02070203 (2) CITX:OF CUPERTINO
' �L'Anpn.DINGDIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, - _ PERMIT NO.
22893'`,LONG DOWN RD FOUR SEASONS ROOFING 02070203
OWNER'S NAME: APPLICATION SUB DATE
SULT ARNELL -R AND MARY S TRUS 64S HORNING ST 07/30/2002
,'PHONE:- ~' SANITARY NO, CONTROL NO.
(408) 278-0330 .
ARCHITECT/ENGINEERF B'LDMG PERMIT INFO
Opy r ` n _ BLDG+ ..ELECT t. PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z :;A- I hereby affirm that l nm licensed under provisions ofchapmr 9 uomounting. Job Description
'with Section]000)o(Diviaionlof the Busincas end Rafasions Code,endm license REROOF �® /� o �LE^
is in full(arcs ane a�l@pi.,'3 G' FBa®9b.
i 0 .License Class 'Lit,p
Date, "2i- Q-A , Commctim
'�3 a,t; - -� '/ ARCHITECT'S DECLARATION l=a.Og - - luodenand myplens shall heusede;public nemda JAN '3 1 2003
. p.,
O O
Licensed Profasionpl
OWNER-BUILDER DECLARATION LDINC
tt ' 1 h ,(Sect that I m, rapt from the Cations r s License Law for the �'
C Z Q followingmireason,(Santo 7031.5.tr Business atd Pre,demli Calc Any city or counry - - O O
FF _
which req su permit re construct.veer peer improve,demolish, fie pati any structure
B O
such
it
ie that
mus issuance,also recants the ovisio sofd,anT for Conamirmes lice se aw(Cned hmmmt. -
.th the slEenutl pursuantmthe provisions of the Contrcmrslsrnulaw(Chapter Valuation
(commerris ni i(h Secnon Tu00j The bacon Sof the Busineuapd Prvfastons Code) f 21YI'F 34 LBS�L VJOT�Ea s, 5•t a
or Nm io is 31.5 b therefrom and or baso fns the crsth a aempotto Any l Penalty - p•- -
-t of section 7031.5 it any applicant for a permit subjttu the applicant m e civil penalry
.:troth moa th.n eve hundred moan(ssoe). 3 0 5 APN i�FA Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
''wiltBur do'the workfana is Code:ureThe C'eat intended eneR'Law fordue,me(Sec.]Baa; - - Ins ections
Bun r of ane ery Who Wilds
Cade.The roves thereon,
,License ae Law pas not apply m an 601 — ROOF TEARet P. .., -.
owner.(h his
arlmidedt thereon,end whodas such our intended
or• 602 - ROOF PLYWOOD NAIL
• .a through hip own em ever.t buildin that such Improvements are our imetded or „_ _.-__--___ . _.. .___.._...__..
;painted fors he:lf:hhwuilder will have
gorlmpmof Imayis said within ane Weer of 603 - ROOF BATTENS 'I• -'� � �- �'
chmpinion,the ownervbuilder will have the btNen of proving shat he did nor build or I '
impmc for purist of sale), 604 - ROOF IN-PROGRESS
. _ ._.. _ ...---- _.._------ _. _ .._..
❑1 weer of the property am exclusively contracting with 1 c nsed contractors to
'- consnuct the project Sec ]OWt,Business and.Professions.Cade:)The Convenor's
.. ...
Littnu law does not epPIY men owner of property who Wilde neimpmas thereon, - _ - ..
-' .and who.commcts,for such projaa.with.a camacmrts7.licensed.Pursuam m.the -.. .-.._ ... ._..._... .._.....,.-.. ..._.._-._....-_ _ ,-:_ . .__...... -...._.. .. '.._.. _..._
Olee a ri License S.';: .
❑lam eumP,under Sec: PCfor this reason i. :v l'i::V4` '
W1OR ERS COMPENSATION DECLARATION
I herebyliffirm under penalty of perjury rte of the following declarations: . .
