05050001 CITY OF CUPERTINO °"- •✓�� " y' -• '•`• ^"
BUILDING DIVISION PERMIT "CONTRACTOR'INFORMATION:":
hBUILDING ADDRESS: PFAHLER' S ROOFING & WATERPI2�W"05050001
T r9l AT.(-A2A AVR
11 OWNER'S NAME. PERMn ISSUE DATE
VON T.T. VOTTfVC; -I '/ TT nnnc /� �
SANITARY ON �a CONTROL NO.
(408) 224-9013_
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.[BBLL�DTGG {,1EEL-EECCT`' PLUMB MECH
u0G LICENSED CONTRACTOR'S UECLARATION --- -- -JobD44�O p^ N
w I hereby affirm that 1 am licensed under provisom of Chapter 9(commencing Job De VV OOIL�f`k11FFppmm IIQQ((mm--
iW wish Section 70(a))of Division3 ofthe Buvness and Professions Code.and my bccme is
n<% in full force and effect.
;°y= LianaeClass Lie.is REROOF W/SHINGLES /1f F
Date `•`°O`v
ARCHITECTS DECLARATION �/
a 1 undersoond my plans dull he use]o public mends
Dwu
a.
�9LUD IN
o In Licensed Professional
` 3 OWNER-BUILDER DECLARATION gill
a Y I hcmhy affirm Nat 1 em exempt from J r Contractor's License Law county
shy
o O following mason Permian 70315, 1.asand Pmfcanns Coor.Anymy nrcounty
K$ which mgmrm a Permit m Co..,.nL alter,tmpmvc,dcmuluh,or repair any swnum C O n n n
y¢i poor m to issuance.also mama¢the applicant for such Permit to fie a signed mmement -
s< that he is licensed pursuanu ntheprovisionsof theContractor'sLncnselaw(Chapter9 Sq. Ft. Floor Area Valuation
,- (commencing with Section?WO)of Division J of the Business and Professions Code)at
that M or cramp,thcrofmin and she basis for she alleged exemption.Any violation of
Section 7051.5 by any applicant for a parmitsubj.cu the applicant to a civil penalty of 3 5 1Hef0 0
not mom Nan five hundred dollars(S50)). J'aa 1RbsaDalY Occupancy Type
0 1,ss ow.,of the property,tar my employees with wages as Neu sole campemmon,
will da the work,and she structure is not mvsded maffeted finial.(Sec.?044,Business
and Professions Code:The Contractors Ltanae law does not apply to an owner of Required Inspections
property who bulds a,improves Om.m,and whodoes such workhtmself orthrough his
man employees,provided deal such impo vsmenu are not branded aroRered forsak If,
however,the building or improvement is cold within are year of completion.she owner-
budder will have the burden of proving that he did not build of improve for purpose of
sal.).
❑1,as owner of she pmporty,am exclusively contracting with licensed contractors to
construct the project(Sec.7W,Busm.ss and Professions Code)The Contractors LL
«me Law does not apply in an owner of property who builds or improves Nemon,and
who contracts for such projects with a comncmr(s)licensed pursuant o the Contractor's
License Law.
❑1 am accmpt under Sec. .B&P C for Nu mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hcmby affarrn under penalty of inquiry one of the fallowing declinations
1 as ve and will Woman aC.mfiam of Consentto self-insum for Worker's Compen•
section,as provided for by Section 37M of the labor Code,for the performance of the
work for which Nis pmmu a issued.
❑1 have and will maintain Worker's Compensation Insurance,ss required by Section
37W of the labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cook'. Policy No
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
Qhu socunn need no(M completed tithe permd is for one hundred dalhrs(5101))
err feu)
I ecoi y Nat in Ne performance of she work for which this permit is issued,l shell not
employ any person m any nead.,se u Its become subject to she Workesi Compensation
Laws of Caldpmu.D••^
Apphcam
NOTICE To APPLICANT:If,after making this Centficak of Exemption,you should
biome subject to the Worker's Compensation provisions of the labor Code,you man
Z frMwdh comply with such pro vain.or Nu pum,shall M deemed mveked.
Z O CONSTRUCTION LENDING AGENCY
.�. I hereby aMo.that there u a eminbu mn[ending agency Im ilk perfmmonce of
C4 the work for which Nu permit is issued(Sec.3D9?,Co.C.)
Pgl Lenders Name
=Z Lenders Add,
U O 1 comfy Nn 1 have mad Nrs application and sick dot On aWv.mfamatmn is
Fcanto 1 agree to comply with all city and county ordinances and rook laws minting to
p U budding construction.and hereby mYmrm moreknutives ofths city to enter NO she
W alrove-mentioned pmpeny for inspection purposes
CL (We)agree to save.hileromy and Ime,F" , liabdmeir udgmcnu,woo and expenses whch May in any way accrue aggxtrmtadCity
U Z in consequence of the granting of Nis permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. _Q
Re-roofs
Stgvwm of Appha Aan Date H
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant no Nmm building Co acupant mare of handle bamdous
anmaker[
C defined by the Cupertino Municipal Code.Chapter 9.13,and tM Health antl Safny
Ga1C.Oyes 255)3(a)r All roofs shall be inspected prior to any roofing material being installed.
Yes Nu
Will the applicant or future budding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rmfh reudova air contaminants as defined by she Bay Arco Air Quality Management all new materials for inspection.
Dismn?
Dyes 0 N
I have maJ the harardousmaknals mquimmenu under Chaptirb 95 ofthe Ctlifor
nice H.Il &Safcy Cade,Saumu355(15,35533wd355J4 lundentandthanfthe budding �� a Z— O `•'
does not currently have a knam.that it u my responsibl'ny,k notify she acupant of Oc /Le6 ��I'7 /l.'C/t
mqut mmenowmmh Muslim met pnormissumccofaCemfcakor&cupmcy. Signature ofApfilicant Date
Owner Or nuthanTCd agent Dak All roof coverings to be Class "W'or better
F Community Development
10300 Torre Avenue
F Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
-�? i / L11,IA ?A!C Ru,r ososoos
OWNtk'S NAM$: R � Y(-)/ In PHONE # ^�'7 4/-egm l�
GENERAL CONTRACFO ��4/�l�. R r I�� Lini� FAX # 2-
71�
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
I ® ISUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
�I I Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing I p FA I 1/ 2 11 c�O FI hd�i
Septic Tank
Sheet Metal
Sheet Rock
I I Tile I I I
(Swner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
ItUPEkTINO 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.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: lP
i -
Job Site Address: 2Z621 41-64 7A- —,t V C
Roofing Company Name: P P A (f) tZ�S 2cr" F— i N (q—
Applicant's Signature: �/j(A Q�/Q� Date: 5--(-)
Greg Casteel
Building Official
Revised 11/2/04
Pnnted on Recycled Paper
CITY OF CUPERTINO
REROOF
8CUPERTINO PERMIT APPLICATION FORM
APN # S —1 9 2— Dat�_Z —0 s j
Building Address: 11
0� �����
Owner's Name: Phone
A ) //, 6. N049>z-2-qg013
Contractor: P Phone#: License#:
ArA4197Z� 77141- 0 / 69-68 �2
Contact: Phone#: Cupertino Business License#:
Type of RooeCovering:
Existing: Proposed:
O Built-Up Roof. ❑ Built-Up roof
❑ Asphalt Shingles -a- Asphalt Shingles
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:
�P_C kluD i�IS� EL
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: Ll
Cost of Project: _ Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE I Bldg Permit Fees BUILDING
1
'> BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res j BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING. 1
BUSLIC Business License BUILDING
�4 , 7