07060011 CIT x;OF ICUPERTINO �TIQ
BUILDING DIVISION PERMITlTRATt? (�
�p
PERMITNO.
""In DOWN RD FOUR SEPSONS ROOFING 07060011
L L PERMIT ISSUE DATE
OWNER'S NAME:
DEANZA OAKS HOA P 0 BOX 1210 06/04/2007
SANITARY NO. CONTROL NO.
NE: (408) 27E-0330
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0
p Q LICENSED CONTRACTOR'S DECLARATION lob Description
P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE EXISTING SHAKE AND INSTALL ASPHALT
=y in full farce and–� L O SHINGLE.
Lie.
o ? License C1azs #
a Date Ji – Contractor
tA HITECTS DELLA ATI
i aa
< I understand my plans shall he used az public records
�yV
'u.H Licensed Professional
w OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
in Op� 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
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement `q Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions o!the Contractor's License Law(Chapter 9 $8000
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'.�41 Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages az 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 does 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 conuactors 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 Contractor's
License Law.
❑1 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:
❑1 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 Wor s Compensation Insurance carrier and Policy number are: h'
Carrier: Policy No.: AIR!. V
CERTIFI AT OF EXEMPTION FROM WO KERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 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 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z, CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
LIG the work for which this permit is issued(Sec.3097.Civ.C.)
(SI Q Lender's Name
Lender's Address
U C 1 certify that 1 have read this application and state that the above information is
Lt." correct.1 agree to comply with all city and county ordinances and state laws relating to
O U building construction.and hereby authorise rcpresentativcs of this City to enter upon the
W ahove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against /
Co) liabilities,judgments,costs and expenses which may in any way accrue against said City
V'z in consequence of the gran' this permit. Date
APPLICANT UNDERS A D WILL COMPLY WITH ALL NON-POINT Issued by:
LATTO S. LA-62i—
Re-roofs
Signa ure of Applica Co for Dam Type Of R)Of
HAZARDOUS MATERIALS DISCLOSURE
Will the a�plia t or future building occupant store or handle hayardous material
as defined by the Cupertino Municipal 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.
❑Yes EJ'Nu
If a roof i:.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 az/�t�fined by the Bay Area Air Quality Management all new m iterials fo ,laaSpec
District[❑Yes o L5+
61 have read the hazardous materials requirements under Chapter 6.95 of the CaliCor-
nia Health&Safety Code,Sections 25505, 53)rod 25534.1 understand thatif the building
does not currently have a ten it ponsibility to notify the occupant of the
rc must be l prio su c of a Certificate of Occup _ Sign ture of A�pli ant Date
All roof coverings to be Class r'B"or better
Owner Jr authorized a cnt Datc
CITY OF CU?ERTINO
2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk: mot :
APN . . . . . . . . : 34240 )11 . 00
DATE ISSUED. . . . . . . : 06/04 /2007
RECEIPT #. . . . . . . . . : BS000 )01528
REFERENCE ID # . . . : 07060 )11
SITE ADDRESS . . . . . : 22941 LONG DOWN RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPER`CINO
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 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 8, 000 .00 :_47. 96 0 .00 147. 96 0 . 00
BSEISMICRE VALUATION 8, 000 .00 0. 80 0 .00 0 .80 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT :_48 .76 0 . 00 148 .76 0 . 00
CITY OF CUPERTINO
REROOF
euPE TINO PERMIT APPLICATION FORM
l
APN# Date:
342 - 1 (0- C1-Q)--Df
Building Address:
l7W
A,
Owner's Name: Phone#:
Contractor: License#:
Contact: Cupertino Business License #:
r--:513 3 0 a / 3 a 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles arAsphalt Shingles
L9-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.
Er
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: A,-~e exp sf�a, s1,.�,fc .-G� .,,,rf�i� r�c�✓ 2 f,�x .�/y.....
/0x/.tW 3a �/f �h`/�/.�y+��ts�t za®/suw /mss /a �?f/F �•�.��.Sc c.s, Sli.. /tet
Residential Commercial ❑
Fire Zone: Yes ❑ No 2- Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: T e of Construction: �`L_ Occupanc gro .
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Pen-nit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK -Plan Check Fee BUILDING
BUSLIC Business License BUILDING
y¢ �a;ti Community Development Department
r Building Division
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 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. 1f plywood is installed, a plywood n&I 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 pei formed.
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 ort the job site at the time on inspection.
I understand and will comply with the abox a stated policy on re-roofing.
Homeowner's Name:
Job Site Address: dy Ck).
Roofing Company Name: �`'�
A plicant's Signature:
Greg teel
Building Official
Revi!ed 1/30/03
Printed c n Recycled Paper