❑ I ha end "ill` at i Ceri( be ofConuni'm self-imme for Worker's
C pen auom as,provided for by Section 37W of the Labor Code for the
performance of the work for which this permit is issued,i:;
❑I h e dna wilYmaintain Wo 1Co peneuon Insuinnce,u required by Section'
37Oo of the:Lobo Code f th perf.ma ce of the k(r which this Pent is
is dMyW e�so{q'Qe d I u re carrierand%he,nu�max,srs:
`Cam
,,y,yCLR"TIFICAOF IORRER$'f'
COMPENSATION INSURANCE
S
(Th s seciitn'need not he aomplded H the permit is for one hundred call...
a.
-
'° Ic nOY thei'in the,pesformance of th }k for veli lith peirnu siso d 1 -xIi. I tsl'. )', ° 'tI _
ehnll'art employ rmy", .m any manner sn as in become subject to the Worker
compensation Laws of Califomis.Date
NOTICE TO APPLICANT.War:IL after Compermaking)h s Croof of Exemption,de,you midst _
beet boon m the Work p C -pc t provisions- of the labor Code,roti must
O
forthwith co p1Y lh inch provision,.,,his perms shell be deemed ocvord.
' IA s';� CONSTRUCTION LENDINGAGENCY
•" r 1 h by firm that the- c n t n on d o6 aBenry( the PeAormance
"pe ued(Sec 309] Cry C) \ _
s7 of rh work(M litchi h.i r s Il- -+ ,.,_'r .... . . ............ . .... ......_. ..._ _. _- - ... _ _ _
Z Larder AdAd d
-t .I certify that 1 have read this application endcorse ohm the a,bove informationsretis t
C)r U tobeci.d I con to comely with all city aid counry,amitoses end cute Wws enter
upon
QpO '�to'.1mvegii,mimniomand forin,uthoniepossenativa of this city to cnmr upon
M. th b nuaneap pcnyf ify and purposes.
M. (We)dgmeto a en npeand kaphamy in OreC eof Cupertinoagainv
•Vi liabilities j olaln cs sat and expenses which may in pry y ecerve against said
C.7Z
City cq en elfthe gmlmg of ahs pe
APP[IC g*,T U ERST OS AND WILL COMPLY W} A NON-POI. !
SUDIy/RF:'LAT s i A ;, n —n` Issued by: ate
Sr6rtL APPecaMControctor. "Date Re-roofs "
Cade Sau HAZARDOUS MATERIALS DISCLOSURE
Wll the applicam or fmurc,Wilding occupant stow a handle harmdtus mat rel -_,,,-,Type Of ROOF
adefinedb the Cape rolMunripal Cod Chapter 9.12,and the4-11 Health and Safety i IC„ s .,4 , 1°I t`- 7,i �•t ._ +r,
❑Yost h 1 p No . t4}. _+ ..
/ .: All�roofs.shall,be in pected:prior.to any,rooffng'material-being installed.,,,_, ___-_
W Il that applicant future Wilding occupant '�q pment tee nttn If a roof is insialled'without firs obtaining an inspection Ito ree to-remove
,I mn h zvao c..r noel as- ted by theBe,ArtAir Qualuy MenaBemcm t v+ g ..- - .- .-
t to
r all new materials for inspection...;—n Applicant understands and veli] co_rnply with.
Dn n
Jl ❑Ya, ❑No f , „ ;' `all tion-point' ree ulahotis'- ,. , 1
i
r ha e,read the'harardous mnienal y rememe.0 der Chapr r 695 of the /���pOo -
C hf ma Health&Safety Code 5 tions 35505 25533 my
eslunaenana th t Q /'
' W lltl g d n urrrmay hp e a ant auuns mY responsibility to notify rh (��/'
a pent of th rt a h ch mum bo mtt prim,to Issuance of a C nifcme'of "
Occup _ _ _
I ���j '�'�_ Signature of Applicant Dale
o rte t a r,:ea g Date . All roof coverings to be Class B' o`better
„ .. ..- OFFICE '
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
4aw I IFax: (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) 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 that the
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 of inspection.
We understand the abovepolicyon reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company Name: -PotCpy1S� O �-fr�►/
Applicants Signature: -���l✓ C / Date:
Joe Antonucci
(Chief Building Official)
6/25/01