07050200 CITY OF CUPERTINO
BUILDING 0ivIS1ON PERMIT +C �gtACTClR INEQM�TI�N'
PERMIT NO.
BUILDI1NfdU ffnESSFIRW00D DR FOUR SEASONS ROOFING 07050200
PERMIT ISSUE DATE
OWNER'S NAME:
CMS C/O DE ANZA OAKS HOA P 0 BOX 1210 05/21/2007
SANITARY NO. CONTROL NO.
NE:
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
REROOF-REMOVE SHAKE, INSTAL BLDG ELECT PLUMB MECH
„
o p LICENSED CONTRACTOR'S DECLARATION _^ T� _ —lah Description
up 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
h=H in full force and eff
? Li •CIasG Licti
o Date 1 n�- Contractor
A CHITECT'S DECLAR K7N
i d< t understand my plans shall be used as public records
)aU
u.1` Licensed Professional
y
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m� which requires a permit to construct,alter,improve,demolish,or repair any structure
u Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
ti (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 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($500).
❑I,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 We(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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 Contractors 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 Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑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 War s Compensation I urance carrier and Policy number are:
Cartier. Policy No:t%)C,?Z1 i SD\4 1, y d 1
CEFMFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this 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 Workcri Comperhsaton
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.
Z , CONSTRUCTION LENDING AGENCY
(.r CA I hereby affirm that there is a construction lending agency for the performance of
fY, > the work for which this permit is issued(Sec.3097,Civ.C.)
Wfl.A Lender's Name
Lender's Address
U C) I certify that I have read this application and state that the above information is
w►-' correct.1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►– APPLICANT UNDERS DS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S RC UL 1
Re-roofs
Signaiurcol'ApplicanNondactor Dare T of Roof
ttAY.ARDOUS MATERIALS DISCLOSURE Type
Will the appli2W or future building occupant store or handle hazardous material
as defined by the Cupertino Muni ipal Codc.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs Ehall 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 contaminants aydCfhncd by the Bay Area Air Quality Management all new maerials for inspection.
District? rY✓'^/
❑Yes u
1 have read the hazardous materials requirements under Chapicr 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
d not cunend have a tenan4 a my ponsibility to notify the occupant of the
require.n hch must be met dor to i an f a Ccruficatc of Occq2ancy. Signature A Applicant Date
_
l\ All roof coverings to be Class "B"or better
Owner or authorized agent Date
. x
...... ' Community Development Department
+ Building Division
' '. City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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 first 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 the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: ,,*ea, �57- (-s
Job Site Address: /GG 1 rrw�o
Roofing Company Name: ��
A plicant's Signature: /' C�12 Date:
&(�4
Greg Qdteel
Building Official
Revised 1/30/03
Printed on�3ecycled Paper
CITY OF CUPERTINO
-7tL-v
REVOOF
• 01y or
CUPS TING PERMIT APPLICATION FORM
APN# 0-71/ 14 Date: S�Zz
�
Building Address:
IDU �� �i�✓v�c�
Owner's Name: Phone#:
C'r1'I S /27 7
Contractor: J Licce/nse#:
16 P
Contact: Cupertino Business License #:
&z9�J 3V-0 3 3 a 3 a 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles C3--Asphalt Shingles
ar"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 Cufertino's Tear Off Policy:
Job Description: 44mwove exp s�� s��.F� /Go ..+sty i� �a c 4.• C��x .�'/y ••
Ja�f•v!/ �tw 3a d� e/f ��ad//.�-yzdsvt �i��uw /fir /! 6flf e�174,iel rx as, %a 5141" /es,
Residential Commercial ❑ ._S4
Fire Zone: Yes ❑ No [S3— Confinned with Planning Det. if
_ there are any restrictions: LJ
Cost of Project: T e of Construction: -1zWfJ Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 1_adg Pen-nit Fees BUILDING
BENERGY Jnergy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCI-11K. 31an Check Fee BUILDING
BUSLIC Business License BUILDING