a Certificate of Oc�uPa _ Signat e A Appliea t Date
"�J 7 All roof coverings to be Class"B"or better
Owner or authorized age t I Date
CITY OF CUPERTINO
2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34210008. 00
DATE ISSUED. . . . . . . : 06/)4/2007
RECEIPT #. . . . . . . . . : BSO)0001528
REFERENCE ID # . . . : 07050010
SITE ADDRESS . . . . . : 22923 LONG DOWN RD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DEAVZA OAKS HOA
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM FOUR SEASONS ROOF
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : P O 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 8, 000 .00 147. 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8, 000 .00 0 .80 0 .00 0 . 80 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 148.76 0 .00 148 .76 0. 00
CITY OF C UPERTINO
RE:VOOF
.` cup TY Of PERMIT APPLICATION FORM
-10�001
APN# Date: _ �w
Building Address:
Owner's Name: Phone #:
Cres J. ,¢ k S ,yo,9 ���a8 S9- �� 7
Contractor: License17W /0
#:
Contact: Cupertino Business License #:
.2 3 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles C3--Asphalt Shingles
W"Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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 Cupertino's Tear Off Policy:
Job Description: lYwow-Ove exp.r11 1 S/ra ft
�irjfv// �w 3o 4' t/f //i/�y��s�t a��o/su�✓ �'/4Jf /� �i9� X trs, •• s/i/.� /es,
esidential [� Commercial ❑
R
Fire Zone: Yes ❑ No [� Confirmed with Planning Dept. if
there are any restrictions: L�
Cost of Project: T e of Construction: �t�= Occupanc�gro�►p:
1,1Z
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Pen-nit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING •
BPLANCHK Plan Cheek Fee BUILDING
BUSLIC Business License BUILDING