05010174 CITY OF CUPERTINO7177777T�K � r'""•
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BUILDING DIVISION PERMITs>..IQMTRSCTOWTNFORMA.TIONa
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BUILDING ADDRESS: FOUR SEASONS ROOFING Pa"MITN"b5010174
OWNER'S NAME: PERMIT ISSUE DATE
SUNESH & G
ONE: SANITARY NO, CONTROL NO.
(408) 278-0330
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a00 LICENSED CONTRACTOR'S DECLARATION O O O O
m I hereby affirm Net I am licensed under provisions of Chapter 9(commencing Job Description
z with Section of Division 3 of NC Business and Professions Code.and my license is
^� in full force and of
5az ue...clas 2- k.x �7��0� EROOF W/ COMP.
Dau Comnnor d� .� /.r�
ARCHITECT'S DECLARATION
�i 1 unelcrsund my plans shall he used As public records
On6
y.N
4_O Licensed PNfeyLOnal
5 OWNER-BUILDER DECLARATION
Q 0 1 masa .(Sero Net 11. exempt from dte Canine Co License law for IW
a p O following season.(Section]onL3,Business and Pm.co ions Cod,:Any city or county
$� which uquima a permit to eonsuuea alter.improve.Ocmulfsh,nee repair any atrueture
FZ< priormiBiensedprsuan toabe Ne applicant for Contractor's
Elcasigncdsummcm
nr O NUMencingsW putsuantt")ofDisiomofoftoB sines ld¢vclaw(CNpkr9 Sq.FL Floor Area Valuation
m 1=-3 thammneinawith5cdionatand ofDivisionoil Atcle exempton.My and violation
or
—
that io u eu5 b therefrom and the Aper for the alleged cxunant in Any viortion of
Section therse by any applicant fora permit subjects the applicant m a civil Penalty of
not more Nan rtve hundred dollars(fN10). eIQ Q Occupancy Type
1,as owner of the property,army employees wish wages as Rush sole comp nsidon,
and Professions
r the work,and the rhueture a not rounded or oRd Ones
not.(Sec.]0aa,Basin...
and property
ywhiobu Code:The res trscmrs and
law don not apply lf an olKr is Required Inspections
Own enywW�uilMviLs dcd ravnlhimprove who are
memlkhimselfrthrough his
own m,Or Wilding
Nat such improvements in not ear ofc mplati ed for calm If.
holder,Nebuilding errrmprovenunsissoldwithinot Wild ofimprom m,the owe of
builder will have Ne burden of proving Nat he did not build or improse(or purpose of
sale.).
❑1,as owner of she property,am eacluaivcly cunbactall with licensed co au sms in
construct dm pmjca(Sec.]Oma,Business and Plefessioru Code:)The COnbactoes Li.
teed law dean not apply In in owner of profanity who Wilds or improv theran,and
who contracts for such projects with a conuactor(s)licensed pursuant in the Co muctofs
Lia.Law.
❑Iamnemptodeascc ,Bk PCfmthrupeon WV/
Owner Dau
WORKER'S COMPENSATION DECLARATION l/ l
1 hereby affirm under penalty of perjury one of the following declarations:
T hive and will maintain a Certificate of Causes m self-insum for WorkcrsCompen-
astion.As provided for by Section 3700 of the labor Codc.for she performance of Ne
work for which this parmh is iducuL
❑T have and will im imern Weaker"Compepeedon I..,As required by Sacuon
37M Of Ne labor Code,for Oa performance of Ne work for which this permit is issued.
My Works Compensation beumrtarir carand Policy number art:
Carrier: /OYWMOeCOPolicyNo.: COT-014" 600_�o
OleCERTIFICATE OF EXEMPTION FROMWORKERS'
14^, 1-C COMPENSATION INSURANCE
(Thr section need not W completed If the pannit is forane hundred dollars($100)
or kis)
1 certify Not in We perlrmmce of Ne work far which Nis permit is issued.I shall not
drnploy any parson in any manncrm u to brume subject to do Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccnrficac of Facmption,you should
Acaam subject w Ne WOAD']COMNWdon proviciope of Ute Labor Coda,you must
O
forthwith comply with such provisions w this pmarl"hall W deed resist
meed.
