02110074 (2) CITY OF CUPEK11NO -
BUILDING DIVISION PERMIT .,CONTRACTOR INFORMATION:
Bu RED:RAKE DR FOUR SEASONS ROOFING PERMHEBD2 110 0 74
owK1&XN1N--: YEE 645 HORNING ST APPLICA'110V a ret T2kr-2002
IONC: 408 278-0330 SANITARY NO.77__��-- CONTROL NO.
ARCIUTECTIENGINr:BR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w00 LICENSED CONTRACTOR'S DECLARATION O O O
c P I M:mny arfixm that l am h.nua um.p ismas of Chapter 9(commenC1ng RE-ROOF
lob Description
�« with Sectinn��IN��ffNNnf Divisinn3nf the BusirmxPmfcssiuns CoJc.and myli.nm is
in full
o°}�Z Liccase lass — Lic.N 4- ��
z—o Dam 1_�_2.__S�Z_—comacl r F.,o< 4a
��~� 'C ARCIIITF,CTS DF RATION ut
DEC0 C a I uhJcratanJ my plans shall M used as Public record.., 0 9 2002
_LL 0t Licensed Professional
� yt.a OWNER-BUILDER DECLARATION
m <Y I hcrchy affirm that 1 am cacmpl from the Contractor's License Law Ire BUILDING
1�IL®Ipt�.G y�1.2 Q 0 0
i 3❑0 following reason.(Section 7031.5.Business and Professions Code:Any city or county
KS which tetluires a permit to construct,ulmn improve,demolish,or repair any somemrc
Fia
prim it)its issuance.also myuires the applicant lot such permit to file a signed statement p�
s Nal he is licensed pursuanttoftprevisionsoftheContractor'sLicenseLaw(ChaPe,9 34Fli?DO&A0d� Valuation
(commencing with Section 70110 o1Division 3 of the Business and Pmfessiuns Cole)or
y $ Nm he u exempt therefrom and the basis for Ne alleged eacmpthm.Any violation of
Section 7031.5 by any applicant fora permit subjects Ne applicant to a civil penally of
amt mem ma love hundred dollats(S5W). 307 P- INSULATION Occupancy Type
El 1,as owner of the pmpeny,or my employers with wages as their,able emaver snion,
will do the work,and be suucmm is not intended or offered for We(S..704x,Businm y1
and Professions Code:The Contractors License Law does not apply to an owner of 602 - ROOF PL V I" ;�t�OBS
property who huilds or improves thereon,and who does suchwork himmifor through his
own employ..,,providedthat such iimprivements are not intradedoroB'ered Nf sale.B. 603 – ROOF BATTENS
however.the building or improvement is sold within one year nfwmplerion.the owner- 604 — ROOF IN-PROGRESS
owner-
miles, ve th
cr will how burden of proving mat he did not build or improve for pmpoae of
.,shoe).
❑1,as owner of de,propcny,am exclusively contracting with licensed contractors to
construct the project(Sea 71Nq Business and Professions C.IeU The Contractor's Li.
.me law does not apply to an owner of pmperty,who builds or improves Nemo,and
who contracts for such projects with a contractors)limned pursuant o the Contractors
Liao.¢Law.
❑ I am exempt under Sec. ,B@ P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following decimations:
1 have and will maintain a Certificate of Consent to aclf imme for Worker's Compen-
sation,as provided for by Section 37W of tha labor Code,far the performunce of Be
work for which mix permit e,issued.
❑1 bare and will maintain Worker's CmmPcnsminn Insurance,m required by Section
3701 of the Wlwr Cwk,for the penorm duce of dm work for which this Permit is issued.
My Wn rs Compensation Insurance carrier and Policy mother me:
C ar: PtIP Policy N W c.K Y4(`i MCI
CERTIFCATEOFE%EMPTION OMWORKERS'
COMPENSATION INSURANCE
(This section need nil he cOmPlefed if the Permit is formic hundred dollars(Slip)
or fess.)
1 certify doctor the Performance of the work for which this permit is issued,l shall not
employ any perxnn m any manner.m as to hccorre mbject m the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become suhicer to the Worker's Compensation provisions of the IaMt Code,you moa
oz forthwith comply with such provisions or this permit shall he deemedrevoked,
z O CONSTRUCTION LENDING AGENCY
[-+ I hereby alarm that there is a Commotion lending agency l in the Performance of
6i the work for which this Permit is issued(Sec.YN7,Civ.C.)
SQ Lender's Name
z Under.,Address
U 0 1 ccnify for 1 have read this application and sum that the above information is
U, F^ correct.I agree to comply with all city and county ordin i roes and sate laws relating to
DU building comwction,and hcrchy amhOriM representatives 0101.1 city to enter upon the
In
abovementionedPmpcst rand expenses purposes
which ma
H 6. liabilities judgments,) rto osis andcoor y and keep harmless Ne City of Cupertino against
rqdid,steed, may in any way accmc against said City
U z A APPLICANT
oftMRSTA gof did,screed,WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NON-POINT Issued by: Date
SOURCE R[GUI. ONS.
Re-roofs
Ignamm mf ApPh"'o unbanor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant store or handle haran me,material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Code.Senses zss3zay! All roofs shall be inspected prior to an roofing material beim
❑Year P P Y g g installed.
Will the applicant otfuture building occupant use equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove
emit Dist/cfJrdr as air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes om,Nu ,r /
1have realtheh.Seems25565,25533ad nts255 .l iedastar darrifine Culding ✓\/�[/'/f
dies nonY<Safny havecaten iom255(15.8yrespo25531.1 at noutly N, fthc building �x ,\/�`,.��{� � $� A
does not currency have o tenant,mal it is my responsibility m nocly m;occupant of the wl`^L__ \gSA ��rJ x�C'�—� 1\--. \
myuicmcnts which muskbe mclpriomoomesoccofa Cerlifciii aruparney. Signature of Applicant Date C..
ownermaumori,elag.t Date All roof coverings to be Class "B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Tei-,phone: (408)777-3228
&CITYO Fax: (408)777-3333
CUPEkTINO
Building Depa ritment
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
Wand written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
MFORTANi':
1. Flat roofs must have a minimum of U"per foot slope and demonstrate that .
there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: L< F.V\N 1 C£
Address: _ �q"{Op QELAKC. 1nCt . CyP�RTwC7-
Reroofing Company Name: oo R S fd�S 0 n1S �pp��n a
Applicants Signature__ \o: �o.�rc�si CA- Date: 11^ \2-- O'Z
Joe Antonucci
(Chief Building Official)
6/25101