04080191 CITY OF CUPERTINO e �`� r'' `
BUILDING DIVISION PERMIT C TRACTOR IN,FOJ M 0'N
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNOO40S0191
OWNER'S NAME: PERMIT ISSUE DATE
DE ANZA OAK T40A r4- T4npmTNr-. Sm
ONE: SANITARY N0. CONTROL NO.
ARCIIITECIDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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unuLICENSED CONTRACTOR'S DECLARATION
With SecsNE ofDiviso3ofdBiimrssad ring( ios(hde, nd my license isC 1 hereby afrthat I am licensed underprovisions of Chapter Y(commencing
'�e. vu,A—0 sp\
D
�yz Liansc a �-' Lic.N �. ar— REROOF
Dam `pSr SEP Z2. 2004
ARCHITECTS DKDECI:ARATION
I understand my plans shall he..ties public records
a
;fig Licensed encs lonel D II ILII D�I,�\ �I S
OWNER-BUILDER DECLARATION U IL'J II❑II\\VII
a E 1 masa affirm Ihm I am exempt Busine from Ne Cssions License Low for the
00 following reason.(Section](131.9.Business and improve.
demolish.
h.Code:Any city Or county
K$ which requires a permit re construct alter,improve,h Permit t fi repair sg any thenen
that heor imiensedpalso rc tot he theapplicantfor sucCompactor's LiceseLaw(ned mamcm
�?< poommencill,ttdpIceonlmthe pm visions I theeBustrasnd Proflaw(Code) Sq. Ft.Floor Area Valuation
QFC (commmsing with Scminn]IMIO)nf Division3 of the Business and Professionsto aof
i
that he is exempt therefrom and the basis far Oe alleged exemption.Any vinlat on of
Sordoni 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3,A2412-0thtri-00 Occupancy Type
not more Nan five hundred dollar(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and lhe5trumure is at intended or offered for auto(Sec.]064,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
pmpeny who builds orimproves thereon,and who does such work himself or through his
own employees,provided lhal sueh impmvamerm are nm intended maOered far ole.If.
however,Ne building or improvement is said within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am axelusively contracting with licensed contractors to
construct the project(Sec.7014,Business and Professions Cade:)The Contractors Li-
cense law docs not apply to an owner of pmpeny who Wilds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to Ne Contractor's
License Law.
❑I am exempt under Sec. ,B&P C for this mason
Owner Date—
WORKERS
amWORKERS COMPENSATION DECLARATION
I hereby alarm under Penalty of perjury one of the following declarations:
I have and will maintain a Cenificam of Consent o self-insure for Worker's Compcm
7Rtion,
as provided far by Section 3]00 of the labor Code,for Ne performance of the
ork for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
W of the labor Code,for Ne performance of the work fmrwhich this permit is issued.
y Worker's Compensation Insurance carie'''rated Policy number art:
m f..+. C•. Nm.:VwS'Oto4 0 060 30
CERTIFICATE Ot EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ma,section need not M1n completed if the permit Is future hundred dollars($100)
or less.)
1 cenify that in the performance of the work for which this Permit is issued,1 shall nal
employ any person in any manneran a In become subject10 the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,y.a should
become Subject m the Worker's Compensation provisions of the Labor Code,you must
.,0 forthwith comply with such provisions or this Permit Shall be deemed revoked.
z .~N. CONSTRULTION LENDING AGENCY
[r shcrehy atilt,Nat Nare is aconswminn lending a6cncy ler the perfurmancc of /�
Cl. > the work for which this Permit is issued(Sec.3097,Civ.C.)
W� Q Lender's Name
z Lender's Address
V 0 1 certify that I have read this application and sate that the above information is
Iy F cor,eL 1 agree to comply with all city and county on inances and sate laws relining to
0V building construction,and hereby ampona representatives of Nis city to enter upon He . ,/lfyt(/, //
W above-mentionedpmpeny for inspection sees whichpurposes.
may
(/`^!/�C./N/
y (We)agree to save,indemnify and keep homeless the City of Cupertino against
rq liabilities,judgments,casts and expenses which may in anyway eceme ageing said City h
of the granting of this
C) z APPLICANTeUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOU ¢E L N$.
I Z —a Re-roofs
gnawrc a ApPIial ARDOUS MATERIALS DISCLOSURE ltor Dam Type of Roof
Will the applicant or foto,building occupant stow or handle haous material
as defined by the Cupenion Municipal Code.Chapter 9.12,antl the Health and Safety
out,Section 25532(x)? All roofs shall be inspected nor to an roofing material beim
❑Yes �a P P Y g g installed.
Will the applicant or future building occupant use cquipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil hamrdm is air contaminants as de0ned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have mal the d,Sections 255 5,,ls requirements under Chapterd6.95 that if
f the Calding
does alth&Safely Cale,Sections 25905,2myrespo25Si1.l to
y thoccup building ply O
does mol c Ily ha a tenon s my responsibility m molly IhC occupant of the
requ "cntswmh stbemtprionrissuance OfaCenificamofOccupancy. Ig atureofApplicant Date
$�3a �O'( All roof coverings[o
Dam be Class "B" or better
Owner ser authorixeJ agent
. Community Development
i 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPE"'IN®
-Building Department
JOB ADDRESS: PERMIT #
1o136 Sc,. %lQ4 O�to�Ol°t
OWNER'S NAME: nr�w o wlo.s PHONE # vkosl
GENERAL CONTRACTOR: o� c -- FAX #
I am not using any subcontractors: Sf X1 •o`l
Signati& Date
Please check applicable subcontractors and complete the following information:
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
19 Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing ow eas yZz1oB
Septic Tank
Sheet Metal
Sheet Rock
Tile
CJQ(00— 8 ®23 .6Y
Owner/Cont6dctor Signature Date
Community Development Department
Building Division
Cut, City of Cupertino10300 Torre Avenue
CITY OFTelephone: (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 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: Qn no Ga w� 4
Job Site Address: _1 0 13 6 La 01 a V ker S.,
Roofing Company Name: l=o u 2 Scirasoas Q o s r 1 N C,
Aplicant's Signature: Date: $. x& •pt{
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# 3 cq 2`120 10 Date: S -Al -04,
Building Address:
10136 I.a�b\ 1. �+« Sq . Eilvd ,
Owner's Name: Phone#c
Awwa G1ww�aS — De A�ILA OAW-. (AoA 0108) Z -18 '0330
Contractor: Phone#: License#:
o IC -o Lt"1 .108
Contact: Phone#: Cupertino Business License#:
CiARt,oS C.A2A7LE8 8 Tgo-okIt
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �V Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
ed Other(Specify) C O Mw O" ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
Aft
40 I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1 LL 1
V—sev obs.
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
gCn> rc o1 F3 16
Qty�,if
Appliqable 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
-2,1,67 F-7
W. 0