03100197 717YVo
CITY OF CUPERTINpi.
_ '-' e s •I' g 1 a tr,�' ,,y K
BUILDIN',DIVISION PERMIT CONTRACTOR INFORMATION ''
BUILDING ADDBZ ALL SEASONS ROOFING SERVIC MITNN3100197
10970 KESTER DR
NER'S NAME: 2640 PACER LN PERMITI.SUEDATE
OW
COMPASS MANAGEMENT 10/28/2003
IRV"E: 4089724455 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION =1O O
F❑ I hereby.form that 1 am noosed rnW,provisions of Charter v(commencing JoblLl ip i n
?z with Scnion 7Xp7 of Division 3 of NC Busincasand Prufiesim,Code.nd my license is �B E®
+�N mmu rose and effect 09L
/ REROOF
+ � CTDate CoSDECLAR T10N ,�r,,,;«, NOV 2 4 2003
f i U I understand my plans shall boused as public fecmds
_off Licensed Pmfcssional �JIL®ING
3 Oat I am exempt
from
DECLARATION IF�[Y{/Y
s o 1 hereby affirm on 11. exempt son Ne Contractor's Co License Law for the
9 o following mason.(Section TB1.5,Business and Professions Cole:Any city st county
.fm poor to
its too ne.also re cores the etre,.nt for suh Perlia merepair any
tatuaure 62OO
iy pnonointcensed aaluantto the thovisiosO for Contractor's
Clea,Lawned sl
cx� that ccnxd pursuanttothe)of Division
of the the
nd Professions
(Chapterode)of Sq.Ft. Floor Area Valuation
2 t— Outheis(commencing withdulnelm.add the basis
Of the Businexempt on.A.vi.hurdc)of 35628013 . 00
NatSectio is exempt any applicant
oro and Nc busrd for Ne c.the
d exemption.Any violation of
not Mn)O11.36y uryreddanars($5crmit subjccu the applicantto.civil daily of APN Number Oecu ane T e
not more man five nrnama douses(ssW>. p y yp
1,m owner of the pmpeny,or my employees with wages as their sole compensation.
will do the work,and Ne structure is not intended or offered for sale(Sec.]Oda,Businem
and Pmfeasioas Code:The Contactors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who doe,ssuch work himself or through his
own employers,provided that uch improwmennt are,not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion.the Owner-
builder will have dx burden of proving that he did OR Wild of imprme for purpose of
sale.).
❑1,as owner of the property,am uclmively contracting wild licensed crnba[LOrs to
conswet the pmjecl(Sec.]Oda,Business and Poefdol Code:)The Contractor's Li.
Genu law docs not apply to an owner or property who Wilds of improxrs Ihemoe,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor'a
LKcOY Law.
❑ l sm exempt under Sea ,B&PC for this reason
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under,penalty of perjury ofr.of the following gee stratmos:
I have and will maintain a CcniOCam of Consent to ulf-insum for Worker'sCumped-
aation,as provided for by Section 37W of the Labor Code,for me performacce of Or
work for which Nis permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3?W of the Labor Crude.for the performance of the work for which Nis Nord is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Commr':_ _aRL'P , A PolicyNo.: T _
CERTIFICATE OF EXEMPTION FROM WORK RS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is for one hundred dollars ISI W)
or Icss)
I Crotty Nat in the pmfnfmance of she work for which this pe,mit is issued.I shall our
employ any person in any manner an as to M1ceume subjen to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL arm,making this C.Mfie.m of Exemption.you should
become sitect 10 the Worker's Compensation provisions of the Labor Code.you must
�p forthwith comply with such provisions or this perm it shall W deemed revoked.
ti N CONSTRUCTION LENDING AGENCY
I M1cxby.ffrm Out Nem is a consumerism lending apeney for Nc pe,drmaae of
]: ti the work for which this permit is issued(See.3097.Civ.C.)
Y Q Lender's Name
S Z Lenders Address
)Q 1 coolly Nn I have read this application and surto that the above information is
L F-' correct.I agree to comply wit all city and county ordinances and sure laws relating to
)C.) building construction.and hereby authorise xpmsentativet of Nis city to enter upon Nc
rty
W abovctmc judgdpropcst furl extensor
purtuwhich ms
Q. (We)agree to save,indemnify and keep harmless the City or Cupertino against
N incoitid,jnce of ts.the granting cxpenuamia. may in any way aerneagainst said City
) z in conseyucnce of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOURCE AfTONS. y Dale
ares, pplicam/Contol 2Suc Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building Occupant store of handle hazardous material
az dcrmed by the Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
ak,Section 25532(.)?
❑yea �]Nr All roofs shall be inspected prior to any roofing material being installed.
Will mea licant of future building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
PD g p equipment or devices which g
it hazardous air conmminants as dermcd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs fT NO
Ihave&Sudet NehuaSecthu 25M5lsmqui add n33 .1u dentur6.v5 if c Calding
nicer nalm&Safety Code,Mends unit 255Jmmarre534.1 un door off if the Willing
dud not currently W,c a tenons Nat it ism respomibility m nntiry the oceupant of the
xyuirtm a must Wmn cc ora Ccnifmam of Occupant
n O7gnat
y of Applicant Da e
Qwfc,err luirr,i,ed agent D, All roof coverings to be Class "13"or better
Community Development Department
Building Division
{ , City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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 LC.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: rwIr�-
Job Site Address: dftp log 7o /-Gsfi di
Roofing Company Name: �l5,4f,, + _r e,4, s"
Applicant's Signature- Date:�7
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
' CUPERTINO PERMIT APPLICATION FORM
7 1 7 9 /o 0
91
APN # 5�r f� Date:
G� p
Building Address:
0 9 7n emwfr/ D/
Owner's Name: Phone#s
�., izsr to 8' Z Z
Cont actor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
cil—)k�-ff� �. o� (o Yo ckpcd o
Type of Roof Covering:
Existing: Proposed:
�5 Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number 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 Polic :
Job Description:
Residentio,K Commercial ❑
Fire ne: Yes ❑ ❑ Confirmed with Plann' )e t. if
there are anrestr' Ions: LJ
Cos of Project: Type of Construct Occupancy grow k'. 2,/
a7
Qty. i
A I' a Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
441 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING