05070018 (2) "CITY OF CUPERTINO 14
BUILDING DIVISION PERMIT 4 CONTRACTOfgR INFORMATION
BUILDINGADDRESS: FOUR SEASONS ROOFING PERMITND05070018
OW HER'S NAME: PERMIT ISSUE DATE
RIC
ONE SANITARY NO. CONTROL NO.
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�WU LICENSED CONTRACTOR'S DECLARATION JobD
m❑ I hereby afrom Nm 1 am 3.f the
Bu i n ss previsions of Chapter 9(commencing
�ZW with Scaion]Ig)0)of Divlsion3of de Business and Prpfessipnx Cole,antl my licenseis VIPINALLU
in 0ll fore.and eff k '�-%O% REROOF W/COMP .
WG License CI s I Contracmr, S C a_t N L'
�� Dale 4
2005rej ARCHITECTS DECLARATION ' `
u I understand my plans shell he used ss public records I1aIg��p1}g},.���y���a],
u.v, Licensed Professional
OWNER-BUILDER DECLARATION .
<� 1 hereby affirm the 1 1. cscmpl s ad Jw Contractor's License Law far the
yp poi which re moon. ronedun](DIS,Business and Pe,deami Calc:Any city oir county
It which rtquisu n e,alsl r1.e CnRtWe,aIN[imform n Permitt Or¢paif d aWaYR
�¢on pdormits censed e,.nottoOr the apPlicanl for suchpeter's .asi w(ChHmcm
on that is in&wit ..not uoNc pmvisiom of Ne Centimeter's aw¢nse Law(C Code)
Sq.Ft. Floor Area Valuation
YFp (comm mingwith Secfdr.a00racDosianr tof he
Business awl Pr.Any ilaton or
i;•:� Wt bee u eumpt Ncrtlrom and the bes6 for dm illebW cacmpuen.Any violation of
Section]031.3 by any applicator for a permit subjects the applicant o a civil penalty of 3 6 LM bel0 0 Occupancy Type
not more Nan five hundred delta.(SS())).
❑I.as owner of the lemperty.or my employees with wages as their sale compemadun.
will do the wart,and the stsucl ire is not intended or offered for sale(Sec.704a.Busirvss
and Pmfeasions Code:The Conuacmrs License Law docs Out apply to in owner of Required Inspections
properly who builds or impmves Hereon,and who doessuch work himself 9r through his
Own employers,provided Nal such impmvemeno arc nor inlcndcd.offered far sale.If.
however,Or building or improvement is sold within one year of complc6un.the owners
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,as owner of the progeny,am exclmively contracting with licensed contractors to
co edge,the pmjca(Sec.7(H4,Business and Pre feseemu Code:)The Contrawries Li
arse Law docs not apply to an owner of property who builds or impmvu thereon.and
who contracts for such projects with a contractor(a)licensed pursuam m the Contracmrs
License law.
❑I mo eaunpt under See. ,B&PC for Nis mean
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I have and will maintain a Certificate of Consent m self-insure for Worker's Compcm
radon.m provided for by Section 3700 of the Labor Cade,for the performaom of the
W
for which this permit is issued.
Wve and will maintain Worker's Compensation Imu.na,as required by Section
]00 of the Labor Code,for Ne performance of the work for which Nis permit is issued.
My WorkersCompensation Insurance carrier and Policy number am:
Caller:IL L l nSwrw a4 e GO Polity No.:W Gt�� K a I o Ao( acs
aCERTIFICATE OF EMPnON FROM WORKERS'
Aas��Tllo'uCOMPENSATION INSURANCE
" tucuun need not becomplcted Kthe permit is(prone hundred dollars($100)
or leas.) ,
I unify Nal in the performanec of the work for which this permit u issued.I shall not
employ any person in any manner an as to become subject to Ile Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making Ihu Cernicata of Exemption,you.NouW
become subject to He Workers Compcmation provisiom or the Lahr Code,you must .
C Z forthwidl comply wit such provisinm or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[+� I toothy grim Nat them is a construction lending gency for the perrurmmm of
a the work for which His permit is issued(Sec.7097.Civ.C.)
�W A Lenders Name
.7 Z Lender's Address
V 0 1 certify Nat 1 have read this application and stale Nn she shove inform odun is
IT. F correct.1 agree to comply with all city and county ordinances and some laws relating to
CU building construction,and hereby amhome rcprewmadives of Nis city to curer upon the .
r L21 above mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless de City of Cupertino against
E' fA liabilities,judgments.costs and expenses which may in any way accrue against mid City
V z APPLICANTCof the ra
gTAf I Ipermit.L
UNDENDNL COMPLY WITH ALL NON-POINT Issued by: Dato7-''S-'T
SOURCE REGUL NS.
Re-roofs
Signature of App eanUContracmf Data
HAZARDOU M IALS DISCLOSURE Type of Roof
Will Nc applicant or tutu ingoaupaud mremhandlehvawmetravieng
.dc0ned by tae Cupertino Municipal Code CTaptcr 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes
Will Nc applicantrumm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haurdom air contaminants m defined by He Bay Ama Air Quality Managemant all new materials for inspection.
intim
❑Yes
Thaw mad the haver ousmawrialsmquimmcnuun&rChaper6.95ofthc Califon
nine Hr.1O&Saf?=nuo
c5,25533and25534.1undemindtholildw building J (�
dors nos eufrenJat is I c mihility to nnul'y He ceeupenl of Or
myuircmcnuw cl prim ssaan«pracemhnale of Occupancy Signatureo plicant Dale
_�-65 Al r coverings to be Class"B"or better
Owner or aulhoriacde Dale
Community Development
10300 Torre Avenue
�* Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: CT PERMIT #
6So 7aai f�
OWNER'S NAME: ', PHONE #
GENERAL CONTRACTO FAX # �---
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Tile
Owner ontractor afore Date
t Community Development Department
Building Division
dr City of Cupertino
I 10300 Torre Avenue
ppCI[TY�F p�II Telephone: (408)777-3228
U f C��'I V 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.
7. NOTE: If you call fora plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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 ly with the above stated policy on re-roofing.
Homeowner's Name: i
Job Site Address:
r
Roofing Company Name: crI1oco
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
{
CITY OF CUPERTINO
az' • RE12OOF �/S-
CUPEkTINO PERMIT APPLICATION FORM
APN # Dat
3 - 5- 05
Building Address:
P ner' Nam Phone #:
4A'01070—
Contractor-
? oontractor- Phone S/OB License,#:
0//&0 —0,X3 Q .7�S!
C t t: Phone •"yW— Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ . Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ 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.
A210 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: n
C IC All
Residential ' Commercial ❑
Fire Zone: Yes ❑ Confirmed with Planning De t. if
there are any restrictions:
Cost of Proj t: Typ f nsVon: : Occupancy group:
Q
Qty. if
Applicable 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