03050073 CITY OF CUPERTINO ��=' �'"'
BUILDING DIVISION PERMITCONT=1tA.CTUI2 XdKRMATIUNa w .
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO 03050073
1027 rRTrT<P.T T4TTT RT)
OWNER'S NAME: 645 HORNING ST `MIT�°`f16/2003
YER LYN TRUSTEE
NE: (408) 278-0330 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG t PLUMB MOECH
�00 LICENSED CONTRACTOR'S DECLARATION
1 hereby afflnn that 1 am licensed under FMVWOna Of Chapter 9(commencing Job Description
with Section 7UlD)of Division 3 of the Budneu and Professions Code.and my license k
^� infunfmceandelkc 3 10 REROOF
j lr-.Z License Cl IJe.g Fa.O HHB A L E
k Uete ARCHITECT'S DConECLARATION
yq. IuMemanJmyphos"lbousadaspubllemmum JUN 1 0 2003
L O 5 Licensed Professional
OWNER-BUILDER exempt( DECLARATION
f I hereby waso afOm that 11. exempt from We Con miss Code:
s License Law for the
pO which
following rees,aIsmcuon]1131.5.Buarcsased Dv(esiumh.oe:Any city armoury BUILDING
$ which us burr a e.than to e t srmes eWs Improve,dcmmil i or repair try Wmcnl
prior b ins mnwd pursuant,skis nto the No applicant for Cork permit n file a signed wnmmni
a' < durWislicensedothe PmvislOnsn(NcCanuacmraLicensOlaw(Chapkr9 Sq.Ft.Floor Area $471i(5blgtion
$ (commencing with Secuun7000)of Division 3nf the,Buomessuit Pmfessiau Cade)un
.. rhe he L sumps Nuefmm and Nu
e basis for IAe alleged emption.Any AslNan of
Section 7031.5 by srryappliwnr for a permit subjects Ne applicants m a civil penalty of 3 41P�PImdlger0 0 Occupancy Type
not mete dufi
n w hundred dollars(1500).
1,u owner of W pmpcny,m my employee ww wge u dnhule compemsedon,
willdo flu work,and Ne swnum Is not wooded ororteted tarsele(Sec.70th.Biomass
and Professions Cod.The Conmenaes License Law oma ser apply N u Owner ofReg it d Inspections
property who wildsmimprows dnreon,and wWdocsamhwmit Mthrough augh his307 - INSULA'PMU
own employee,provided that such improvements am nollmnded ora0ered for We.If. 601 — ROOF TEAR OFF
however.the Wilding m improvemut issuld within one year ofcompleuoo,the owner,
builder will have the buNen of proving that M did out Wife m improve for purpose of 602 - ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
❑1,u owner of the progeny am exclusively contracting with licensed contractor in
construct now project(Sec.70".Business and Professions Code:)The Coninesur's LL 604 — ROOF IN—PROGRESS
mase law done not apply to an owner of property who Wlids or improves themm.and
who conlruu for such pmjecu with a emuomrts)licensed punemin to Ne Commoner
License Law.
O Tamexamprundm Sm. ,B&PCfmthlareaon
13cmil
er Dau
WORKER'S COMPENSATION DECLARATION
1 Wreby aBine under poorly of perjury oro of do following declaration c
I haw am will monWn a cmdficaumrConsem au16Wme fm Wmrt .Cmpm-
on,as provided for by Section 37000(the labor Code,for the performance of the
rk for which this permit is iced
1 haw and will maintain Worker's Compensation Insurance,u requirod by Section
of Ne labor Code,far the performance of use work for which Nu permit ts hismid.
y Workse; C.oml�l�e.Limajour7tcarrier sed Policy n beQQOIrtier. �N.gt"IS /'+�` PoIIry No.: a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectim mad notbecomplered If the Permit Is foram hundred dallm($100)
or k es)
1 certify that in the performance of New rte Ice which this permit n Wood,I shall not
employ any Pe•,,-,T�•Y•,'uY mss^ r �e subject m Newarlmn'Compewdon .
Laws of Calf 1 y( ,�
NOTICE TO APP LICANT:IL-.7immaking this Cerifficaut of E Latina om,youshould
Wcomesubject y it Worker's COmpeoutian ermiwnsof ore LaMar Code,. muse
Oforthwith comply with such Pmvloans w this permit MHI W dcemad rewkcd.
z► CONSTRUCTION LENDING AGENCY
[�. 1 Wmby affirm that there is a comtruclin t lending agency for the performances of
Gl, the work for which this permit is Issued(Sec.3097.Civ.C.)
W Q Lemm'.Name
Z z Lender's Address
U0 1 cattily that I haw read this application and sun that the above information is
IL F cones,l agree in comply with all city and county ordinances and sun lawn totaling on
O V Wilding construction.and hereby authonre representsuveo of this city renter upon Ne
LLl above-mentioned pmperty for inspection purposes
l3.
(We)agree to sew,indemnify sed hep ham sere City o(Cupenino againstl
wr(A IlabiliOe.Judgmnu
e ,calm and expenses which mayy In in try way Deme agalnstsald City '\\)
C)z In conseq c of roc granting of a it.
w. APPLI NUDE Date
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC E LATI
�� Re-roofs
Signature of ApplicarmitCowniflor DaDa�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m forum building Occupanurow or handle huudow material
an defud by the Cupertino Municipal Code.Chapter 9.11,arm the Health aad Safety
W
e.Seetian 15531(1)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
it hevaNnw air cone=I.%as dclined by rad Bay Ate At,Quality Management all new materials for inspection.
❑Yes �No
I haw read Ne huaNnmmwriats mquimmcnu umkrCempterd,95 orNe Califon.HOaIN& tYCodS07U .15533ad25534.1unMnu airdnWilding
s norcumhown0umytosponubility m nothy the Occupant or the
uiremco w hmatWuancc ofaCcniftean aro _._/O� Signature of Applicant Dale
(�wmm er wthariynda ter All roof coverings to be Class"B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4UPECITY OF Telephone: (408)777-3228
TINO Fax: (408)777-3333
R
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:
Job Site Address: a�
Roofing Company Name: dmf SP^Sc� t S
A pli
can
Ys Signature: a Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Pe0er
010 1
CITY OF CUPERTINO 7-3REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# � O� Date:
Building Address: '
a30a-'7 C., %Nr_K-e-{- ((
Owner's Name: Phone#:
Contractor: Phone#: License#:
Four See.S I v-t.5 01) °b� aW-C,33o c4
70 16 Sr
Contact: t Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles t* Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles / LlWood Shingles
❑ Other(Specify) Qeyw,0A ❑ 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 Polic :
Job Description: C< )-tb
qd- V°I A/C �W
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: Ll
Cos ct: Type of Construction: Occupancy group:
OTD
Qty, if
Appc 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
7,, 87
t 17. 5 '