04060179 CITY OF CUPESION �CUNTIRA&TOR INFONATTO `
BUILDING DIVISION PERMIT . ,�,, ,•, , „ ,,
t,-BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITNc0g060179 -
10185 POTTERS HATCH
OWNER'S NAME: PERMIT ISSUE DATE
DE ANZA OAKS HOA 645 HORNING ST 06/21/2004
ONE: SANITARY NO. CONTROL NO.
(408) 278-033,0
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MFC"
0 0 0 0
p p LICENSED CONTRACT'OR'S DECLARATION Job Descr>� ®�'
I by affirm that 1 am Ifmmed under pryf talons of Chapter 9(commencing a
withllf )u(Division 3of dm Buvne ofmsions Coda,entl mylicense is
Nmommeantlert Z O REROOF W/COMP. SHINGLES
z�G DainnuC ConLic.g J A
'y$ � ARCHIM ehe l be used upuhlic mcmds - WOZ " AGN
3 01 Liccnud 4cuionel qq
S OWNER-BUILDER DECLARATION ®� y
g I hereby affirm'n 1 1. exempt from Ne Contractor's Cone:
:Any c Law for the v
i G 202, following reason.(Section]031.5,Business and Profession Cmle:Any city stcounty
m which requiem n permit m conewn,pike improve,demolish.fie pair any awmure 0
FZy petal Nits ctrood e,elsorcgo the the inion nt ofthc ontracch miOo Oense La ed statement
< (com incing ithSccanttnthapmvixiomnfoftheBrumr'aLimnseLaw(Codum Sq.Ft. Floor Area Valuation
$ (comleis exempt Secfrom and
basis
the
entl Professions Cnda)of
3b, Not he u exempt therefrom and Ne basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of e Occupancy Type
not mom Nan Eu hundred dolhrs(SSM).
❑I.se,owner of Ne property,or my employ=with wages as their sole compensation,
will do the work.and theswcture is not atundeim fired formic(So..]D44,Business Required Ins CC
and Professions Coda:The Contractor's License Law does Wt apply m an owner of q
property who buildsorimpraves daemon,and whodoessuch work himulfor through his
own employees,provided that such improvemenkare not intended croRered formic,If. Q004
however,the Wilding or improvement is sold within one year ofoompletion,the owner- NOV ��
builder will have the burden of proving Nat he did not build or improve for purpose of 2
sale.).
❑1,ru owner of ct Property,,a.B exclusively Contractingnesss with licensed convectors t. BUILDING
01,asConstruct the project(Sec.]044,Business and Contracting with licensed
The d contractors
in
came law does not apply to an owner of property who Wilda or improves thereon.and,
who contracts for such projects with a contractor(s)licensed pursuant in the Convector's
License Law.
❑I am exempt under Sec. .B R P C fm Nis reason
Owner Dam
W O0.KER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of do following declarations:
Fl I have and will munW n a Cenificam of Conunua self-insure for WmketsCompen-
workfor
for by Section 3]00 of Ne labor Code.far Ne perfermence of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance canner and Policy number am:
mer. I acY No: OR
CERTIFICATE OF EXEM . WORKERS'
COMPENSATIO ANCE
(Ibis section need notbe completed if the Permit is for one hundred dolma(SIM)
tor less.)
I certify that in the Performance of Ne work for which Nis permit is issued,I shall nut
employ any person in any manneran as;to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Carepensaden provisions of tbe Lebo Code,you must
O roMwith comply with such Novitiate;or this Permit shall W deemed awaked.
z ryN., CONSTRUCTION LENDING AGENCY
[-a I hereby affirm that there is a conswctina lending agency for NC Performance of
Ci> the work(ser which Nu permit is issued(Sec.3097.Civ.C.)
W� LeMe Name
r7 z Lendeh Address
U O I certify Net 1 have read this application and sum that Ne above Information is
(~ contact.l agree to comply with all city and county ordinances and auk laws relating to
0U Wilding construction,and hereby mutatim representatives of this City to enter upon the
f1.1 shove-mentioned property for inspection purposes.
(We)agree an save.indemnify and keep harmless the City of Columned against
M Ilabiliics,judgments,casts and expenses which may In any way accme against said City
U z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS-AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S
64'2110 Re-roofs
Signat f pplicat an= am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fmnmbuilding Paul.'
or handle hazardous material
as&flood by lie Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ode,Section 25532(a)? a All roofs shall be inspected prior to any roofing material being installed.
C3Y.
Will the applicant m future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conmminanu u coiined by the Bay Area Air Quality Management all neW(il�te s o 'nspection.
DisvictT ^,S //
❑Yes
Ituvereel the haxaNnus mamriala requiroments under Chepmrh95ofthc Calif / J
nig HcalNASafesy cu 255(15.25533 and 25534.1 understand that if the Wilding
decorate. illy van
rant. at it is my rcspamihility m notilj the occupant of the
a�roiga.enccoraceninestc.foe pseey. SignatureofApplicant Date
owner whodzadage.l Da All roof coverings to be Class"B'.' or better
Community Development
10300 Torre Avenue
ef Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #. / _l
rz
OWNERS-NAME: PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontra � ' Z
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
'' � OwrlefXContractor Signature � Date
I '
Community Development Department
z Building Division
City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
U P E kT I N O Fax: (408)777-3333
O
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: TCz,(�i-�
Job Site Address: `D I S 77 S `�
Roofing Company Name: o v SEi? 50 ti S
A plicant's Signature: Date: Z/ 6
\il/Q61il1D�X1
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINOg
' REROOF U � � '� � / �/
• CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address: t /
Owner's Name: hone#:
Contractor: Phone#: Licee#:
?va F. �� Ca, 104S
Contact: Phone#: C Cupertino Business License#:
l�l.✓�\' SS a _ 0 Z ( 3 z 3
Type of Roof overing:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 4i-,Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) CC--N L..%o oh ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
>C_To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential 954-1 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan Dept. if
there are anrestri 'ons: Le
11
Cost of Project: c�.d Type of Const t' n: Occupancy grou
ty. if
1 cable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees 7 BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Z6
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