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04060242
CITY OF CUPERTINO - = • —— �'' r„a�. BUILDING DIVISION PERMIT ® 'TR�A.CTOR llk'URM'ATT,ON •— - - BUILDINGADDRESS: _ FOUR SEASONS ROOFING PERMIT N004060242 10164 POTTERS HATCH OWNER'S NAME: PERMITMUEDATE Igh DE ANZA OAKS HOA 645 HOMING ST nr /29/2oo4 ONE: SANITARY NO. CONTROL NO. (408) 278-0330 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +�ipp LICENSED CONTRACTORS DECLARATION I Job Description u 1 hereby affirm that l am licensed under previsions of Chapter 9(commencing p " wimh SectitnJ0P11)rf Division Sof the Basin.,an Pprim....ns Ctde.mdmyliccescr s n in(ullforcet�e ` . _3 Z REROOF W/COMP. SHINGLES j�� License CI s Lk.d DEC GanlrIEC jr U rsu RCHITELTS ATI N 2, I undersand my plans shall he used public records y Licensed Professional - OWNER-BUILDER DECLARATION I Itroby affirm on I ore ucmpt from the Contractors License Law for the my x p o following eaten.per edun B13 s r Business and Strove. derpol Code:Any city as county K$ which requires a permit m cnnnmct elloa improve,demolish,nr repair any ewaum000 m4 prior to its issuance,also requires the applicant for such permit m File a signed statement - pz?C that he is licensed pursuant to the previsions of the Contractors License Lov(Chapter 9 Sq.Ft. Floor Area Valuation y $ (commencing with Section 7000)of Division 3 of the Business and Pmfcsions Code)or .- that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er0 0 Occupancy Type not more Nan five hundred dollar($500). _ ❑I.s owner of the property,or my employees with wages s their sole compensation, will do the work.and Ne dWCNm is non Intended proffered female(See.7044.BualMsa and Professions Code:The Cantractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended aro@red foe , however.the building or improvement is sold within one year of completion,the owner, wnerof builder will have the burden of proving Net he did not build or Improve for purpose of sale.). ❑'1.as owner of the property,am exeisively contracting wit licensed conwcmrs nt J conswet the project(Sec.7044.Business and Profssiren Code:)The ConVOamr's Li can=law does not apply to an owner of property who builds or improvs thereon,and / who contracts for such projects with aconaacuu(s)licensed pursuant to the Conmacter's Licensa Law. ❑I mm exempn under See ,B&P C for this msson '/ Owner Data O� WORKER'S COMPENSATION DECLARATION 1 hereby aff fou under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate ofConacm to self4nsum for Warkei s Compere Suite,as provided for by Section 37W of Ne Labor Code,for Ne performance of the work for which Nis permit is issued. ❑1 have and will maintain Worker's Compensation Neutrons,as required by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. My Worker's's C�nfmpe tion Imummce canner and Poli o bet am: 97 Policy CERTIFICATEOFEXEMPTIONFROM ERS' COMPENSATION INSURANCE (Thisscclion need not Mcomplened if the permil is furore hundred dollars($100) ar less.) 1 certify Nat in the performance of the work for which this permit is issued.I shall not , employ any Person in my mannerso as to become subject a the Workers'Compensation Laws pf California.pale Applicam NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of No labor Code.you mus( .,O forthwith comply with such provisions or this permit shall be deemed revoked. Z tifCONSTRUCTION LENDING AGENCY s Ihereby affirm that there is a construction lending agency for the Performance of fSa Ne work fur which Nu permit is issued(Sec.3097.Civ.C.) PW.A Lender's N. z Lender's Address V 1 certify Net 1 have mad this application and sate that the above information is Uw F suspect.1 agree N comply with all city and county ordinances and Stalo laws relining to OU building construction.and humbyauthorix tepresennativs of this city to color upon de CL almvcmee)ancol gree I. pecorty for demnify an keephs. (Wc)agree m save,indemnify and kith hay incan the way of Cupertino against CL liebilities,judgments,costs and expenses which may in any way accmc against said City620 V z APPLIC ucnce of Ne tin�A4A WILL COMPLY WI LL NON POINT_ Issued by: Date CE NS. Re-roofs Signazum of AppiionVConuanor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futum building Occupant store or handle hvardous material s defined by Ne Cupertino Municipal Code.Chapter 9.12.and the Health and Safety av Section zss3z(an All roofs shall be inspected prior to any roofing material being installed. ❑sea Will the applicant or fume building Occupant use equipment or dcvics which If a roof is installed without first obtaining an inspection,I agree to remove mit havardeus air con ts defined by the Bay Area Air Quality Management all new materials for ins n. . District? ❑Ycs No Ihaveeadtheh.; nalsrequire ntsundet Chapter niSHcalN&Sa(ctyC dos 8505,255JJa 5534.Iuodcrsmndthanifthchuilding docs no,cuncn}I moan �bu.h spansihillny m notify dm ecu m,of Nc - Ownefw,r af16 ef�pw msum of a'C,eniOc �7•"hY //// `� Signe ure of Applicant Date owns pr aathorivad agent a ,e All roof coverings to be Class"B"or better •a, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNERS NAME: { i t, - PHONt # f5Sg —/kF-7 ? GENERAL CONTRACTOR: FAX# 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 Septic Tank Sheet Metal Sheet Rock AN Tile IV Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 ;UPE �iNO 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 Y4"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. Homeowners Name: ` 7 n- � r3 Lt` Job Site Address: 1^`1 o LI Roofing Company Name: `r' .=_ " �S .� t�� +�/ A plicant's�Signature: --tea —7—Z`1 t� Greg teel Building Official Revised-1130/03 - Pdnled on Recycled Paper ' i CITY OF CUPERTINO REROOF CUPEkiNO PERMIT APPLICATION FORM APN # Date: B 1 c Building Address: ©l G4 Flo ttcc�S L Owner's Name: Contractor: Phone#: Ltcens #: Ov1r��zB �•�S cry' - —0 Contact: hone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Qt=-Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles P� Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide LC.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: s� tom•-N,ae.s.a:s-� .( /J� !�t 1G Residential Commercial ❑ Fire Zone: Yes ❑ No M--- Confirmed with Planning Deft. if there are any restrictions: U Cost of Project Type of Construction: Occupancy group:: Qty A ica Fee ID Fee Description Fee Group BPERMFEE B14Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License ' BUILDING � I A> 3 7