03100094 I I CITY OF CUPERTINO
I BUILDING DIVISION PERMIT CONTRACTOR TNI 08MATION:',::
aUILBI6NG ADDRESS PERMIT N0.
MARTINEZ-OJEDA CONST. 03100094
i `70a,q nrnnTn rte
OWNER'S NAME: PERMIT LSSUE DATE
326 STAPLES AVE
YTT T,TTT ,6 T,T YTA(1T,T 7 n_,/1 -:l /e)pn7
(408) 259-5171
NE: SANITARY 17d. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Oo LICENSED CONTRACTOR'S DECLARATION JbDescription
i d❑ I hemby affirm that 1 am licensed under provisions of Chapter 9(commencing o
;z,u with Seaton7000)of Doiamn 3 of dm Busmcssand Podoxiona Codc.and my license is
;�& in fun frrcend ffeca kl /?'q � TEAR OFF SHAKE
tg� Lmenac Clos ,�Lt.M
i Dam Contract /uSSI{1 INSTALL PLYWOOD 1/2 LIGHT WEIGHT TILE
!t� \ CHITECrS D TI N /
Wu 46rsund my plans shall M used as public records
G�; Licensed Professional
)s S Oat I am exempt from DECLARATION
0 0 1 hereby affirm thin 1 1. escmpl from dm Contra% o :Any c Law for the
n following mason. ornat in]1)31.5, t,Business and Rofdonfola Code:Any tray or county
which requires a permn ro construe,ahcn improve,demolish,or repair any talonatu
5=� pnonnslummance,alwregmthe Prevision of for such Permit lL fin a Law(Chmmenl
es< that
mencin With pursuant
ction7 the of Divans 3thee0 usiner's LumnCo Uw(C ouc)or Sq. Ft. Floor Area Valuat OR00o
I�,C do,he I.. g pt tomion,and the Ourns for oftheBed exemption.and Professions An vi Code)of 7
$ Nn io is escmpl thctefrom and the beer for be alleged esemant to Any violation of
Section man by any wddo])for apetmnsubjccssNeapphcauoa civil penalty of 3MN�yI51TIIer00 Occupancy Type
not more Nan five hundred dollan($500).
❑I.u owner of the Amway,of my employees with wages M their sole compenaatlon,
wdi do the work,and the structure is not intended ofaffead fonde(Sec.7044,Business Required inspections
and Professions Code:The Contractor's License Law dots not apply m an owner of q p
progeny who builds or improves themon,and who does such work htmalf or through 3055 - FRAME
own employees,provided that such improvements us not inandcdmoRercdaale d_� 3 INSULATION I
however,the building or improvement is mid within one year r(compleuon,the own /.s'� f, -
builder will have the burden of proving Nat he did not build Or improve for pit /' 6 O„1 ' - /iel J+pp^�jTp ',AR O F F
❑1.as Owner of the properly.am exclusively contracting wM licensed canuaeo o >] 6 0 2 - ROO` . LI Y W V,V AI L
construct the project(Sec.7044,Business and Professions COde:)Th.Chirac br' I. t.J 603O /-�'{1R60 I TTEN
cease Law dwa not apply to an owner of propeny who Wilds Or imp roves Nerto d ,ws-�� \�\1 �q Q 4 -(,/ Tjy @-'±'RE' S
who comment for such projects with a comanctons)licensed purauanl o the COnm J 4II7 UU /
Line Am Law.
I exempt under sec. ,Bd<PCfor this -
wne Itud
WORKER'S COMPENSATION OECLAR,::ION
I hereby affirm under penally of perjury ow of the following declarations:
0I hoe and will inflation a Certificate of Consent to al4insum for Worlac?,Campen-
Milan,a provided for by Section 37M of the Labor Code.for the performance of the
work for which the permit to Issued.
A1 have and will maintain Worker's Compensation Insurance,a mquited by Section
l A of the Labor Code.for the perfmmanee of the work for which this permit is issued.
My Worker',Compensation Insurance canner end Policy number am:
Comer: Policy No.:
CERTIFICATE OF UEMP ION FROM WORKERS'
COMPENSATION INSURANCE
phis Contra wed not W cnmplcwd of the perms rforone hundred dollars($180)
of less.)
