09030228 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �' � '
BUILDING ADDRESS: PERMIT NO.
20091, 20111, 20121, 20131, 20141, 0151 FOUR SEASONS ROOFIN 22
OwNNl9)RqA14WOOD SQ PERMIT ISSUE DATE
PMT MANA( FMFNT SANITA O. CONTROL NO.
ONE:
( 108) 278-0330
ARCHiTECT/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby a1rrm that I am licensed under provisions of Chapter 9(commencing
z� witbSection7000)ofDivision of the Business and Professions Code,.and licenscis
in full nd e R:3-RF RPLC EXTNG ROOT SYS W/NEW GAF GRNDCNYN
y farce a �
]r�z Licenac Claw y Contractor A,3PHLT RTSYS p Datc
Contractor
ARCHITECTS DECLARATION
CI u rstand my plans shall be used as public records
5WU
Win Licensed Professional
n0.<
a OW NER-BUILDER DECLARATION
I hereby affirm that 1 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
,4 8! which requires a permit to construct,alter,improve,demolish,or repair any structure
yZ In prior to its issuance,also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yr (commencing with Section 7000)of Division 3 of the Businessand Professions Code)or $44000
y .. 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 APN Number Occupancy Type
not more than five hundred dollars(5500)• 3 L 6 3 6 0 4 2 .TWNH S E
❑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 q
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 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 Workers C pe7ation 1 surance carrier and Policy numbcber/a��rQ
Cartier. tC1/ Polity No.:Y^` J 7 _
CEFMFICA F EXEMPTION FROM WORKERS'
CO PENSATION 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
E r C4 ►hereby affirm that there is a construction lending agency for the performance of
a > the work for which this permit is issued(Sec.3097,Civ.C.)
WCI.A Lender's Name
Lenders Address
(�C) I certify that 1 have read this application and state that the above information is
LL" correct.1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
Wabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
rF,y liabilities,judgments,costs and expenses which may in any way accrue against said City
�iJ
U Z in consequence of the granting of this permit. Date ��_� /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued b)
SOURCE REGULATI
G-=y 7 Re-roofs
Signature of Applicant/Contractor Date r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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(x)? All roofs shall be inspected prior to any roofing materi ming installe
❑Ya
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
it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new r.iaterials for inspection.
rstrict?
❑Yee f °�
I haveread the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupan of the
requirements which must be met pno u f a Certificate of Occu
P � giiature of App scant Date
0 r rrrcd agent
Date All roof coverings to be Class'J ''or better
Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on i e-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be appli ed without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the I uilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to a:1y 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 nF.it 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 f,!e of$176.18. The re-inspection fee must
be paid before another inspection c,tn be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of I,i "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be cn the job site at the time on inspection.
I understand and will comply with the alb/cve stated policyonre-roofing.
Homeowner's Name:
,p,:z�y/_ ill
Job Site Address:
Roofing Company Name:
,o
Applicant's Signature:�'�-----'sem • �''G' Date:
Greg Casteel
Building Official
Revised 07/30/08
q 03 0zzg
^ CITY OF C'UPERTINO
REV:OOF
CUPEkTINO PERMIT APPLICATION
APN # �� 0(4 Date: 3 1S11c)
j
-31
Building Address:
Owner's Name: ri�, �aircG.v Phone #: (41tAV --
'373y
HOA: Yes No ❑ If yes, provide letter from HOA
Contractor: Phone #: CCt 0S) v 3
Fax#: '
Cupertino Business License #: Contractor License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles LL_ ❑ Wood Shingles
X Other (Specify) C�1,� ` hkkl, ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: /ke e4(4s/7;V /vv;C-
Residential Commercial ❑
Green Building: Please complete relevant porton of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
+ REROOF
-UPEkTINO FEE SCUEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Corrmercial B ICOMMLROOF
IBCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBSEISMICO Seismic Commercial B
1 REROOFRES Re-roof Res.dential B 1SFDWLR00F
6 �
IBCBSC Cal Bldg St«ndards B ALL PERMIT TYPES
Commission. Fee
IBSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Mu.ti-Family B 1MFDWLROOF
IBCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBSEISMICRE Seismic Residential B
1 BUSLIC Business Li,-ense B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
f'UPEkTINO
Buildin V e artment
JOB ADDRESS: ,, // PERMIT # Cl p
OWNER'S NAME:
PHONE # rf�'' 2 7k—vs G
GENERAL CONTRA 0 R oir, ,,,✓ S;r,. FAX#
017
I am not using any subcontractors:
Si€nature Date
Please check applicable subcontractors and complete the folloEin BUSINESS LICENSE #
SUBCONTRACTOR BUSY ESS NAM
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
Owner/Contractor Signature Date