05070122 CITY OF CUPERTINOBUILDING DIVISION PERMITCONTRAC�TORINFORMAT `
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BUICOING ADDRESS: FOUR SEASONS. ROOFING PERMIT No.05070122
114? KEDITWOOD AIT
OWNER'S NAME: PERMIT ISSUE DATE
TRWTN RFRNHARnT
E: SANITARY NO. CONTROL NO.
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ARCHITECTrENGINEER:
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ARCHnECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
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LICENSED CONrRACTOR'SDECLARATION JObDesDn Description
C 1 hemby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P
b witb Section lIXN))af Division3of Jm Business and Prufcssinns Cndc,end myliansc is
�„ inmBm eanderreµ9L. 41, t0T TEAR OFF EXISTING 2 LA
YE
RNALED
�� Date o-o contatorRATIO _c- 40 YR GAF COMPOSITION
ARCHITECTS DECLA
wU I undersand my plans shall W uud u public records /)
LL Licensed Professional _�J/s��
A03 OWNER-BUILDER DECLARATION 2005
.�i 1 hereby mirm Nat 1 am exempt from dm Contractor's License Law for the
00 following mason.(Section 7(01.5.Business and Professions Code:Any city Or county
S which mquirn a permit to construct,alte,improve,demolish,or repair any suucture
prior m its issuance,also requires the applicant for such peroit to rile a signed statement 01 oil rII go
< NatW isliccnxd pursuanun Nc provision oftWComractor's License Law(Chepmr9 Sq.Ft. Floor Area 'a 00
Y_O (commencing with Section 7000)of Division J of the Business and Professions Code)or
i 3$ that he is exempt Nciefrom and Or butes for the alleged exemption.My violation of
Section 7031.5 by any applicant fora permit subjects the applicant O a civil penalty of APN Number Occupancy Type
nm mom Nan five l undmd dollen($S00).
0 1,as Owner of Or property,or my employees with wages ueir Hsok compensation. 35931052 . (](]
will do the work.and the structure is not imencied or mRcmd period.(Sec.7044,Business
and Professions code:The Contracmra Licence Law dms not apply man..or of Required Inspections
property who Wilda or improves Ncmon,and who doessuch workhimselfor through his
can employees,provided that such improvements are not intended moRered krsale.If,
however,the building or improvement is sold within one year of completion,the Owner-
builder will have the Wrden of proving Nat W did not Wild or improve for puryosc Of
ak).
0 I,as owner of the pmpcn,,am exclusively contracting with licensed contractors to
construct Or project(Sec.7064.Business and Profastions Code:)The Cmtracter's Li
cove law does not apply loan owner of progeny who Wilds or improves theme n,and
who contracts for such projects with a eontnctor(s)Iicnued pursuant to Ne Contracto's
License law.
0 I am exempt under Sec. .B h P C for Nis mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hemhy altno under penaltyof perjury one of the following culaations:
I have and will maintain a Ccrtifimu of Covent m elf-ivurt for work.rs
work Compcn-
, provided ripe by$sIsiun 3700 of the Labor Code.for the performance of the
wmk for
which this permit is issued.
have and will maintain Worker's Compensation Insurance,as myuired by Section
3700.f Ne labor Code.for Ne peRormanee of Or work for which this permit m issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis sectim reed not becompleted if the permit is for obe hanNed dollars($100)
or dcsa)
1 unify that in the performance of the work for which this permit is issued.I shall nm
employ any pecan in any member an as to become subject to Or Worker Compeream n
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nis Certificate of Exemption,you should
become subject to the Worker a Compensation previsions of the Labor Code,you must
.J,$ forthwith Comply with such provisions or this Permit shah W deemed invoked.
z OCONSTRUCTION LENDING AGENCY
��+F
I heriby affirm that ft.iso construction leading agency for Nc performana of
a the work for which Nis permit is issocd(Sec.309'/.Civ.C.)
