06050038 (2) CITY OF CUPERTINO ��k,�� It4Pe�sp� w".�a/'.?ia" �wT "'
BUILDING DIVISION PERMIT C0N��1�11V 1OR NF0RMATI�t�R.1,£ ,. t
BUILDING ADDRESS: ` FOUR SEASONS ROOFING P`R`MITNO 06050038
22856 POPLAR GROVE D
OWNER'S NAME: PERMIT ISSUE DATE
DEANZA OAKS HOA 502 HORNING ST 05/04/2006
NE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECf7ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
200 LICENSED CONTRACTOR'S DECLARATION -
FF 1 Wreby afrrm that 1 un licensed under Provislom ofChaper 9(mmmcncing lob Description
EZW with Section 70t10)of Dividon 3 ofde Business and Profccsioro Codc.and my licenw is
j'c„ lnbBto=and affect. o �j TEAR OFF SHAKES, INSTALL 1/2” CDX, AND GAF GRAN
,ya? Limen Chia L.
L4--?T2�\ D
o Dain Contra _^,pEQUOIA SHINGLES, 50 YEAR CLASS A
ARCHITECTS DEC I N L C
f m i 1 udcrsand ery plans shall be it as public records J
JyU
esteemed Pmfcuional
Q3 On I a.BUILDER DECLARATION
0 I bereso .(Sam that 1 1. exmpt from Ne Cssions Code:License taw for the
❑O following moon.(Section 7(D I.3,Businer.and Pmfcssiom h.oAny city or county
3 m which its issuance.
permit re construct,she ;ler,improve,demolish.or repair any wuctum I At en
Priormits issuance.alw requires the applicant for Inch permilmfile asigneJ saemcm
s that he is licensed purmantmon,pmviaiomoftheContractor's Li¢nwLaw(Chap=9 Sq.Ft. Floor Are Valuati$r5 5 0 0
e� (commencing with Sedan 700(l)Of Division 3 of the Business and Prof CT mCde)of
O R$ that he u exempt therefrom and the bate for the alleged exmpdor Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant m a civil penalty of ppN NumberJUN — Occupancy Type
�tmammwE.ehandleddoll.(s5ML 34233020 . 00 p Y yp
0 I,u owner of the property.or my c uploycu with wages as their sale compematian.
will do dowerk.md theswctum H nataendedor offned formic(SO,.7041.Business 1 d
and Professions Cade The Camoanars License law does act apply in an owner of I
property,who builds ar improws Neeson,and who does such work himself sir through his
awn employees,provided that well improwmmm tie not toiled aronered forsak-IL
hmvewv,the Wilding or improvement is said within arc year of completion,(he owner-
builder will have the burden of proving that he did not Wild or improve for purpox of
aleI
0 1,as owner ar the property.am exclusively cam eme ing with rceued contrecmn to
construct the project(See.7044,Business and Professions Cade:)roc Conegagers Li-
come taw does not apply in an owner of property who Wilds or improves those n,and,
who contacts for such projects with arnmractorts)licensed parson in take Cunuacmrs
License La-
0 lameaemptimder See .BBPCfOrNisneuen
Owner Date
WORKERS COMPENSATION DECLARATION
41 1 hereby ff..under penalty of perjury ane of the fallowing declarredam:
0 I hart and
will maintain a CeniBcae of Cament to scINnwm for Worker's Compen-
sation,as provided far by Sccuan 3700 of the tabor Code,for the performance of the
wok for which this permit is issued
0 1 haw and will maintain Worker's Compmaauom Insurance,u napired by Section
3700 a the tabor Code,for the per(ormatme of the wmfr for which this permit is issued. '
My Work//ek1rs Compensation hommucc carrier and Policy number am:
Cartier.FV`r�CP ,.Ljbv� e�-1�tM'Aiy-Nal2���4
CERfIFlUTE OF)'EMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This sttdm need oat becempleted if the permit is foane handled do0aa(3100) �
or leu.)
