03050104 CITY OF CUPERTINOt j 7ft *� `� �•' ",
BUILDING DIVISION PERMIT �ONTRACTORIN'It'O1tMATQN ,
jBU1LDINGADD RUSS: FOUR SEASONS ROOFING PERMIT NO
Z9944 T,nmr, r)nwN RD
OWNER'S NAME: 64S HORNING ST PERMITISIJa�A'r�2/2003
E ANZA OAKS HOA
NE' (408) 278-0330 SANITARY NO. CONTROL NO:
ARCHITEC(ENGINEER: _ BUILDING PERMITINFO
O ELECT mum
O O
+00
LICENSED CONTRACTOR'S DECLARATION Job Description-1,11',"
e V 1 hereby affirm o
that I am licensed under previsions of Chapter 9(commencing
e with Section 7000),d Division 7of the Business it Processions Code,and my hear c is u
s in full farce anile pt. .Z,ID� REROOF .1UIV U ZOOS
Ll Z_ Lice uc Clu v "3 Lm.g
Dau Co.". r
LDECLARA ION
ARCHITECTS
i 1 understand my plans shall M used As public records BUILDING/�
Licensed Professional BUILDINGi
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Comoutor's License Law for the
O O following reason.(Section 7(01.7.Business and Professions Code:Any city or county
3$ which requires a Permit to construct,star.Improve.demolish,or repair any structure
prior W its issuarue.alarl requites the applicant for such permit to file a signed sutemem
E-ZsQ that he is licensed pursuant to the provisions of NC Comuacmr'a LIecna Law(Claim,9 Sq.Ft.Floor Area $4V(5;"ion
tFs (commencing with Section 70100)of Division]of the Business and Professions Cude)or
6 —
that he is exempt Lhcmfmm and the burs for the Alleged eumption.Any violation of
Section 705 LS by any appllnntfor a Permit subjects the applicant W a civil penalty Of 3ARM 0 thrier 00 Occupancy TI pe
not more than five handled dollars($500).
❑1.u ownu of the pmpeny,a my employ.wW wgu u Mev role cempensadon,
will do Ne work,and the awoure Isnot intended a offered for We(Sm.7061.Business JUb — FFUAMES
RRee
and Prefealons Code:The Conumme.Lt..law don not apply a an ownu of 3 0 7 - INSULA yy Rd Inspection
Property who builds or millions u
thenn,andwho doessuch workhimself orduough his
own employees,provided uw uch improvements vent intended a.ffuW tensile.If. 601. — ROOF TEAR OFF
however.the building or Improvement bsold within One Sear of ce.pmdon.Ne.,.
builder will Mve the humeri of proving that M did not Wild a improve for purpose of 602 - ROOF PLYWOOD NAIL
s1t')' 603 - ROOF BATTENS
❑1,as owner of the propcny,am exclusively contracting with licensed conuulas to 604 - ROOF IN-PROGRESS
construct Ne project(Sec.70x,Business and Professions Code:)The Contsaelora Li
cents law does not pply to an owner of properry who Wilds or improv Merton,and
who contracts for ouch pmjccta with a contractor(a)licensed pursuant W Ne Comomm's
Lkenm Law.
I am Ciampi under Sac. B k P C tar this..on
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby AT.under penalty of perjury,one of da following declarations:
1 have and will..lots].a Certificate of Consent to self-insure for Wake's Compere
113t100
on,u Provided for by Section 7700 of the labor Code,fa the performance of the
k for which Nis Permit is aimed. '
I ban and will maintain Workers Compensation Insurance,u required by Section
.(the labor Code,(or Ne per(mnsocc of the web(or which Nis permit is Wad.
Workcra�omlarjution I n Rrtiu end Polity ytmZ9 D„pe,sier. �l 1`��— a Polley No.:u Ci Ll
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mamsecdon and not W completed if do permit is two=hundred dollars($100)
or mail
1 certify that in Ne performance of da work for which this Permit is issued.l Nall not
employ any permit in any manner an tib become subject m da Workers Compcuadon
Laws of California.Dau
Applicmt
NOTICE TO APPLICANT:IL after making this ComfrcaW of Exemption,you should
become subject W the Worker's Compensation provisions of the Ice Wr Code,you must
,J 0 forthwith comply with soeh provision or this permit shall be dcemcm
d m ead.
„z,� '^ CONSTRUCTION LENDING AGENCY
[ti row 1hereby AM.Net Nene its urnawmine lending agency for the perfa.anm of
�: site weak for which this permit m issued(Sec.71197,Civ.C.)
aQ Lenders Name '
.7 z Lenders Address
V Q I comfy that I bave rod this application and stag Nat the above information is
Fcornet.I agree to comply with all city and county oNinances arta sum laws relating W
O V Wilding conswclion,and hereby mthoda apresenudv of this City W toter upon the
(Jl above-mentioned property for inspection purposes.
G (We)agree to ave.indemnify and keep hasmlea the City of Cupenimp against
y Iiabili0es.judgments,costs and expenses which may In my way accrue against said City
L)Z in cansegwnce a(Ne granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature o(ApplianUConuacta Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant ter future Wilding oceupanlarole or handle haartlous material
As dcaned by Ne Cupenino Municipal Code.Chapter 9.12,and site Health and Safety
cam, enzss7x(.l7
Dyes 0pn No All roofs shall be inspected prior to any roofing material being installed.
yrs
Will da applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
At harvdous air conuminants As dolned by da Bay Area Air Quality Management all new materials for inspection.
at ict7
❑Yes With,,
(havered thelSectti 25505.25533 and
255underderaard.95 ifNc Wilding _
I
.no, . .C,ban Sectio 2.SSf iAroy7aru12557d.lundestandthar if the Wilding
ariot circ hichocaa etLLmmymem'a Ceittiicnndl'y NcWcpy
yimm hath must orW issuancc.fa Cenifmau pfSignature Qf Applicant Datwner.nut oAnd agent , All roof coverings to be Class "B"or better
1
Community Development Department
Building Division
fir
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST 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 com/pply with the above stated policy on
n re-roofing.
Homeowner's Name: Y-/>°, /�'4 Z p� d``-(U G4 4
Job Site Address: CO. �g
Roofing Company Name:
AA12Phcanls Signature: Date: .S~
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITYOF CUPERTINOOo
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# O 2 Date: S d
Building Address'
aa9 Yq L.O luwA �
Owner's NameI o� „ n Phone#:
� H Z� VY�'
Contractor, Phone#: License#:
Rup S�oA6 Aoo7 WW 633
Contact: 60APhone#: 3 ?g'a3 3� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles if Asphalt Shingles
PA-Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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: � � CS k
� �r 3 D (Z Set
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Proje Type of Construction, Occupancy group:
Qt •-
A 1' a e 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
�' 97. 5-0