03100089 CITY OF'CUPEW1'INO ( az • §�aS ,z , "`' 3> :>
BUILDING DIVISION PERMIT °CON TRAGTOMINFORMATION x
+.).ler§ta.4: . '2aeP.9'd a uza
oUILDINGADDRESS: FOUR SEASONS ROOFING PERMITNO.03100089
OWNER'S NAME: 645 HORNING ST PERMITISSUEDATE
)NE: SANITARY NO. CONTROL NO.
(408) 278-0330 C
ARCHITECT/ENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S a.&,Provisions
of chapter
- Job Description
i u 0 1 hereby affirm that I am RedresseONTRA under provision of ION Y(commencing C—y,_tL/C'—„s•7
with Section]Of0)of Divieion 3 of Ce Businsa end Prrfcuiom Code.and my license is
io, in full fame and c t. �/��t�. ��` /
n, Licence Cla.M �-59 uc.x�L2/QFS REROOF ! O
r F p Date 40—. 6�N'__Camncbr F�4✓�' /
q plARCHITECTS DECLARATION
i I understand my plans shall W meal o public records
G/
'u•� Licensed Professional ell
I OWNER-BUILDER DECLARATION 3
I 1 hereby affirm Nal l am exempt from the Contractor's License Law for the
:S o following mason.(Section](01.5,Business and Professions CWC:Any city or county
which requites a Permit to ennswct,alter,improve,demolish,tar repair any structure
prior in its issuance,also barium the applicant for such permit to file a signed statement
that he is ticconed pursuant to she provisions of da Contractor's Limmc Law(Chapter 9 Sq. Ft. Floor Area Valuation
j a (Commencing with Section 7")o(Division 3 of the Business and Profusions Code)or
Not he is exempt therefrom and Ce basis for she alleged exemption.Any violation of 31646039 . 00
Section 7031.5 by any applicant far a pesmllsubjects Ne applicant to a civil Penalty of APN Number Occupancy Type
not more Nan five hundred dollars($500).
I,as owner of the property,or my employees with wags u their sole compensation,
will do Ne work.end shestmcwre is nm intended m Critical fouate(Sm.104,1,Business 305 — "
and Profession Code:The Comes Litten law dead not apply to an owner of Re wired Inspections
property who builds or improve.Nemnn,and who does such work himselfor through hid 307 — INSULATION
own employees.provided that uch improvements are not intended oroffemd for sale.If. 601 — ROOF TEAR OFF
however,the building or improvement is sold within am year of compedon,she owner.
builder will ban the burden of proving that he did not Wild Or improve for purpose of 602 - ROOF PLYWOOD NAIL
.ak.). 603 - ROOF BATTENS
❑1,s owner Polices
es property,,Business ss and contracting Cade:)
iNlicensed Conntnnon i.
cense La shoes notpplytoanowneofproprtywho builds
CC or I ThevesnOanm.Li 604 — ROOF IN-PROGRESS
Leine law alma not apply to an owner of property who builds m improves Contra,and,
whence Laces for such projeN with soonuacsor(s)licensed punnet to the Contractor's -
aw
Ll I am ext
tem exempt under Sec. ,B&PC for this meson
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury aro of use following declaration:
1 have and will maintain a Cenifnte of Consent to selfimum for Worker.ComPcm
1017.19")
on,as provided for by Section 3]00 of Ne labor Code,for the Performance of the
rk for which this,permit is issued.
1 have and will maintain Worktfs Compensation Insurance,as mquind by Section
of Ne Labor Calc,for lie performance of Ne work for which this Permit i.issued.
Workers CnmPen anon lennnce artier and Polity mhcr am:rtier: Policy !l L i 6L
CERTIFICA EOFEXEMITION FROM WORKERS'
COMPENSATION INSURANCE
(This amens need not W completed if the permit is fnronc hundmd dollen($IM)
,it Its..)
1 cenify that in she performance of she work for which this Permit is issued,)shall not
employ any Person in any manner so as to become subject o the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ccr ifcanc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
JO fCMwish comply with such prnvismis at this Permit shall be deemed revoked. -
�y CONSTRUCTION LENDING AGENCY
+,
5:
I hereby affirm Cat Nem is a Co 3tMCd n lending agency for the performance of
]$� Ne Work for which this permit is issued(Sec.3097,Civ.C.)
A Lender's Name
J Z Lender's Add..
C) I cenify that 1 have rad this application and sense that Ne above information i.
(•" CmnaL.l agree to comply with ell city and county aNinnces and state laws relating to
J V building conswetion,and hereby authorise repreaenwives of this City m order uPnn the
�I21 abovo-mentioned Propont,for inspection purposes
(We)egret to save,i keep harmless the City of Cupertino!gains
h IiabiliLlecjuit te,c andexpcnscaw ich may in any way accrue against mid City
J Z in Con=WUd,Cof Bmntingr(thispean .
^ APPLICANT D STANDS AND LL COMPLY WITH ALL NON-POINT Issued by: Date
CER
Re-roofs
Signet o pPlicaHAZARDOUS MATERIALS DISCLOSURE ate Type of Roof
Will the applicant tar fnture building OCCUPam nom m handle havardous materia:
as defined by Ne CUpenlno Municipal Cak,Chapter 9.12,and he Health and Safety
Code,Section 25532(a)? / All roofs shall be inspected prior to any roofing material being installed.
❑Yea q
� 9 If a roof is installed wit its
taining an inspection,I agree to remove
Will the epplican ori EUilding mcupant use equipment or devices which
it haimmous air carom) tats as dcfncd by the Bay Arca Air Quality Management all new materials Inspection.
Notes?
❑Yes ❑Nu
(have rad Ce haraNnusmamrials requirements under ChePtcr6.Y5Of Nethkh
ria HCalthKSafctyC dM25505: 533 end2553a.1unrknund CvifNe Wilding
dms not currently h a tenant,that it i my responsibility m noddy the neupant of am
requiremcros a be met prior rsCameofaCmdficakofOccupancy. Signature of Applicant Dat
owmrmaa ori,<dagent , All roof coverings to be Class "B° or better
r
u Community Development Department
Building Division
Q� r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�TINO 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 theabovestated policy on re-roofing.
Homeowner's Nam/e': l .S ;A C>
Job Site Address: J CA 1n)E t7t t.I.
Roofing Company Name �—O�✓ E G1 go.J I
A plicant's SSiig^na re:
Wil
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 03 � ° a
CUPEf�TINO PERMIT APPLICATION FORM
APN# O 3 Date:
3l 4 (c>
Buildin Address:
t c� D 4—
Owner's Name: Phone#:
�rn ^
CO �tiS L E7�7Ye License#: oZ{O
act Phone#:
rJ C _�, 0-3
Applicant/Contractor: Fax#:
8- a-34 - 6333
Building Permit Info:
Bldg Elect Plumb ,Mech
Job Description: l 1174 J-- W P5
t
Residential: - t(Q Commercial ( . fi 5 PC, 27
Sq.FFloor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Cons ction: \ r" Occupan up:
Qty 'f
A is b e Fee ID Fee Description Fee Group
BPERMFEE —Bldg Permit Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEI$MICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG