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07060013
CITY OF CUPERTINO BUILDING DIVISION PERMIT1 'I'RExmfl * } M+�T�©lY' PERMIT NO. ""'L NGA�DpR.' ONG DOWN RD FOUR SEI�SONS ROOFING 07060013 L G`�4 S f PERMIT ISSUE DATE OWNER'S NAME: DEANZA OAKS HOA P 0 BOX 1210 06/04/2007 SANITARY NO. CONTROL NO. JNE: (408) 2713-0330 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH (� 0 p p LICENSED CONTRACTOR'S DECLARATION Job Description U1 P I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing 'Z with Section 7000)of Division 3 of the Business and Professions Code,and I- is REMOVE )EXISTING SHAKE AND INSTALL ASPHALT t y in full force and Affeq, ;aJZ LicenscClass Lle.tf SHINGLE!! ;Eq Date Contractor C ITECI'S DECLAR TION i < I understand my plans shall be used as public records tyV ' U.rn Licensed Professional y OWNER-BUILDER DECLARATION > I hereby affirm that 1 am exempt from the Contractor's License Law for the j00 following reason.(Section 7031.5,Business and Professions Code:Any city or county .01 which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statementValuation e= that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;iq.Ft.Floor Area $8000 O 0 O F $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or r 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:? ( Number Occupancy Type not more than five hundred dollars($500). 0 1,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 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.). 0 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. 0 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: 0 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. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Woes Co pensation Insurance carrier and Policynuun1bcr { Carrie Policy N.W. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F. ►�-� I hereby affirm that there is a construction(ending agency for the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name =Z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is ►� correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding conswction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. 44 a (We)agree to save,indemnify and keep harmless the City of Cupertino against to 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 �� t ►" APPLICANT UN ERSTAN N ILL COMPLY WITH ALL NON-POINT Issued by: S1 ATIONS. Re-roofs SignaturefAppl ccant/C r Dare Type of Roof HAZARDOUS MATERIALS 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,SQYoonn 25532(a)?es ❑� All roofs ;hall be inspected prior to any roofing material being installed. 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 as defined by the Bay Arca Air Quality Management all new materials for inspection. District? �p� 0 Yes `- s � I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not curtently have a tenant, t 1 ' mn responsibility to notify the occupant of the rcq ust be met p r to i an a Certificate f Occu Signature of A p cant Date �� ''�4 All roof coverings to be Class"B"or better Owner or authori-zcd agent Dae CITY OF CLPERTINO 2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 3424C012 . 00 DATE ISSUED. . . . . . . : 06/04/2007 RECEIPT #. . . . . . . . . : BS000001528 REFERENCE ID # . . . : 07060013 SITE ADDRESS . . . . . : 22943 LONG DOWN RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DEANZA OAKS HOA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2657 RECEIVED FROM . . . . : FOUR SEASONS ROOF CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323 COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING ADDRESS . . . . . . . . . . : P O BOX 1210 CITY/STATE/ZIP . . . : ALAMC, CA 95407 TELEPHONE . . . . . . . . : (408) 278-0330 FEE ID UNIT QUANTITY AMCUNT 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 CUPERTINO RLROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: 3 �2 — ' }a '� Buildin Address: 6y__.� v Owner's Name:_^ Phone#: rm S 9"" �/e W,70a 4 . k s yD.-�, 5S,q— /,�; 7 Contractor: License#: Contact: Cupertino Business License #: .2 5'97--0 3 3 a / 3 a 3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles & Asphalt Shingles C9_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 C upertino's Tear Off Policy: Job Description: 171-owwwve exl rlly e"';X /y..... ; Jirjf•v//�w 3a/f �.sh_��.�-�J''�'.cs�y` ,z�m/�uw ellA.I ' /V �f/f F140 Residential Commercial ❑ Fire Zone: Yes ❑ No [r Confinned with Planning; Det. if _ there are any restrictions: Cost of Project: Te of Construction: c� Occupancy group: 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 Check Fee BUILDING BUSLIC Business License BUILDING Community Development Department Building Division l 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 a€Yee to comply with 1997 UBC Standards and manufacturers specifications on -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 a ny 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. 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. IMPORTANT: 1. Flat roofs must have a minimum of 1/i " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be as 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: D►'1 �O�v-\ Roofing Company Name: "'� f"� S �iGU�i�p A plicant's Signature: " " -Date: Greg teel Building Official Rev sed 1/30/03 Printed on Recycled Paper § Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 C17Y OF Fax(408)777-3333 ';MkTINO Building Department JOB ADDRESS:�a RA PERMIT �j OWNER'S NAME: r 04J;"s PHONE#�;' g-� GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Z?� ii,nature Date Please check applicable subcontractors and complete 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