I certify that in the performance of the work for which this Permit is issued.I shall not
employany c o�asp)gy manner`ao scams rob t tithe Walked Compenaton
Lowe of C
Applli�ican}} ^ �I
NOTI�9JL0 AP LICANT:IL after ma lira Nis Ccmficate otFaemption,you should
Won object o the Warr nM1 Compcassoon provisions of the labor Code,you mum
z forthwith Comply wit such prnvoinw Of Nu reach shall W 4wmcd revoked.
Z� CONSTRUCTION LENDING AGENCY
I hemhy drum Nat Vert is,Constantino lending agency for the perfommance of
Y, the work fur which this pesmu ts issued(See.3097,Ctv.C.)
d] <a Under,Name
34 3 z L mh,r',Addmvv
;) 1 certify that I hats rtAd Nn application end mm that the above inform W tin is
i F COMO.l agree to comply with all city and county ordinances and state laws raising to -
D U building Construction.And hereby 11111i Ociancontfolvall of this city to enter upon the
N
above-mentioned progeny for inspection purports.
G (We)as.to save,indemnify and keep hannlea the City Of Cupertino against A
(n incotoduedgmenLL Costs and expenses which may in my wayeccmc regains said City /`p �
;Jz Aconsequence UNDERSTANDS of Ns.permil. / /j'7/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATION _
f 1 A ro"/3-C-� Re-roofs Q ( l�
Zpallignature PPI¢HDate ZAROOUSMATERIALSDISCLOSLIE Da Type of Roof
Will the applicant or future building OCCOpaI mote or handle loorrh ,malaria
u defined by the Cupertino Municipal Code.Chapter 9.12.and the HcaIN atl Safety
Code,Sector.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
C]Yes EINo
Will the applicant or future building Occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanrdous air contaminants a defined by the Bay Arta Air Quality Managcmcnt all new materials for inspection.
attics?
❑Yea �NV
I have mail the ha>arthos materials rcgmnmenu under Chapter 695 of the Cabfor-
Health kSdctyCode.Sccomr25505.25533 and 255341uadcmandi NShche Wilding - .A
es not currently have a lenat.Ns n u m rcapmaibiltty,tu wufy the occupat of then, J
whmh most the met pnor to in ancerfa Cemficaleofcecupaey. Ignatur of Applicant ✓ Date
/�Py '� `LID-1'7,-0'7.
I owns or llnoriCed agent Dam All roof coverings to be Class "B"or better
1
a&UAI Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEf�TINO 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.
is 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 Y4 " 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: U V
Job Site Address: —n V Z/ A -0, i a « -
Roofing Company Name: MA 2T-I AJ V--Z- / oo C s' rvA c 00 0'
A plicant's Signature: RN ( u 1 Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
'i
CITY OF CUPERTINO c) 3I X00
REROOF
CUPERTINO PERMIT APPLICATION FORM
r
APN# / 2< D Date: /
(^1, ?.
Building Address:
'LDCQk4 ArtAmA c_-F. f
Owner's Name: Phone#:
`/ U V' v / �lpZ
Contractor: ' Phone#: License#:
NA&a2 ( ti cz- 1 0 SCYJ/:%, cc9ti 2 S't S k 7 I .y Ll P1 I Z
Contact: Phone#: Cupertino Business License#:
AL oNSD „2� tn, �4 3S9 z -52
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
l- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report# 7 L S V lI l 10. Mo„nk e1
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
.I I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Description:
'I -'t- S tAnV--� iv 57' dc� u�ood
Residential q Commercial ❑
Fire Yes ❑ Noy Confirmed with Planning De t. if
T there are any restrict onsr�
Cost of Project: ' Type of Construction: A,� Occupancy gro
9 OQ70 2�_ r,v C,
Qty
App]3c�
�le Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees I BUILDING
BENERGY I Energy BUILDING
/ (1 BSEISMICRE I Seismic Fee Res BUILDING
L/ I BSEISMICOM I Seismic Commercial I BUILDING
BPLANCHK Plan Check Fee I BUILDING
BUSLIC I Business License BUILDING