1¢nib dot in the parknouce of the work for which this permit is issued.l dull not
employ anypermn in any manger m as to become subject to the Workeri Compemuion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate,of Exemption,you should
bes:ome subject a the Worker's Compenadon prowtiam of the Labor Code,You muss
.J z forthwith comply with such provisions or this permit shall be deemed invoked.
ZOCONSTRUCTION LENDING AGENCY
I berehM.Nu f.u a cansuucunn pool. a
I—' Y g gc^sY for ft parkins.of
CL the wok far which this permit is issued(See.3097,Civ.C.)
A Lender's Name
D
,7 Z I<ndcrs Adificaut
V Q 1=try that I have mail this application ad sue that the aWve information u
IL, F correct.I agree to comply with all chy and county Ordinances;and nae laws relating to
OU building eomuunion.and hereby authome representatives of this city to enter upon the I [ �/�fy�t(/ /
r F11 above-mcndond pmpersY for inspection pugysoxs 1/
gy (We)agree to save,indemnify and keep hamless the City or Cupcnino against l
U Z inconseq judgmentsecostswduff Of thiumwhichmryin any way attme gaimisaid City
U z A APPLICANT
of the RS7ANofthis permit.
s-. APPLICANT UNDER AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC REGULATIO 5. .
Re-roofs
Si azure of Applian onfiricuor pas
HARDOUSMATERIALS DISCLOSURE Type ofRoof
Witsdea orfuture Wildinge.Chanlatamo hadk haighli maerid
u domed io the Cupertino Municipal Code.Chapter 9.12,and de Health anJ Safety
cde.s«tianus3z(,). All roofs shall be inspected nor to an roofs material beim
41 E3 Y. �No � P P � Y g g installed.
Will f applicant or future Wilding omvpam use equipment or dcAcm which If a roof is installed without first obtaining an inspection,I agree to remove
emit honored..all contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
DiwictP \—
GYca No
I have read the humNous mamrials eq aingre is under Chaper 6.95 afthe Califor-
nia Health h Safety Code.Sections 25505.25533 ad 25534.1 understand Out if the Wilding
dam oat cumandy host a enatd,that it u my mamasihility he noify the reentrant or the
myyj.n�p�\n=h m g cwr gorr c paa y, Signature of Applicant Date
Owner in authored S Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
F Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S N PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 3�0(B
Signature Date
Please check applicable subcontractors an com Tete 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
ZO Per/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
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 for a 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(comply with the above stated policy on re-roofing.
Homeowner's Name: ,1 X A�z� 0e-kr WA
�
Job Site Address:r C az�t 7A, (] (}l�
Imo' ,� `i�'
Roofing Company Name: 7
Applicant's Signature: Date:!� -Ctc
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
am 5 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34233020 . 00
DATE ISSUED. . . . . . . : 05/04/2006
RECEIPT # • • • . . . . . . : 34240
REFERENCE ID # . . . : 06050038
SITE ADDRESS . . . . . : 22856 POPLAR GROVE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DEANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 278-0330
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ----- ----- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
•
CITY OF CUPERTINO bW
REROOF
CUPEKTINO PERMIT APPLICATION FORM
APN# Date:
Z-3 3 -0Z 2 0(0
Building Address:
11r-
Owner's Name: Phone#:
0.
Contractor: License#:
Fou( el 7 1 Z O
Contact: Cupertino Business License #:
tf
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof Cl Built-Up roof
O Asphalt Shingles Al Asphalt Shingles
-W— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) __ ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report#
;a To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
• Job Description: _Q04(-r- (Cj Sys ( t;75 y ` CD)( , qt &X Ginn Suof
O ks
Residential ®_ Commercial ❑
I6>�
Fire Zone: Yes ❑ Nom Confirmed with Planning DePt. if
there are an restrictions: u
Cost of Project: oo Type of Construction: Occupancy group:
S Soo — 2e - �oFv � CL �3
Qty. if
7NBUSLIC
Fee ID Fee Descri tion Fee GrouPERMFEE Bld Permit Fees BUILDING
ENERGY Ener BUILDING
SEISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDINGPLANCHK Plan Check Fee BUILDING Business License BUILDING
•