04070143CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
t,CONTRAC�R-INFORMATION
BUILDINGADDRESS:
0172 RTT.TrT4 PT.
ALL SEASONS ROOFING SERVIC
ERMIT"°04070143
OWNER'S NAME:
PERMIT allE DATE
ROY & MARIE TEA
)NE:
SANITARY N0. CONTROL NO.
(408)971-4455
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
eunder provisions Chapter 9 (commencing
1 rummy affirm thin I am licensd M
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Job Descri tl
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wide S.tnn70lkBaf Division Sof NC Bmu..WPla ns Codc.mdmyliccnxeis
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License C'�/ Lie. N
REROOF W/ COMP.
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ARCHITECTS OECLAR 0
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1 andmin tan shall W mod as puM1lic rcmFda
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Liccnxd i nal
OWNER-BUILDERDECLARATION
All
1 hereby afffm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professiom Code: Any city or county
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which mquires a permit m construes alter, improve, demolish, nr repair any structure
p110f N IL41aSYdnCC, aI3U exclude Ibe applicant for such Permit an rile a signed Statement
NL Be Is licensed pulau aor- time Provisions of Ric Contractors Licen411w(Chapter 9
Sq. Ft. Floor Area
Valuation
(Cammeneing with Section 700(0) of Division 3 the Business and Professions Come) ar
dual he is exempt therefrom and IM basis for dice 91.90 exemption. Any violation of
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Occupancy Type
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Section 7031.5 by any applicantPermit subjects the applicant to a for a pecivil Penally of
not mom than fire hundred dollars ($500).
❑ I, as Owner oflhe property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and Ne structure is not intended Oroffe ad Tomad,(See. 700,1, Business
and Professions Cade: The Communes License Law dor not apply to an .in of
property who bei Ids mr improves dwman, and who does such work himself or duaugh his
revs employers, provided talsuch improvma nts are not intended declined! forsale. If,
however. to building or improvement is sold within one year of mmplcuon, to owner-
builder will hese the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as Owner of the property, am exclusively contracting wit licensed rommuctors to
conamet the project (Sec. 7000, Business and Professions Cede:) The Contractor's Li.
ecru, law does not apply to an owner of property who builds or improv demon, and
who contracts for such projects with a com metoKs) lican ed pursuant to the, Contractors
License law.
❑ 1 and exempt under Su. . B At P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of de following declarations:
I have and will main ain a Certificate of Consent to self-insum for Worker's Comp,n-
sinion, as provided for by Second 3700 of the labor, Code, for the per(mmance of Ihm
work for which his permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as mquimd by Section
37W of tc labor Cade. for to performance of to work for which this permit is issued.
My Workers Compensation lnsursnce c Gruel and Policy number are:
Cartier. Policy No.: 17/% fiS0 - UZ-
,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectio mend not becmnplpermit is for ane hundred dollars ($1018
Or less) //
1 certify tam in to perfornvec of the work for which tis permit is issued. I shall net
Cmploy my person in my incou,sm as to become aubjecl to the Workeri Cmirism afian
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cur iricate of Exemption, you should
become subject 0 the Workers Compensation provisions of the labor Code, you must
forthwith comply with such Prnvisians or tis Permit shall the deemed rooked.
CONSTRUCTION LENDING AGENCY
I hereby aRrm that dere is a construction lending agency for the Performance of
tc work for which this permit is issued (Sec. 7097. Civ. C.)
Lender's Name
'
lender's Address
1 comfy that I have read this application and mule din the shove information is
cored. 1 agree m comply will all city and county ordinances and sus laws mating to
building conswction, and hereby audorim representatives of this city to must upon de
maw-mentioned property for iexpenses
penes purposes
(We) acme to ave, indemnify and keep harmless the City of Cupertino against
inconsequence ftocoeuand of this esmit. may in any way accrue against said City
of to granting of this permit.
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APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
Issued by: Da
�
SOURCE REGUtA ONS.
fl �ZS-eH
Re-roofs
re o _
ApP i° Dam
HAZARDOUS MATERIALS DISCLOS RE
Type of Roof
Will dm applicam or future buildin6 occupant Tom or harmlc hvalloua maerial
u deRncd by de Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Scclion 25572(a)?
Ye. Na
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant me e equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mil hawthous air contaminants as defimed by the Bay Arca Air Quality Management
all new materials for inspection.
Duuict?
❑Yes *No
Ihe. Cum
dthelia,&Nd
&Sdr ,23Nmaterials 5,255uimmenuunder
umdersf dt.95ofdm Wilding
building
Sectionshatiti
lip/
,11nolt&eateryino a myrespo25570.1
Jnr not currently have a lenenl that illi my responsibility to notify do aeupanl of to
me
rcquimmcnts 1' Ir to metph.,tocamanceofaCertificaeOnLC'uryncy.
-�
Signature of icant Date
All roof coverings to be Class "B" or better
Owora a ml agent Dae
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
/0 /;
PERMIT #
o 3
OWNER'S NAME: t ' ?
PHONE # Yo3 25 7- fel
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors:� 3 U
Signature Date
Please check applicable subcontractors and complete the following information
Owner/Contractor Signature
Date
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
S�
c!
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
Date
I
i
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre 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 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: In N 1'-\-e_n
a �/ �-CA S
Job Site Address: 101 7-L t 1`\G_. 'F' (0 c
Roofing Company Name: 4 ( ( J Sp/JS
A plicant's Signature:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date:✓ --o