4 Q Isnder's Name
7 z Larder's Address
U0 1 certify Nat I have mad this application and sum Nat the,above information is
IP.F coronet.I agree to comply with all city and county ordinances and sum laws Orating to
O U building construction,and hereby authorim representatives of this city to enter upon me
F61 imovo mentioned property for inspection purposes
gy (We)agree on save,indemnify and keep haumksa Ne City of Caputo.against liabilities.judgmcnu.costs and nsacm
expenses which may in any way uc against said City
U in consequence of the granting of this permit-
^ APPLICANT UNDERSTANY54kND WILL COMPLY WITH ALL NON-POINT Issued by:94 oilDate
SOURCE RE L S.
—.w+ �' z Re-roofs
Srgnawrc of Apphc H o R US MATERIALS DISCLOSURE Dau Type of Roof
Will me applicant lir future building occupant stare or handle hanrdous mammal
Us defined by the Cupertino Municipal Code.C1mPmr 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes 930
Will the applicant or future Wildingoccepant use equipment or devices;whim If a roof is installed without first obtaining an inspection,I agree to remove
..rat husmomus air cmaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑yes
I have real Ne hanniour materials requirements under Chapter 6,95 of ft Cali foo-
nia Health&Safety Code,Secuom255O5,25533and25534.1un&m=dNatifthe Wilding "7 --Z- 0S-
dpi notcumenthe Liaw a t +d�tP;�tt t is my mspomihility to neeOccupant needy the of the
requirements h etprtormissuameofa Ccrefiamof Occupancy' Signat4of Applin 3I Date
Owmrmacsherimdepmt Dam roof coverings to be Class"B"or better
CITY OF CUPERTINO
I� 6 of 6 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35931052.00
DATE ISSUED. . . . . . . : 07/20/2005
RECEIPT ##. . . . . . . . . : 30441
REFERENCE ID # . . . : 05070122
SITE ADDRESS . . . . . : 1142 KENTWOOD AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : IRWIN BERNHARDT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SUNNYVALE CA, CA 94087-2429
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 5, 000.00 115.56 0.00 115.56 0.00
BSEISMICRE VALUATION 5, 000.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 116.06 0.00 116.06 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 642.36 A/E
TOTAL RECEIPT 642.36
Its
- Community Development
fL 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OJPEkTINO
Building Department
JOB ADDRESS: PERMIT#
1147- ke„-Fwoo4 Ave (j—CO-70 /21L.
OWNER'S NAME: =c-�;„ B a,h l and+ PHONE #
GENERAL CONTRACTOR: F w r �..sa.s R. , ` FAX #
I am not using any subcontractors:
Signa Date
Please check applicable subcontractors and complete e following information
66 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
Owner/Contractor Signature Date
Y i Community Development Department
�€ Building Division
# City of Cupertino
• 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEI�TIIVO
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.
S 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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.
Homeowners Name: 7t:70Lw#,+ SER+ 2nd
lob Site Address: ` M?-{ 1��✓ � t.9�oc� Av e
Roofing Company Name: ra r Seas o,n z "Fi"r
Applicant's Signature: te: -7-74 -ate
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
OF
*"EkTINO PERMIT APPLICATION FORM 0,56 70/c�2 a
APN # 3 ,S`3 31 0,S7'7- Date: 2 O . os'-
Building
sBuilding Address:
1142 K-eA4w000 Aver.
Owner's Name: Phone#:
1:rw4n gerrt�,ar-ck+ 9,T—+- 6`t 02
Contractor: Phone#: License #:
Four Sera.SonS &,,ciFl"a Z-48 -o33(3 Li09
Contact: Phone#: it t , Cupertino Business License#:
l- 'rulo CaZarC% o5-1 a3
Type of Root.Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
,e- Asphalt Shingles �Asphalt Shingles
C) Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
,2)- To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, On and Will Comply With Cu ertino's Tear Off Policy:
Job Description: _rear 0eYiS41A3 2 lwyarS $ wrF1y t-lo yr CAF CoMp6Si+f on .
Residential1Qo SQ Commercial F1
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
a T000 (Z.er,,.F
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING