03090215 CITY OF CUPERTINO .- ,,.. *tww:c.�:.t,-i4%ir:;"a�;:•:. +: :J.,•;�i•,/.,;
BUILDING DIVISION PERMIT CONTRACTQWINFORIVI'ATION:
OlBUILDING ADDRESS: BARRAZA JOE S AND JUDY A PERMIT"°'03090215
t?nFgS ArAr1TA rT
OWNER'S NAME: PERMIT ISSUEDATE
BARRAZA JOE S AND JUDY A 09/25/2003
NE. SANITARY NO. CONTROL NO.
ARCHITEC tENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECI3
lop LICENSED CONTRACTOR'S DECLARATION
u I hereby affum Net I am licensed under provisions.(Chapter 9(commencing Job Description
sz1S with Section 7arin.r Division 3of the Bunnesat and Pro(essuru Code.and my license is
E m fall(o= ad effect. REROOF FWAL.E „C
;p License Class I v.a
Dote Contractor
ARCHITECrS DECLARATION OCT 0 7 2003
I d I understand my plane shall W reed as public rccnrds
cgw0 Licensed Professional OWNER-BUILDER DECLARATION R�� ,
d<x 1 hereby olfirm Chot I am exempt from IW Conuaeurs License Law for the BUILDING
p 0 following mason.(Sacuun 7101.5,Business and Professions Code:Any city or county
5$� which requires a permit to contract,alter.Improve,demolish,or repair any structure $ S O O 0
_iv, nn Prio its issuance,also requites CM applicant for such permit m file a signed summer
2 < that he islt cc nud pursuant m the provisions of the Contractor's Ltccnx Law(Chapter 9 Sq.Ft. Floor Area Valuation
2 e (commencing with Section 7")of Division 3 of the Business and Professions Code)or
9 that he is exempt therefrom and the basis far the alleged exemption.Any violation of 32656023 . 00
Section?031.5 by any applicant(of a permit subjects the applicant to a civil pemlty of ,AFN Number _ Occupancy Type
not mme than raw hundred delta.($500). - ' -- --
❑I,as owner of the property,or my employees with cages as their sole compensation.
will do the work,and the fracture Is at amended or Offered for sale(Sec.7044.Bmmem -3 U - Vruluvli'J Re y�L�d ins eCt100s
and Professions Code:The Conuutor's License lsw dons not apply u su owner of 3 0 7 - INSULA`T UN p
Property who builds or improves thereon.and who does such work humxlf or"rough Ms
own employees.provided that such improvements are not intended proffered for ale.If, 601 - ROOF TEAR OFF
however,the building or improvement is sold whin one year of completion,the owner-
budder wall have the burden of proving Nat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
"to'1' 603 - ROOF BATTENS
❑I,as owner of the property,am eaclusively contracting with licensed contractors in 604 - ROOF IN-PROGRESS
construct the project(Sec.7044,Business and Professsom Code')The Conuscufs Lt-
come law does net pply to an owner of progeny who Wilds or improves lhertmn.red
who contracts for such projects with a convanarG)licensed pursuant to the Comnnoes
L'trim Law. .
l rent mgt antler gee. .B,Y PCfonhla moon _
WORKER'S COMPENSA iO ECLA ATI
1 hereby affirm under pemlCy of perjury ono o(the following deel.ndom'
I hew and will mainain a Ccrufi0.ae of Comem m xlGunsure for Workers COmpen-
u0on,as pr raided for by Section 37W of the IsWS Code,for the performance of she
work for which this permit is.soed.
❑1 have and will maintain Worker's Compensation Insurance,ex required by Section
3700 of the Labor Code,ray the performance of the work for which this Penult is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OFEKEMPrION FROM WORKERS'
COMPENSATION INSURANCE
(ITis senioe need rim h(CcomPlemd if IW permh is for one hundred dollars(5100)
or less.)
