04030127 CITY OF CUPEC()N RAC' UR T�NX+'�RAY. ATIU� '
BUILDING DIVISIONSION PERMIT .�( r'6 s
BUILDING ADDRESS: FOUR SEASONS ROOFING PElimrr"'04030127
OWNER'S NAME: PERMIT ISSUE DALE
NORTH POINT HOA (;4S T40RNTNG ST f)2 /1 _L�nng
ONE: SANITARY N0. CONTROL N0.
(408) 278-0330
ARCHIMCDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�+Op LICENSED CONTRACTOR'S DECLARATION
uF 1 hereby affirm Nat 1 am licensed under previsions of Chapter 9(commencing Job Description
a¢ with Section 70pR))of Division 3 of the Business and Professions Code,and my license is
pp<< inc.11foreaande REROOF (10883/10893/10903/10913/10923/10933)
j Id Z L full f Cissa Lic.p
n::hatq Dale- R—sZ+—e c.v Conlru
g W= AR HITRCPS DECLARATION
I understand my plans shall M used as public records
?EU
3 Licensed Professional
OWN"R-BUILDERDECLARATION
I I hereby Jr.aOut m exempt from the Contractor's Loch.Lew for the
00 following mason(Section 703 1.5,Business and projections Code:Any city or county
$Ion which requires a permit to.mumu.,.eller,improve,demolish.or repair any slrucmro
Hsi prior its isshenm,also requires the applicant for such Permit to file a signed statement
<
that heislicensed pursuant tothe previsions of the ContraceLicense Lew(Chapter 9 Sq.Ft.Floor Area Valuation
mr
'�c (commncing with Section 7000)or Division 3 ofte Businessund Professions Code)or
E R$ Out Me u exempt stanchionand the basis for the alleged exemption.Any violation or
Section 703 1.5 by any applicant for a permit subjects the applicxnuo a civil Penalty of 3 14 3i'd'fl"erO 0 Occupancy e
not mom than five hundred dollen($500). P Y '7 P
❑Lasowner ofO.property,ormyemployes,with wagesss theirsolecompensation, '
will do the"A.and the muerum Is notintended ora@red portal.(Sec.7044,Business
and Promus or.Code:Th.Con recmPt Lmeve Law does not apply in an owner or -Required InspCti
t
property whobuildsorimproms enlhro
r.oand whodevessuch work himselforugh his NNALE®
own employees,provided that such improvements are not intended oroQered for sale.IL
however,the building or improvement issold within one year of completion.Ne owner-
builder will have the human of proving Nat he did not Mid or improve for purpose or MAR 0 1 2004
tile.).
❑1,as owner of the property,am exclusively contracting with licensed ronvacmrs in
construct Ne pmjm(See.7044,Business and Professiant Code:)The Conleacmr's Lt.
.cote law does not apply as an owner of property who builds or improves thereon,and, BUILDING
who contracts for such pm
projects wit acomraaKt)licensed pursuant to the Contractor's .
License Law.
❑Iamesemptander Sec. ,Bk PCfarthismsson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Mreby aRrm under penalty of perjury mm of the following dedantion e
1 have and will maintain aCenificate of Consent to self-insum for Worker's Compen-
7371M
on,as provided for by Secdon 3700 of the Labor Code.far the performance of Be,
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the labor Cod..for the perfmmume of the work for which this permit Is issued.
y Worker's Compensation Insurance correct and Policy number arc:
rtier. f�tAa/J'H�'*' Policy No.:
CERTI ICATE�PTION FROM WORKERS'
COMPENSATION INSURANCE
(This it..need not Mcompleted lfthe permit hilmi m hundred dollars($100)
or loss.)
1 certify that in to performance of me work for which this permit is issued.I shall not
employ Laws of
many mann a.W Mcomc aub'cct to dim workers Compensation
Laws of California.Data
Applin
NOTICE'TO APPLI shaking this Cerificam of^xen
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply wit such provision or this permit shall M domed revoked.
CONSTRUCTION LENDING AGENCY
.n► �
IMr which�termiti is agency for dm Performance of
ai dm work far which this permit is iuuctl(Sec.309'L Civ.Cd
ct, Q l,a
Led.r3 Name
a z
eder'a Address
U Q 1 certify mat 1 have mad this application and state tat the aMw information is
Lkn P correct.I agree to comply with W city and county ordinances and state laws totaling to ---
0U building convection,and hereby authome mPresenmtives of this city to enter upon the
417 above-mentioned property Tor inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
r ti liabilities,judgmenu.coats and expenses which may in any way accrue against said City
U Z in consequence or the granting of this permit, i
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
CTY
Re-roofs
HAZARD
Signature of ApplicaO Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will use applicant or forum buildingle,Chapter
9.1 or handle Health anmaariai
n defined by tiro Cupertino Municipal Code,Chapmr 9.12.and the Health and safety
Code,Secdon 25532bj? All roofs shall be inspected prior to an roofing material beim
❑va: P P Y g g installed.
Will the applicant or future bending occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
kir
ic@ henrdous air contaminants as defined by the Bay Area Air Quality Management all new materials
resp tion.
❑Yes [tea
Ihow mW the baraNnu/sonuefials requirements underchaplcr 6.95 of the aror-
riaHeal"Safety Cade,Sections 25505,25533 and25534.1 undersand that rhe Wilding
Jars not cunemly how a annl,tar it u my mponihility m notify the occupant or the
uiremcme usCM met priorm issuance or.carGRcato or Occupancy. Signature 0 pp' Cant Date
ro\-e'� Date All roof coverings to be Class "B"or better
Owner au orirsd agent Date-
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
�UPEI�TINO
Building Department
jOBDRESS: RMIT #
b 3 0-- CS�a3c�lz
OWNER'S NAME: HONE # 279 — c,3-3c>
GENERAL CONTRACTOR: FAX # 7 g 6
I am not using any subcontractors:
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 oa' o� 152
Septic Tank
Sheet Metal
Sheet Rock
3 ( 2-)6c(
er/Contractor Signature Date
� Community Development Department
� Building Division
City of of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEI�TINO
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: NoV'� l�a, ✓t— 'y
Job Site Address: I()%-t3 - 10463 - 1 D r+t 3 - 1OS23 - l oq�,3 AbvDG. c'•d� S^7 .
Roofing Company Name: C--Vk-sw
A plicant's Signatu e: ate: 3 Z — o e/
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
6q oz7
CUPERTINO PERMIT APPLICATION FORM
APN Dat -
4lding/Address:
oa 5 1 /6 R 43 -" 16 90 /6513 - /ogzg, /D q3 — /VOr ��Lrz"l'7
Ow s Name- Phone#:
Contractor: Phone#: License#:
Cm + c bfr
Contact: Phone#: Cupertino Business License#:
�✓K�-� �trG 7 -7$ -0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
'_V< Other(Specify) C-b4 A SSG ❑ Other(Specify)
Number of existing coverings t ❑ Provide I.C.B.O.Report#
>IC,,To be Removed .�K Provide Mfgr. Installation Specs. GAF 6�+
• Cof-
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential5g__, Commercial ❑
Fire Zone' 'Y6s-❑ No Confirmed with Pla�g_ept. if
there are ant'rictions. L��TT
ost of Project: T Construction.. Occupan
I
Qty. if
A 1' a le 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