07060014 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDINy G,.PTI"LONG DOWN RD FOUR SEI�SONS ROOFING 07060014
L L S S PERMIT LSSUE DATE
OWNER'S NAME:
DEANZA OAKS HOA P 0 BOX 1210 06/04/2007
JNE: (408) 278-0330 SANITARY NO. CONTROL NO.
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0
0 O LICENSED CONTRACTOR'S DECLARATION Job Description
U
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions'-Y-) Coded my license is REMOVE EXISTING SHAKE AND INSTALL ASPHALT
y in full force andelrr
�z
Li cen ClassCC.� Lic.x SHINGLE:;
F w Datc Contractor
ARCHITECTS DECLAR 1ON
i C< I understand my plans shall be used as public records
>yU
'
U.F Licensed Professional
t y OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's Uccnse Law for the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
Z prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 :iq.Ft.Floor Area $8000
O O 0
t t=- (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 any applicant for a permit subjects the applicant to a civil penalty of 3 4 2 4 0 01 I) Number Occupancy Type
not more than five hundred dollars(5500).
❑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 salt(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractor's 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 contractors)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
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 Workers 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 Wor Compens tion I ince carrier and Policy, be
numr are: / `
�,
Cartier s Policy No. ,r �:.��v �O�v`
CERT ATE OF EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not bo completed if the permit is for ane 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 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' CONSTRUCTION LENDING AGENCY
F~ ►�.r I hereby affirm that there is a construction lending agency for the performance of
(Y > the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
aLender's Address
U 0 1 certify that 1 have read this application and state that the above information is
VY ►'r correct.I agree to comply with all city and county ordinances and state laws relating to
CU building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned properly for inspection purposes.
L1. (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of-4hi N"L
DateAPPLICANT UNDERSTA L COMPLY WITH ALL NON-POI Issued by:Sc�c7cPATIONS. �_j e"h
Y` `_J J V Re-roofs
Signature of Applicant/Conlractor Dare Type of R sof
HAZ OUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni pal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs:;hall be inspected prior to any roofing material being installed.
❑Ycs Mur)
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m 3terials for inspection.
District? /"
C]Yes OXu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections,25505, 533 and 25534.1 understand that if the building a O
does not currently have a tenant. at it i responsibility to notify the occupant of the
re must be met nor ssu cc of a Certificate of of Date
All roof coverings to be Class"B"or better
Owner or authorized ageml Date
CITY OF "-UPERTINO
2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 34240010 . 00
DATE ISSUED. . . . . . . : 06/04/2007
RECEIPT # . . . . . . . . . BS000001528
REFERENCE ID # . . . : 07060014
SITE ADDRESS . . . . . : 22933 LONG DOWN RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DEANZA 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 743 . 80 006931
---------------
TOTAL RECEIPT 743 . 80
Community Development Department
zo Building Division
t City of Cupertino
10300 Torre Avenue
-..' Telephone: (408)777-3228
�- CITY OF Fax: (408)777-3333
CUPEkTINO
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 i e-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildijlg 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 Ci-y, 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 withou:first obtaining an inspection,
will require the removal of all new m iterial down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 114 " 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: G-
Roofing Company Name: �`'�
Applicant's Signature:
Greg QaWteel
Building Official
Revised 1/30/03
Printed in Recycled Paper