'zy CONSTRUCTION LENDING AGENCY
Iberebyafrnm Out Vert rte A construction Ic.O.I.Incy for the performance of
lY
to work far which this permit is issued(Sec.3W7,Civ.CJ
C 0 UmIcfs Name
5 z Lender's Add.
U0 I cervi%that I have mad this application and spec Net Ne shout i.rmaa.am is
0 F' cartes I agree m damply who all city and county mstims or and star hole relating e
�O above-gcoaional mn,anyfm hereby insvuNodrtmpresenutiva of Nr city uencrupon the
Lk7 shoe,-mentioned to sam forimnify An limp
4 (hoc)agree to ave.indemnify and keep harmless Ne City of Cupertino against
(�
liabilities.judgments.costs and A.p,"",which may in any way...against rid City
V z nems"PLICAcnee of Nc gran' go! rmit. dD 1^�
APPLICA E N A WILL COMPLY WITH ALL NON-POINT Issued by: Date �- J
SOURC GU S.
Re-roofs
Signatureof ApplicanUCon Data
H S MATERIALS DISCLOSURE Type of Roof
Will theappiicamo utum huilding Occupanumre or handle hazardous material
As defined by the Cupertino Municipal Cods.Chapter 9.11,and IW Health and Safety
1[�,trictl
de,Section 23531(a)?
❑Ya C>16-
Will
hf All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha,ardous air contaminants pe de ed by the Bay AMA Air Quality Management all new materials for inspection.
❑Yes
(ham real the ha aAeusmaterials requirements uncer Chapter6.95 a(&Califon I
Health&Sa(ctyCods,Sccuom 23505.23533 And 23534.IumkrstaM dutifNc Wilding
r n y Aa tenant.Net itis my responsibility to notify the eacupant of the /" Q
man met prior w beaamcc of a Ccn hate of oa.pmcy.
_1 P_at� Signature of Applicafir Date
Owner or authors rat Date All roof coverings to be Class "B"or better
Community Development
6 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
/oS�� ivorh,�;d�•e Ss _ oS'o/ 0 l
OWNER'S NAME: U 12o PHONE #
GENERAL CONTRACTOR: Fo„ S;,,s o,.cii)„ FFAX # ,2��-a'Z?
I am not using any subcontractors: �v� - 5Q,4 -- / y8 6.1—
Signatur 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
17 Roofing Sbyt$ n �l?:2 08
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor ature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U P E kT 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: cSvne' `, �oS�aa i
Job Site Address: /D e-7 N a,-itl,ids c S!7 -
Roofing Company Name: Fo u o` ,S'n xo^S e.,4:.,
A plicant's Signature: Date: /-.1 -oS—
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO S� l d /
REROOF /
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 1006 019 Date:
Building Address:
/0e-n S'9
Owner's Name: $uneSkn t GuP�A �l/540k4l Phone#cz.,� _6330
Contractor: Phone#: License#:
Four S"sons I?oo-Pi'n a-18-0330 q } 108
Contact: f} Ifredo Ca2ar-CS a..1 g-o330 Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles e�W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
eV Other(Specify) Clk L SNA V_L ❑ 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 Policy:
Job Description:
0 oAL. SitAlL300 FS:t-'C A?e L7 GAF Gr" Caw o�
Residential 0 Commercial ❑ CA ta,�P
Fire Zone: Yes ❑ No Confirmed with Planning D,-e,Pt. if
there are anrestrictions: u
Cost of Project: Type of Construction: Occupancy group:
080 F-Z-(LM f
Qty. if
A licable Fee ID Fee Description V__Ou
BPERMFEE BldgPermit Fees
BENERGY Ener
BSEISMICRE Seismic Fee Res
BSEISMICOM Seismic Commercial BPLANCHKiE Plan Check Fee BUSLIC Business License BUILG
z� 2-
2,
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