03090164 (2) ;• CITY OF CUPERTIN0 7.% 77
BUILDING DIVISION PERMIT ��,ICONTRACTnR INFORMATION
fl UILDING ADDRESS: ALL SEASONS ROOFING SERVIM1r No03090164
OWNER'SNAME; 2640 PACER LN PERMIT ISSUE DATE
COMPASS MANAr�FMRNT 2,12
9'1
HE' 4089724455 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Op LICENSED CONnsed ad, mvisi DECLARATION
' F 1 nereny armm that 1 am Geentta ander provkdana..r chapter 9 aommenang Job Description
<� with Seen..7")of Division 3 of NC Bushessand Profession,Code,add tryle..is
n full fame and cf t. �p p p
'�c Dam ag�cl�z f��_uen -9 i6`1 REROOF F'�tl/ LED
s m IV Cuntracrar NOVARCHITECTS W TS DECLAR A O V a� g akoo�
1
,—I
U 1 unticrstanJ my plans shall M1c used as puM1lic records ` 4 L
,a
yap ALicensed Pmfcsxional
OWNER-BUILDER DECLARATION
iy 1 hereby affirm but 1 am exempt room the Contractor's License Law for the IN HIDING
00 fallowing mason,(Section)ID 1.5,Business and PrefesNum Cade:Any City or county
<m which requires a perm)to construct,alter,improve,demolish,or repair any etructure
prior m its issuance.also requires the applicant for such permit to Glc a signed statement
_s< that he islicensed Potential mthe provisions arthe cantracmrsLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 356028018 . 00
Section 7031.5 by any applicantfar apermit subjects the aPplicanuo a civil penalty of APN Number Occupancy Type
nut ream than five hundred dollars(5500). P Y YP
I,uowner of the pmpeny.or my employee with wageuthev salt compensation.
will do the work.and the structum is not intended Or offered for sale(Sec.7 a,Business 305 - FRAME
and Prnmssions Cade:The Contramors Liecom Law docs not apply to an Owner of Required Inspections
property who builds or improves Nemon,andwhodaessuchworkhimxlforthmugb his 307 - INSULATION
ovacmployces.provided thmsach impmwmentsare natimendedoroffemd tarsale.¢ 601 — ROOF TEAR OFF
however.the building or improvement is Sold within one year of completion.he owner-
builder will haw the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
salcJ.
C 1.as owner of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
constrect the preject(SecJ(3aa,Business and Professions Code:)The Contractors Li- 604 — ROOF IN-PROGRESS
cerise law dors not apply to an owner of pmpeny who milds or improve mc¢on.and.
who contracts for such prujecu with a comractor(s)licensed pursuant o me Contractor's
Licm law.
0 I am exempt under Sec. B&P C for this mazon
Owner Date
n WORKER'S COMPENSATION DECLARATION
l\ I hereby aRtm under penalty of perjury one of the following declarations: .
I have and will maintain it Certificate of Consent to elf-inane for Walker's Cumpen-
cation,Or provided for by Section J]W of the tabor Code.for me performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insuranec,as required by Section
39W of he Labor Code,for the performance of the work for which this permit is issued.
My Workers -�om/Mma/t on Insurance carrier and Policy number am: ,tI
Carrier: _policy
CERTIFICAE 0EXEMPTION FROM
WORKERS*
COMPENSATION INSURANCE
(This section need nut be completed dire permit is for enc hundmd dollars(SI(g))
to cas.)
1 cenify that in the performance of the work for which this Permit is issued.I shall not
employ any person in any manner.So as In hecome subject to the Workers''Compensation
Laws of Califomia.Dale
Applicant
NOTICE TO APPLICANT:If,after making his Certificate of Exemption,you should
ECCWC subject to the Worker'a Compensation previsions of the labor COM.you must
.J rZ forthwith comply with such provisions or him Permit shall be deemed invoked.
z O CONSTRUCTION LENDING AGENCY
�-- '+ l hcaby affirm that here is a concoction lending agency for performance of
C' the work for which this permit is issued(Sec,Ly)?.Co,C.)
lgl Lender's Name
4' Underi Address
2
U 0 1 ecnify hat 1 have read this application and loam that the above information is
Fconeak I agree to comply with all city and county ordinances and state laws misting to
O V building concoction,and hereby amboriae mPresenoative tar his city to enter Upon(he
1 above-mentioned property for inspectionpurposes.
(We)agree to save,indemnify and keep harmless the City of Capcnina against
F ti Iiabiliucs,judgments,costs and expenses which may in any way acerae against said City
C) z cPAPPLICANT ofthcgSTANof this permit.
r SOUUNDEONS NDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Dale
s Re-roofs
gnvur pp0IRII/L nhacmr arc
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will the applicant or fumrc building uccupam store or handle hazardous materiel
as d0mal by tM Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
CoJc.Setion 25552(a)?
❑Ye �Na All roofs shall be inspected prior to any roofing material being installed.
Will he applicant or fumrc building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,it ha>aNnus air codurimm raw as Jcfi.Cd by the Bay Arca Air Quality Management all new materials for inspection.
isaiet?
❑Yes �Nu ..
1 have mad the hasaNtms malcrialsmyviremcnu under Chepter6.95 of the Califor-
niaHralth&SoetyCU ,Sccuoms Y)5.255JJaN2555G.lunde an duifthe Foil -
does not currently have a mnam,hat it is my responsibility W nnul'y dtc Occup _
en h astbe do faccrafieateofaea ig eofApplicant ale
0
neva adnedagenl ate All roof coverings to be Class "B"or better
` Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fay:: (408)777-3333
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection and/or tear off approval.
2) In progress inspection approval-
3)
pproval3) 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
J, require the removal of all new material down to the sheathing so that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/a"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: OO!Llpti-55 Atetc,q P e ;f
Address: Kfla�—
" / II
Reroofing Company Name: fF I6,e'a-C,6.0
Applicants Signatur Date:
• Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO
Sam- REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
z
Building Address:
e r
Owner's Name: Phone#:
C vot- 2- 3,40
Contract r: License#:
Contact: ww yr�d� Phone#:
d - 9 7
Applicant/Contractor: Fax#:
✓i - 938' —y/ 7
ui ding Permit Info:
Bldg Elect Plumb Mech
Job Descriptio
Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Enginee : Valuation:
Type of Construction: Occupancy Group:
Of— 9CY3 t�
Qty. if
A li b Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILIDNG
BENERGY Ener BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPL CHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
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