07050201 CITY OF CUPERTINO
BUILDING DIVISION PERMIT GC?R IEURM�iTIQN�
BUILD11361MEsFPERMIT NO.
IRWOOD DR FOUR SEASONS ROOFING 07050201
OWNER'S NA ME: PERMIT ISSUE DATE
CMS C/O DE ANZA OAKS HOA P 0 BOA: 1210 05/21/2007
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
REROOF-REMOVE SHAKE, INSTALL BLDG ELECT PLUMB MECH
L� D D C7
i p Q LICENSED CONTRACTOR'S DECLARATION .doh Description
LU r I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7000)of Division 3 of thc Business and Professions Code,and my license is
r a a in full force and c,Cfec rl
.=4 License Class ` Lic.# '--LA- -Q_\ ( �l
h p Datc o- ContraMor - •
ARCHITECTS DECLARATION
7 a< 1 understand my plans shall be used as public records
.0.
U.y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m ff which requires a permit to concoct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement t,
=c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,.q.Ft.Floor Area Valuation
I- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
❑f,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under See. B&P C for this reason
OwnerDate
. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wor is Compensad n insurance carrier and Policy number
number arc:
Cartier: Policy No. C- �>1 S0 u 1 0 10
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
7_2 CONSTRUCTION LENDING AGENCY
re. 1 hereby affirm that theta is a concoction lending agency for the performance of
Ix> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
a M Lender's Address
U C) I certify that I have read this application and state that the above information is
V. i— correct.I agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby authorim representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Cp] liabilities,judgments,costs and expenses which may in any way accrue against said City
,) �,
Z in consequence of the grantin aC thi crmit. ( w/
APPLICANT UNDERS A A WILL COMPLY WITH ALL NON-POINT Issued by: Dale 2
GULATIO
Re-roofs AP z
Signa re of Applic t/Contractor Date Type of R)of
AZARDOUS MATERIALS DISCLOSURE
Will the ap i t or future building occupant store or handle hazardous material
as defined by the Cupertino Muni ipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
C]Yes o
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminantsu djfired by the Bay Area Air Quality Management all new materials for inspection.
District? /
C3 Yes ❑
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a nt,that it is my responsibility to notify the occupant of the
uircm hich must me rio 'suancc of a Certificate of Occup�q Signature �f Applicant Date
5 v All roof coverings to be Class"B"or better
Owner or authariu cn Date
CITY OF CUPERTINO
2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 34233042 . 00
DATE ISSUED. . . . . . . : 05/21/2007
RECEIPT # . . . . . . . . . : BSC00001399
REFERENCE ID # 07C50201
SITE ADDRESS . . . . . : 1OC70 FIRWOOD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CME C/O DE ANZA OAKS HOA
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2640
RECEIVED FROM . . . . : FOUR SEASONS ROOF
CONTRACTOR . . . . . . . : DIPZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : P C BOX 1210
CITY/STATE/ZIP . . . : ALPMO, CA 95407
TELEPHONE . . . . . . . . : (4C8) 278-0330
FEE ID UNIT QUANTITY P.MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8, 000 .00 147. 96 0 .00 147. 96 0 .00
BSEISMICRE VALUATION 8, 000 .00 0. 80 0 .00 0.80 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 148.76 0 . 00 148 .76 0. 00
' 48a A•R,
Community Development Department
Building Division
City of Cupertino
a ' 10300 Torre Avenue
CITY OF
Telephone: (408)777-3228
C U P E n T'N 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 applie I 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 f irst 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'he job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name:
Applicant's Signature: � C?�2 -Date: S�
Greg Qdteel
Building Official
Revised 1/30/03
Printed on i3ecycfed Paper
CITY OF C'UPERTINO
'Mir
RE IOO F
CU'PE,kTINO PERMIT APPLICATION FORM Q W�5-DW/
APN# :.� � � Date:
Building Address:
/G0 .:wao
01
Owner's Name: Phone #:
Contractor: License #:
V7 16 IF'
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles & Asphalt Shingles
Y"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 Cupertino's Tear Off Policy:
Job Description: ,.r v� exi s��, s1,.�,F� lr�o ..+rj�i� .� w 2 CO x //y
Jirji•v// ��.. 3a/1 t/f �r16�/•re-y+�re�t 2r.®//uc✓ (�/i-�f /� �?f/� 4,r,11.;�o
as, .0 �/t�•e /�f,
Residential Commercial ❑ %s
Fire Zone: Yes ❑ No [�J— Confinned with Planning Det. if
there are any restrictions: LJ
Cost of Project: T e of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE IBdg Pen-nit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
SW
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEKTINO
Building Department
JOB ADDRESS: PERMIT# 0 7e?�2j::�11
OWNER'S NAME: ,--� (� (c,_ PHONE # --033 o
GENERAL CONTRACTOR: FAX #
1
I am not using any subcontractors: 1'6
Sig mature 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
-0 -7
er/Contractor Signature Date