1 certify Not m the Performance of the work for which this permit is laical,I shall net
employ any person in any manner an u to income subject o the Worsen'Compensation
Laws of California.Da-- -
Applicant
NOTICE TO APPLICANT:IL after making this Cemfieate of Exemption,you should
become subject to the Worker's Compensation provisions of the UM,Cnde,you
Z
C foMwith cnmPly with such provisions or Can Permit shalt m
dcccd revoked. G/
�'� CONSTRUCTION LENDING AGENCY
I hominy affirm that Nero is a construction lending agency for the Performance of
Si? the work far which in!.permit is mued(Sec.3097,C,,C.)
Q
.0 Lender'sNam-
2.
z Lender's Address
0 1 certify that I love read Nu application and{ue Cast the 1 Ww mform0wn is
y(~' correct.I agree to comply with all city and county aNin mess and sum laws relating to
0O building construction.and hereby authorise mpfesanlnwes of this city to enter upon the ^
W aWw-mentioned property forimpecuon purposes II
y y (We)Ogres to save,indemnify and keep harmless the City of Cupcnino against
% liabilities,judgments,costs and expenses which may In any way accrue against said City
J7 in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EGULAT�ouS. _
9`2_.S-02. Re-roofs
srdkf ApplreuVConlrenor
YY
ISCLOSURE Type of Roof
Will the applicant or future building recupn.nor.or hand urducs amot
ns defined by LM CupeNno Municipal Code.Chapter 'a a'end the Health and Safely
de.semYes No en ns3x.)? All roofs shall be inspected prior to any roofing material being installed.
❑
W0 the
1 applicant or retort Wilding occupant sex equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h.urdnes air conuminuu u lcfined by the Bay A..Am Quality Management all new materials for inspection.
uu¢t? �/
❑Yes Iy No
I have read the Imadousmaterials requirements under Chapterfr.95 ofCW Califine '//1 ///,
ma Health A SafclyCode,Sccdons MM5,35533 and 35534,1 understand thatlfls,WJdmg Y /h S-D3
does not currently haw a tenanL Chet it u my responsibility m nodly the cuPat of the /, IIIJJJ
requrt( nu which rru)kpe met prior to issuance ataCcmficalcofOccupancy. Si nature o Applicant ' Date
Qt /� ^�T A g— 2 r All roof coverings to be Class"B"or better
o auth..ad.,at -�_ Oda
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. 4 All the work authorized by this permit
B. A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City, Phone # State License # ( Type of work to
� aLi$yuavau,cd
I I �
I � I
I � I
I I i I
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• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
I � �
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.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side). f�
Property Owners Signature: / /� / N L/ Date: C/— z t _
Job Address: 2 �l S f/�` q�a Permit#
l
Anv changes to the information provided on this form shall be submitted to the Citv of Cupertino Build,
• Department.
l�
City of Cupertino Building Department
t I CITY OF 303DD Torre Avenu
C U P S ITT I NO Phone: (408)777-3
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division lof Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed,contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
F / Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
CITY OF Telephone: (408)777-3228
UPEI�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.
• 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: o-e- J• !J GIi}�vA S�.
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Job Site Address: 2- 6 6 FS
F pr �hot
Roofing Company Name: �.l-/ �f . ��jUCv4�-A�
A plicanYs Signature: >� �• cz;2C�4. �1� Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 3 c3 o 21 S
REROOF
CUPEKTINO PERMIT APPLICATION FORM
APN# �/b I Date: 12- 1 d
✓
Building Address: /t -�- / t
2 0% 9 5 AG Q,J,A CT ( U 41 1- /Aj
Owner's Name: Phone#:
Tie c. �aaRA zu yob 727- 1/ 4/ 9
Contractor: Phone#: License#:
Toe S , RAnRAZ_ .A Yob A/ '14 S & SS C -29 t/OGZ9 /
Contact: Phone#: Cupertino Business License#:
Tae S, �aR1?14- 7A '11P8 72 '7 - llySJV/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles La Asphalt Asphalt Shingles
11 Wood Shakes J Wood Shakes
❑ Wood Shingles Cl Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Descriptionh.
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ NoA5___ Confirmed with P mg Wit. if
there are an strictions: Lf
Cost of je D= Type o Est Occupan group,
Qty. . .
ApViq;Ab e Fee ID Fee Description Fee Group
I ( / BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee _ I BUILDING I
BUSLIC Business License I BUILDING
I I I
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I
�J 2 3 216
2o,? , 5- o