05080019 OF
Ct BUIILDI c DIVISION PERMIT CONTRA t�T(R INFOR ATION-'3:.
�>f•�.. .
BU ILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO.05080019
22908 CRICKET HILL RD
OWNER'S NAME: PERMITISSUEDATE
DIANA DAANE 502 HORNING ST 08/03/2005
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
v0, LICENSED CONTRACT'OR'S DECLARATION
w I thereby affirm that I am fianwd under provisions nr Chapter 9(commencing Job rD�es{ter`i�ption///,,�,, Il a�
�< with Section]Or10)of Division 3 of the Business and Pr llossiorc Conn.atM myliccre¢is 't, n I'�a ryi�l±�1`n1y1J
� Z inmum�amdnrr t REROOF W/30 YRS . FELT & LJ` 5�
-alal Clua _ ! Lie, _` Tau O`
Dam sono- nr_ Cc
_,j
ti c . 40 YRS . GRAND G.A. F.
ARCHITECTS DECLARATION s /1 an�11q
£ -a l understand my plans shall W used u public records
>yU tltl
s u� Licensed Professional
c03 OWNER-BUILDER DECLARATION
0 0 1 hereby affirm on 1 1. exempt from the fesnionsCc License Law for the
p O following moon.($Orman]1n str Business and Professions Cock:Any city or county
<$ which reyvires a permit n,enetswet,tltoe,improve,demolish,sire poi,any etmetorc -
nai prior m ltsiasuanm.alwtequots the applicam for such permittofk aligned xuamcm
< that he u licensed pursuant the provisions of me Contractor's license Law(Chap¢r9 Sq.FL Floor Area Valua[i 16000
E (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y mat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by airy applicant farepertnit subjects the applicwno a civil penalty of APPN j�j�ff�ther Occupancy Type
not more than five hundred dollar($500). 3 4 Z 3 5 U 13 . 0 0
❑I,u owner ,and
pmpcny, re is employees wih wago ss their wk co 4,Business will do the work,end me he Concis not intended Livens,Law data
a nor apply to
an,Business
and property who
Cade:the Contractor's and
Law acct or apply to an owner or Required Inspections
properlywho buildsoeimprovuchicon,andwho doe notwmkhimwlfor for Wt his
Own employer,provided hm such improvements are not aroawarded mplecrW for sola If.
however.the building or i e.of po emg sold within ane year or completion,me nose of
builder will have he budcn of proving Nat he did not build sir improve fm purpose of
We.).
❑1,as owner or the proPan,,son exclusively convening with licensed contractors to
construct the project(Sec.7014.Business and Proftssiru Code:)The enclosures Li.
CO.law does nut apply to an owner Of property who Wilds or haimems thercrn.and
who concocts for such pmjeets with a eonomeau(s)licensed pursuant o the Contractoes
License Law.
❑I am exempt under Sec. .B&P C for this neuro
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of On,oto of me following dedantions:
I have and will maintain a Ceni leare of Consent an self insure for Weaker's Compen-
sation,as provided for by Section 37M of the Labor Code.for the performanw of the
work for which this mon it is issued.
44Z�k0ave and will maintain Worker's Compensadon Insurance,as required by Section
�55''1Isl rf Ne LOW,Cooke.far me performance or me work far which this permit is issued.
My Worker's Co aria, Rn lnwmce artier and Poligq num
Cartier. N ` Policy No.: 171" Zy�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This wNan need not W compico d if the permit is fm one hundred dollars nl(K)
or less)
I certify that in the performance or me work for which this permit is issued.1 shall not
employ any person in any manner w as w become wbjecua the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cer ifeato of Exemption,you should
Woman subject m the Worker's Compensation provisions of the labor Code,you must
.7. z forthwith comply with such provisions or his pemni uhall W dcemcd revoked.
Z CONSBUCTION LENDING AGENCY
1-. I hereby alftm that then iso construction lending agency for the performance of
C' 7 he work for which this permit is issued(Sm.3097.Civ.C.)
tT] A lenders Name
6. tender's Address
VC) I sonify that 1 hate mad this application and sato that me aWn information is
ty F-' coven 1 agme to comply with all city and county odinwees and sure laws relating h
pU building construction.and hereby authorise representati.r of this city m enter upon the
C abovcmentiuned pmperty for inspection purposes.
(We)agree to save,indcmni ry and keep harmless the City of Cupertino against
F' I, liabilities.udgmcnu,costs and expcnsu which they In My way accrue aBa'u,said City
U in crnsegacnec of the granting or this permit
APPLICANT UNDERSTANDS AND NILL COMPLY WITH ALL NON-POINT Issued by: Date _!j,0
SOURCE REGULATIO f4..
Re-roofs
Signature of AppfonVConrractor ' am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the,applicant or future building occupant store or handle hatsedous material
as def red by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
,MjjCm1O. yes 255)2(a)] � All roofs shall be inspected prior to any roofing material being installed.
❑
yes
Will the applicant or future building occupant use equipment or devicns which If a roof is installed without first obtaining an inspection,I agree to remove
it hazadous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? k�
❑Ycs
1 have read the hmadoesmaterialsmornements unchr Chapter 6.95 orthe Califon
niallealm&SxROYCode,Sections 255()5.25533 and 25554.1 understand thatifthe Wilding X —6
data not currently hose a tenam.that it is my responsibility to notify the Occupant Of the U
requirements whichm rut issuance of a cc,dfcau,To_PyL�. Signature of Applican � Date
3 ell coverings to be Class"B" or better
Owner or authorized agent Dove
Community Development
4. 10300 Torre Avenue
It Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: / / PERMIT #
910A / � / v5� o�vca' `t
OWNER'S NAMEA-0 OAAkle IPHONE #
GENERAL CONTRACTOR: / / FAX #
I am not using any subcontractors:l 1,71 PI � =2rCz5
/Signature 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
Septic Tank
Sheet Metal
Sheet Rock
® Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
*CIOF Telephone: (408)777-3228
UPE' JINO Fax: (408)777-3333
,�! Building Department
Subject: Re-roofing policy for the City of Cupertino
I. 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 withbut first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can bg 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.
Homeowner's Name: //M4,14 iiO4A lec
Job Site Address: n
Roofing Company Name: (LaWAIIAle!
Applicant's Signature: Date:8-2--05
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO.
u REROOF
CUPERJTiNO PERMIT APPLICATION FORM
APN # Date:
' .S0/ G
Building Address:
/
ner'sN e: Phone M
J 'i _.iSnli �
1A AA-Ir
Contractor: I Phone °tp License #:
J
Co tac Phone #0'0,9) Cupertino Business License #:
2A1rA'2 26 0,11 C2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ .Wood Shakes ❑ Wood Shakes
❑ Wood Shingles NL'(jCOC� ❑ Wood Shingles
E
Other(Specify) ❑ Other(Specify)
umber of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Poli c :
b Descripti
Residential Commercial Q
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Co of project: e of struction: Occupancy group:
C .4
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
f:
3063