04090060 CITY OF CUPERTINO ^� yd.- =r -�'•�"w'1 +'�.
BUILDING DIVISION PERMITCQNTRACTOR';,I1VFO�RMAT"IONIw
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITN 04090060
N AM : PERMIT ISSUE DATE
Ay PP.ESTQN CA I; uncim:rMn PT 3:
12
LONE: SANITARY C N OL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
I� E I�
LOO LICENSED CONTRACTOR'S DECLARATION
w 1 hereby affirm that l am limned under provisions of Chapter 9(commencing Job Description
iW Cwth Sac don 700Bof Division 3of the Business and Pro 'um Code.and my list.is
y 11 me and coon. '
,qz Liemanclaaa G-99 ue.a a/ Y7Z/09 REROOF W/COMP.
Zip Dau 9—/l-OY CunlruC
e 'sJ / ARCHr(ECTS DECLA-16
RA ON a
m lundcrsan y plans shall Muuda PUM1lic nrnrds S
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.� Licensed Professionalfig OWNER-BUILDER DECLARATION
I hereby affirm Nat I am exempt from she Comraaor's License Law for the
i
00 following mason.(Section 1181.5.Business and Preasdom Calc:Any city Or County
which"unto;a Permit an construct,after.improve,demnlLsh,or repair any structure
prior to its issuance.also requires she applicant for such Permit to file a signed statement
�Z< that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuators
ni (commencing with Station 7")of Division 3 of the Business and Professions Code)or
Wthat M u exempt Ihcmfrom and he basis for the alleged cumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of er Occupancy Type
not moa Phan five hundred dollars(M). 3 GVVP . O O P Y YP
Q 1,as,owner of the propvty,or my employees with wages as their sole compensation,
will do the work,and the nmcture is not Oriented or offend for sale(Sec.10M1a,Business
and Professions Code:The Contractor's Licame Law does not apply to an owner of Required Inspections
property who builds or;mprows thereon,and who does each work himself or through his
awn employers,provided that such improvements an,not intended or offered for sale.If.
however,One building or improvement is sold within one year of completion.Ne owners
builder will hale the burden of proving that he did not Wild or improve for purpose of
❑1.a Owner of be pmperty,am=elusively contracting with Banead cmnuacmrs to
construct tie pmjcct(Sec.7044.Business and Impostors Code:)The Conf uds's Li.
cons,Law does not apply w an owner of property who builds or;mpmsss themon,and
who contacts for such projects with a contractor(s)licensed pursuant o the Convector's
License Law.
Q l am caempt under See .B R P C for this mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aRnn under penalty of perjury one of the following declarations:
1 have and will maintain aCenifiou of Consent to sel6lnsum for WmkersCompcn-
our,as provided for by Section 37M of the Labor Code,for the performance of Nee
1031',W
rk for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
of the Labor Code,for the pri.romen of Ne work for which this permit is issued.
Work rs Compensation lnsuan<c cartiu�and Pohl. r.g..,w.aa C•. .fAa.uidfrfrN 005 DIDD03D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CITU amino read not W completed if the Permit i5 for roe hundred dollars DIM)
1=a.)
I certify thm in the perfame ncc or the work for which this permit is issued.l shat nm
employ any person in any manncrso as to become subject in one Work W Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this CcoiO=e of Exemption,you should
become subject of the Wod crs Cmmpcmation provisions of this,Labor CMc,you mum
.J 0 forthwith comply with such provisions or this Permit shall he demand mvokcd.
z N CONSTRUCTION LENDING AGENCY _
(-� I hereby afford Nat Nen is a consbuctinn lending agency for the performance of
tai the work for which this permit is issued(Sec.3097,Ch,C.)
W Q Lenders Name
=z I<Mer's Address
U Q 1 certify that 1 have mad this application and state that the about information is '
W F-' commet.1 agree to comply with all city and county ordinances and state laws elating to
DU building construction.and bceby authorine apracnuJsu of his city to enter upon the
17 4 above-(We)agree
to arm,
for inspectionkeeppurposes.
(We)agmc to mars nde expenses
and temp harmless the City of Cupertino against
U Z in
Of
he raning=this Pewh;ch may in any way accmc against aid City
C.)Z in convegwnce of the Sranling of this permit.
APPLICANT NDE TAN ND WILL COMPLY WITH ALL NON-P INT Issued by: Date
SOURCE GU A NS.
% 9 y Re-roofs
Signa of Applic met Date
H.ARDD 5 ATERIAIS DISCLOSURE Type of Roof
Will the applicant or furor tiding occupant same or handle ha udous motorial
u defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Wee.Semon 25531(a)?
❑Yea �Nr All roofs shall be inspected prior to any roofing material being installed.
W;II the applicant or Toone budding occupant esu cyuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmardoua air conmmimnts u Jcfined by Nee Bay Area Air QUIlity Management all new materials for ins 'on.
IDsWa?❑secsNi have mail the Wardousne erials mquimenots underChapter 6.95 ofthe Califon
FMaINBaSa(etyC .Seedolu 25505.15533 am1255J4.l undersand Nv;ftM buildingcs not M1W� aL,,Iomy,��Osimfitym itinotily the mcuPenl of aha con Laic InUnionacntihmterraeapan\y. Signature of ApplicantDate
-�jwyAll 1700 coverin s to be Class "B" or better
er or awhorixcDa¢ g
Community Development
. 4 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT#
10465 Glenview Av. 0kA01oc%0
OWNER'S NAME: 'TAY Pa,eSToN PHONE # (voa) 2-la -03 0
GENERAL CONTRACTOR: F.IX GlEASONS V( oFiN� FAX # o%r 2n8-o
I am not using any subcontractors: ca J —�(/
� qIf?,
'
Ig ' 04
Signature U 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 SeA50,4s �1}2t09
Septic Tank
Sheet Metal
Sheet Rock
^� Tile
_ 9- 13 oY
Owner/Contracto St ature Date
Community Development Department
Building Division
,? City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
SUPEkTINO
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 re-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. 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 1/4 " 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: SAv PRESTON
Job Site Address: Qy,
Roofing Company Name: Foul GeAsoNs -P,o�Fi.)q
A phcanfs Signature: CZ gg C===E Date: o4
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF v C� ° " D
CUPERTINO PERMIT APPLICATION FORM
APN # 30- I t—
Q34 Date. 9 13 Ot-I
Building Address:
10465- GtleAviet,. Ave .
Owner's Name: Phone
T #:
V A PIZ.ESTON Cyo8) -,}S-0330
Contractor: //�� Phone#: License#:
Foutz S¢ASO�S �nOFjtjq 41a10$
Contact: Phone#: Cupertino Business License#:
CAeI-0S CAZAe-ES 6-108) SGo - olyl
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) d Other(Specify) F-
( OD .p
Number of existing coverings �-- ❑ Provide I.C.B.O.Report
A To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: tf�� 1
�EMOUI; GX�S�In rb,,R rz ,� Yz"c.oX eLl cows SLS. .»
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni if
there are anyres ons:
Cost of Project: Type of Construction: Occupancy
IL 8 000gelzooy=
Qty. if
A li e ) Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
\ BENERGY EnergyBUILDING
J BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
7 � ��
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