04070089 (2) CITY OF CUPERTINO z"'' �
BUILDING DIVISION PERMIT '#CONTR°A6TOR INFQRM` MON ,
OUI LDING ADDRESS: FOUR SEASONS ROOFING 1E11ITN904070089
10196 CAMBERLEY
O NER'SNAME: PERMIT ISSUE DATE
MATT HULL 645 HORNING
E:
SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O
w00 LICENSED CONTRACTORS and R'SDECLARATION �
U I WrcbY affirm natal em licenced under provisions of ION 9(commencing U
win Sccti n7000)nf Divismn3ofne Busin....it Pfufcsuons Code.and my license is
infol fo and REROOF/PLYWOOD
j b= License Lie 0ami y� �j /.
nH� Dam
ARCHr1ECTStDECLA CFP L4J [OOT
1 u rad my plans shall W used ss publii7.
w
;.G Licensed Pmfcuinnal D �1 IMI ®�I� rs //��
g OWNER-BUILDER DECLARATION U IILII`J I�IQ\\\Ilflf//
1 hereby affirm Thal 1 am exempt from Ne Contractor's License Law for the 1l rv�
�p0 following rcaon.(Section703L5,Business and Pmfecsiuns Code:Any city or county
x m which requires a permit w mo suun,alum,impmw,demolish,or repsir any structure
°—'^ prior m its issuance.also rcquirestW applicant for such permiuo filcasigned statement
FE' position he is licensed puant to ate provisions of than Cmtra
nctursU...law(Chapter 9 Sq. Ft.Floor Area Valuation
�Fe (commencing with Section 7")of Division 3 of rite Business and Professions Codc)or
i F F that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 0031.5 by any applicant for.permit subjects the applicant to a civil penalty of e100 - Occupancy Type
nut mom than rim hundred dollars($500I. r
I,vowrrcr of the propcnY•or my employees with wagesu their sole compensation.
willdo tW work.end Ne awctu n is not intended urolkred for sale(Sec.?W.Business
and Prefectures Coast:The Conoxcmrs License Law does mot w oapply an owner of Required Inspections
property who Wilds orimpormtherems and whodoessuch work himondfor through his
own employees,provided that such improvements are not intended or offered forsale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did rot Wild or improve for purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed concessions w
comouct the project(Sal.7044.Business and Professions Code:)The Contractors Li.
nse law dm not apply in an owner of property who Wilda or improves member and,
who contracts for such pmjccu with a contractor(s)licensed pursuant w the Convectors
License Law.
❑1 am exempt under Sec. .B&P C for this maven
Own Data
WORKERS COMPENSATION DECLARATION
1 hereby aRcm under penalty of perjury arc of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers Con
pen-
Minor,as provided for by Section 3?W of than labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3100 of that later Code,for the performance of than wart for which this panni,is issued.
M Workers Cmmpemauon seat cauand Policynumbtrare:
Polity
\/ CERTIFICATE OF EXEMPTION MOMW KERS U
COMPENSATION INSURANCE
(This section need nm W completed if the permit is for one hundred dollars($10B
or leu,)
I certify that in the performance of tho work for which this Permit is issued,I shall not
employ any person in any mannerso as m Wcomc subject to this Worksix Compcnsadon
Laws of California,Dau
Applicant
NOTICE TO APPLICANT:IL after making this CcmEmu of Exemption,you should
become subject to the Worker's Compensation provisions of the Iaher Code.you must
.�7, forthwith comply win such provisions or Nis pmordtsbull W deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
PI hereby affirm that there is a cons undim lending agency Wt tW Performance of
{Y > ate work Or which this permit is issued(Sec.3097,Civ.C.)
D] 0 Lender's Name
G Under's Address
:Dz
U Q I certify that I have read this application and sou that ate aW w infmmuiun 13
IL t" conch,I agree in comply with all city and county ordinances and shote laws relating to
0U building cinslnnion,and hereby aunomereprescnutives of this city to cnur upon tW
ahove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
saq liabilities.judgments,costs and expenses which may in any way aceme against said City
U in consequence ofne 11 Trost.
�-+ APPLICANT UN STANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Dat
6
-0V Re-roofs
ignawmo ApplicanUConoacmr l Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furan building occupantstom or handle havmlaus material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section
❑Yes 25532(.)? d•� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conmmioants as defined by the B in Quality Management all new materials for in action.
r District?
❑Yes u
I have mad the havasdnusmaurials requirements under Chapter metal this if the
ria Hca Ihav Salm ns25505.2553J anJ25s under
x6.95 if the Wilding
does n Y w a un Nat it u my rceprruibility m mtifY tW uceuW,of ate -
mrtnissnaetcemracemlRaumraenpmry. Signature of Applicant Date
��T —�-0 y All roof coverings to be Class "B" or better
Owner ur authorized.gem Da¢
Community Development
J10300 Torre Avenue
, = Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
I Ol Ca,6&,,- d 0?G 0
OWNER'S NAME: .t 4} r PHONE # Z-7 —o 3
GENERAL CONTRACTOR:[Sir- Seas -s FAX #
I am not using any subcontractors: > 7 l S
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINE E
SS 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
ofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ ntractor Signature Daie'
CITY OF CUPERTINO
3 of 3 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34242018.00
DATE ISSUED. . . . . . . : 07/16/2004
RECEIPT #. . . . . . . . . : 26327
REFERENCE ID # . . . : 04070089
SITE ADDRESS . . . . . : 10196 CAMBERLEY LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MATT HULL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2633
RECEIVED FROM . . . . : FOURS SEASONS ROOF
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 645 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408)278-0330
eE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ __________
BPERMFEE VALUATION 8, 000.00 147.96 0.00 147.96 0.00'
BSEISMICRE VALUATION 8, 000.00 0.80 0.00 0.80 0.00
__ __________ ________ ----------
TOTAL PERMIT 148.76 0.00 148.76 0.00
METHOD OF PAYMENT AMOUNT NUMBER
__ __________________
CHECK 446.28 004002
TOTAL RECEIPT 446.28
CITY OF CUPERTINO
REROOF ��DD
•CUPERTINO PERMIT APPLICATION FORM /
APN # O Date: /
Building Addr ss:
6 6 G bow/t
Owner's Name: / e #
M A 7-T -fes G� gZ411 �-d 330
Contractor: Phone #: License #:
Contact: Phone #: Cupertino Bu iness License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
,�
❑ Wood Shingles ❑ Wood Shingles
iP5/ Other(Specify) ([1+acc,txs� ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report it
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Com I With Cu ertino's Tear Off Policy:
Job Description:
Residential Ej� Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: 15
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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
Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
CITY Telephone: (408) 777-3228
Fax: (408)777-3333
CUPEkTINO
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. An roofing which is applied without first obtaining an inspection,
Any s rr s r
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:
Job Site Address:
Roofing Company Name: Ofl' 5��' J
A phcanes Signature: ate:��/� cy
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper