03050089 (2) CITY OF CUPERTINO ' ' aa�^�" °•'>t� `' -`"' a
BUILDING DIVISION PERMIT �,C"R& TCIR Y, §____ MATIbN ""
x xu S+�F �x'� a!!.LM ,G•'yk $3k '.S r^Ny k'
BUIIl)INO ADDRESS: PERMIT NO.
FOUR SEASONS ROOFING 03050089
PERMIT ISSUE DATE
645 HORNING ST 05/20/2003
SANITARY NO. CONTROL NO.
(408) 278-0330
CHITEC IENOINEER: BUILDING PERMIT INFO
BLDG ELECT" PLUMB MECH
log LICENSED CONTRACTOR'S DECLARATION e Job Description
O
1 herebyN
&film al I am Ilaiued under provisions of Chapter 9(commencing P
with SeNon 7000)of Division 3 ofthe Busin Pro(cssmna Code,and my license is
in to to= e 1.
Mhz ueenMC G3 LN.R REROOF
Dam v+ Con
ARCHITECTS D ATION ¢ms saasa ��e
1 understand my plana shall Ire used a public records uU
`;r� Licensed Professions' JUN 1 0 2003
i�y I hereby A(Rmn OWNER-BUILDER 1 em exemptfrom the Contractors Llcanxe law for are
p O following meson.(Section 70315,Business and Professions Code:My city m county
I$to which requlra a permit to crosuuct,alar.Improve,demolish,m repair any nruclum ma gas r3lpin
Ir interne its Issuance.nor requires the applicant mrsuch permit to file a signed statement
FF<
that he is licensed pursuant In the provisions ofthe Cutaneor'asWanne Law(Chapter 9 Sq.Ft.Floor Area vi Won d� (commencing with Sutton 7000)of Division 3 ofthe Busineand Profeulmu Code)or $48
INt he is exempt therefrom and the basis fm the alleged exemption.Any violation of A phi N
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of 3 Yf241' �0 0 Occas ane f;, e
not mom Nm Bw hundred dollars(5500). P y •7 P
❑I,as owner rims property,or my empioyaa with wagon a their solo compensatim,
.tilde tmwork,and the structural,notlnterded moneyed tarsals(Sec.7044,Business
and Professions Code:The Coommes License taw does not apply in an owner of 305 — FRAME Required Inspections
property who builds ortmprowa thereon,and whodasauh week himerforthrough his 307 - INSULATION
own employees,provided that such improvements are not Intended oroRered for sale.If.
however,the building or improvement is sold within one year ofeompiedon,the owne- 601 — ROOF TEAR OFF
trimer will haw ren Wedan of proving wlhn ala nm lwld or Improve for purpose at 602 — ROOF PLYWOOD NAIL
❑1,as.wner of dm property,Me exclusively contracting with licensed eom0aemn to 603 - ROOF BATTENS
construct the project(Sec.7M.Butdracts;and Potmedrard,Codc:)The Contructer's IA. 604 - ROOF IN-PROGRESS
ams law docs not apply to an owner of property who builds or Improves memon,and
who conmcte for such projects who a conuact.Rs)licensed purawnt to the Conuamma
License law.
1 am exempt under Seo. .B R P C fee this mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one.(the following declarations:heveandwill meinulnaCeNMeu ofConunuo xelf-InanmforWorkerMompen-
-�14 11111I.Fan.as provided for by Section 3700 of the labor Code,for the performance of the
work forwhich this permit its Issued.
❑1 have and will maintain Workers Compensation Insurance,a requlmd by Section
3700.17 The labor Code,for the Performance ofthe work for which thin permit is around.
My Workers oro1p'g'nutLR4surance carrier and Policy num rue:
Grier. •w"� �!O Poliq Oo�0�
CERTIFICATE OF PXEMPnO MIVORKER8'
COMPENSATION INSURANCE
(This=am reed not be completed i f the permit 4 forone hundred dollars(5100)
m leu)
1 cenlfy that In the Performance of the work for which this Permit Is leaned,I"I rot
employ any person in any mumcran as at boxam object to tineWorkers'Compmwdon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.After making this Certificate of Exemption,you Mould
become subject to the Worker's Compensation provisions of the Luber Code,you must
Oforthwith comply with such provision or this permit shell be demand mwkod.
Z h CONSIRUCDON LENDING AGENCY caw
-w�+ I hereby aflim that dune is a construction lending agency for the performance of
7G dm work for which Ws Permit Is Issued(Sm.3D97,Cl,C.)
1)QLundeen Name
3..L3. Lemice.Address
O 1 Mortify the 1 Mw mad this application and auto mu me show infomutlon 4
y comers I spa at comply with all city and county ordinances and suss laws totaling to
7O building C.eatroclim,and hereby authodre represenmiws of this city to enter upon me
'love-m ort omd pmpeny fm Inspection purimses,
(We)spa m saw,indemnify and keep hArmlets Irk City of Cupertino against
�N Iiebilidon,Judgmenu.costs and expenses which may in any way Avenue a Saint add City
;J 7 In conrcgmnro.f me granting of this permaL
m� APPLIC UNDERST AND WILL COMPLY WITH ALL NON-POINT Issued b Date
SO PPL51C �E L s IQSy ALL
N y
Re-roofs
sign ofAppllnHAZARDOUSMATERIALSDISCLOSURE lorDam' Type of Roof
Will the applicant or future building ucupaautom or handle hazardous materiel
as de0ned by the Cupertino Municipal Code,Chapter 9.13,and the Hestia and Safely
Code,Shyer 33532(x)7 to. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant no equipment atdcvlm which If a roof is installed without first obtaining an inspection,I agree to remove
u4t7ednus air contaminants ac defined by the Bay Aron Air Quality Management all new materials for inspect n.
❑Yes on
I have read the trosamms mamdW requirements mdeClupur 6.95 of six Calimr- —'
n4 Healmd:Safely Cade,Satians .35533 and 25534,1undetMnd lhnlfth Wilding
docs rot a rely Mw a It 4 my nexpemlhility m mufy rite oaupant Of de
require nu hick 'orm)uuanec efa Cutifmnu of OecMammry/ 4 Ignature of Ical t DaTe
�Av+7/J 1
Dw orAmhan> aper — OL Mum - All roof coverings to be Class "B"or better
Community Development Department
Building Division
� City of Cupertino
flit
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
qUPEkTINO
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: �e�Z v . ��145
Job Site Address: 013037 C-�lr
Roofing Company Name: OJl s pts 1�oo �•1
A plicanYs Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t CITY OF CUPERTINO 0 S- k7
REROOF
CUPER INO PERMIT APPLICATION FORM
APN# W
„ bDate:�— a o
Building Address: :;1303?
X37
Name:
ame: 1
-
Contractor: Phone#: Lic se#:
!—Dud- S ec�SoKS Rw p, a-?8- q? a.(o
Contact: 'Do”) Phone Cupertino Business License#:
w. :
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles
la 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: -TeC_,i_ Vat" P( 3,D � � �e(� e,)
Residential Commercial F1 [ 1'
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there arerests ' ns: LJ
Cost of ProjemrCV Type of Const t' n: / Occup
Qty. if
ApplicFee 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
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