07050268 CITY OF CUPERTINO T� fit" p
BUILDING DIVISION PERMIT � tI�N*
q�p PERMIT NO.
BUILD{#B,7 SPT'LONG DOWN RD FOUR SEASONS ROOFING 07050268
G G 1 PERMIT ISSUE DATE
OWNER'S NAME:
CMS C/O DE ANZA OAKS HOA P 0 BOX 1210 05/29/2007
SANITARY NO. CONTROL NO.
PHONE: (408) 27:3-0330
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
a 0 a o
p z0 LICENSED CONTRACTOR'S DECLARATION Job Description
U
P 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 REROO F-]ZEMOVE SHAKE, INSTALL 1/2" C DX
H "n
LiceIIIn,
Corcess and If5 Lic.# L4 1 Q JT PLYWOOD. 3 0 LB
Li _
Dam'— 'Cla �Ln Contractor Q
ARCHITECTS DECLARION FELT UNDERLAYMENT 15 SQ, CLASS A GAF GRAND
� AT �
J C< I understand my plans shall be used as public records SEQUOIA
)yU
U. Licensed?mfessional SHINGLE 3.
:O< OWNER-BUILDER DECLARATION
ja I hereby affirm that I 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
which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to rile a sighed statement �'q FtFloor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 . $8000
t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i r3 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 3424001
3 Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc 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.).
❑1,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 Conuwwr's
License Law.
❑I am exempt under Sec. B&P C for this mason
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-insum for Workers 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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Com nsauon Insurance carrier and Politynu am: �
Cartier: r Policy No.. V
CERTIFICATE F EXEMPTION FROM W ERS'
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 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.
z CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
p�.7 the work for which this permit is issued(Sec.3097,Civ.C.)
LIa Q Lendcr's Name
0z
Lender's Address
V C) I certify that 1 have read this application and state that the above information is
II.t- correct.I agree to comply with all city and county ordinances and state laws relating to
OU building construction,and hereby authorize representatives of this city to enter upon the
W
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accnm against said City n c
V Z in consequence of the granting of this permit. Date S (�
APPLICANT UNDERS S A D WILL COMPLY WITH ALL NON
to -POINT Issued by
s. �- ?'- Re-roofs
Signature orApplicanU nuactor Date T Of Roof
H ARDOUS MATERIALS DISCLOSURE Type
Will the ap�l nt or future building occupant store or handle hazardous material
as defined by the Cupertino Mun'"pal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs Shall be inspected prior to any roofing material being installed.
C]Yes No
Will the applicant or future building occupant use equipment or devices which
If a roof i 3 installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Yes u
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 5505,25533 and 25534-1 understand that if the building
d vc a tena my responsibility to notify the occupant of the
rcyu' men ich mast be t prior o s cc of a Certificate of Occupancy. Signature of Applicant Date
n All roof coverings to be Class"B"or better
mer or authori-red age Date
CITY OF CUPERTINO
2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 34240013 . 00
DATE ISSUED. . . . . . . : 05/29/2007
RECEIPT #. . . . . . . . . BSC00001485
REFERENCE ID # . . . : 07C50268
SITE ADDRESS . . . . . : 22S51 LONG DOWN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CME C/O DE ANZA OAKS HOA
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2657
RECEIVED FROM . . . . : FOUR SEASONS ROOF
CONTRACTOR . . . . . . . : DIl.Z, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : P C, BOX 1210
CITY/STATE/ZIP . . . : ALIMO, CA 95407
TELEPHONE . . . . . . . . : (4C8) 278-0330
FEE ID UNIT QUANTITY FMOUNT 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 595. 04 006883
---------------
TOTAL RECEIPT 595 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
Community Development Department
r 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 appl:ed without first obtaining all inspection
and written approval from the buildi Zg inspector. A final inspection and
approval shall be obtained from the t uilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to a:zy roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off app roval.
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 pe:-formed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ " 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 abo,,e stated policy on re-roofing.
Homeowner's Name: ea-
Job Site Address: I GC�•�.� -C.>
Roofing Company Name:
A plicant's Signature: 7 � -Dater
Greg teel
Building Official
Revised 1/30/03
Printed m Recycled Paper
CITY OF CUPERTINO
RE R.00F _
CUPS OF PERMIT APPLICATION FORM
APN# Date:
Building Address: P
Owner's Name: Phone #:
cm - / , / (11) 5"5'"9- /Z 7
Contractor: License#:
Contact: Cupertino Business License #:
. mss (fid„ �o�J �,F-0 3 3 a / 3 3
Type of)Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles S3�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#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: 1-70W-We -rx/5*11V 5-,4 ••,,f/+ e-
/If J/4-111 -Ze
/IfJ/.v/1 .u4.. 3a ��/f �rJ6�/•a�.yr.sts�t li.r!®/suw �dl �i9F fii.x.,�/ /at,
Residential [ Commercial ❑ r S
Fire Zone: Yes ❑ No [R- Confinned with Planning Dot. if
there are any restrictions: LJ
Cost of Project: T e of Constniction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Pen-nit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Cheek Fee BUILDING
BUSLIC Business License BUILDING
Community Development
10300 Torre Avenue
;:, ..
'k,
.� _s.. Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: i� PERMIT p
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: .e FAX #
I am not using any subcontractor -,� l'��`z�"
Si gnature 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
er/Contractor Signature Date