05120081 CITY OF CUPERTINO au.h .:x.,
BUILDING DIVISION PERMIT ~CC')NT.>t2A.CTQR�INFO1, MATIUIVi ;
BUILDING ADDRESS: LOS GATOS ROOFING PERMITNO'05120081
'I n79g AT.nPPRPnnV T.A
OWNER'S NAME: PERMIT ISSUE DATE
STEPHEN ANDERES 888 FAUL$T=CH CT 12/14/2Q05
�j )NE: SANITARY Nil. CONTROL NO.
(408) 298-9399
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�6p LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 recommencing
mmencing
with Section 70110)ol'Divialan 3 of de Suafnessand Professions Coda.and my license is
n'2 infallrareaanderte�y REROOF-INSTALL 7/16-1 OSB ROOFERS SELECT
Dow Clw J.f.�L`�ContruaorO Q /
fff--- FELT/LANDMARK 50 SHINGLES
ARCHITECT'S DECLARA ON /
I undetstsnJ my plans shall he used as public mcnrN
�o Licensed Prufessronal
^m OWNER-BUILDER DECLARATION
E Q I hereby.(film this 1 1 exempt from the Corns Co License Law for The {�
1 O o following moon. (anti t 7(1313,Business and Professions Cade:Any city or county `\ 7 � n
$K,which requires a permit to coutnte4 after,vnpmve,dcmoliah.or repair any flruemre // ('"
_Zje',Prior m its iuumm'.lw requires the applicant for such permit m the a signed natemcnl _
£ G the,heIshesnmdro want to the provisions of the Conuactor'sUormse Law(Chapter 9 '3 SgfFt. Floor'Area �% ValUB11�T54O1
y zp� (commenting with Section 7000)of Division 3 of the Business and Prafm,ians Code)or 1 ����,\
a that he is exempt therefrom and the basis far the alleged exemption.Any violation of 1 I l-t
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty or �.� 1
not mom than five hundred dollars(M). APNINumben 1 l -- � 1 Occupancy Type
0 1,u Owner of the Property nor my employees with wages u their a ale continuation, 3692004]V: O,P �) I J ' /rl
wdldolhewo& ndthesvuctumisnolimm.dedor Onemdf...kt(SM.IDH,Busmen Required-ins reCt10 8'
and Prefessmu Code:The COnuacmrs License law tan not apply m an owner of p �,,,�
propertywhobuildsm improver thereon,andwha doessuchwork himself in though his s
awnemployces.provided dutsuch improvenenu are wt invaded asoffesed farsaln If,
however.the building or Improvement is sold within am yeu of completion,the Owner.
builder will have the burden of proving that he did am build or improve fur purpose or
sale.).
❑1.as Owner of the property,am exclusively contracting with lianred contnctms in
Mostmer the pmjm(Sec.7044.Bottom,and Professions Cade:)The Camacters U-
carom law data not apply in an Owner of property who build&or improves thereon,and
who contracts for such projects with a comiacmr(s)licensed pursuant in the Contncmra
License low.
❑1 ern exempt under Sec. .B k P C far this reason
Owner lam
WORKER'S COMPENSATION DECLAR-DON
I hereby affirm under pacify of pedury arc of the following declinations:
.11 have and will maintains Certificates of Consent m self-inure far WMam'sCompco-
A,as provided for by Section 3740 of the labor Code.far the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Scedon
3700 of the Labor Code,for the performance Akita work forwhich this Permit is issued.
My Worlute Comp &Non Ira.artier and Policy numberme:
Cartier: POlmcy No.: 2-7-7`7
CERTIFICATE OF fEMPT10N FROM WORKERS'
COMPENSATION INSURANCE
(Thtscction need not he complehN if the permit U(moot hundred dollars(SIM)
ar mss)
1 aAfy that in the performance of No work for which this permit Is issued,1 shall not
employ any person in any manner so as At become cob mi in the Workers'Compemnion
Laws of California.Dar-
Applicr
NOTICE"f0 APPLICANT.If,after making this Ceeifscam of Exemption.You should
become subject in the Worker's Compensstion provisions of the Labor Code,you muss
3`Z roMwith comply with such provisions Or this permit hall he decreed revoked,
ZO CONSTRUCTION LENDING AGENCY
[-t thereby affirm that there is a construction lendingagency for the perfarmmce of
P4 m7 the work for which this permit Is issued(Soc.3097,Civ.C.)
W Q Lon der's Nam^ ,
D.z Lenders Address
V Q 1 certify this I ltsw mad this application and sum that the above information Is
W F ee co=t.1 agr m amply with all city and county on inances and sum laws mladng m
O V budding convection,and hereby authodm mpmsenutive,Or this city m enter upon the
W above-mcnuoacd property for inspection purposes,
gym (We)ages to ova,indemnity and keep harmless the City Of Cupertino against
to Habibdea judgments,cots and eapenam which may In any way amuse against said City
C)7 in consequence of the Smites{of this permit.
i7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R ATIONS.
Re-roofs Q
Signature of Appli tiAZARRDOU Dam
S MATERIALS DISCLOSURE
H LS Type of Roof
Will the applicant or future building occupant smm arhandle haninc oar material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section
0Y.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YU )60 No
Will flat applicant or future building acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it husrdama air comtaminwts as defined by the Bay Ara Air Quality Management all new materials for inspection.
has cR
❑Yes (rNu
IhawmN theme,Sect sm MS, re33 and nuunder Chapter thus if Calding / /�I/f�i' [�[/
nices.1M Ally Cede,Soom,co It my 25534.1 in lhncurnat of the
does col chnenlly haw a vnanu that It a my msponsihlllly m nattily the ax:upanl of the
requirements which At"be met pier m ixsuarvx of a Certificate of O.cupaniy. Signature Of Applicant Date
�7 ' f ^r All roof coverings to be Class oll"or better
Owner rauthonroram Daft
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRES�}• /� / PERMIT#
/�D G 2_00 d'/
OWNER'S NAME: fY,v,,.,,f ,4N� r- PHONE #
GENERAL CONTRACTOR: /o) s?rr FAX # I
I am not using any subcontractors:
Signaturi _ Date
Please check applicable subcontractors and complete the following information:
®
ISUBCONTRACTOR 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 I
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CI Of Fax: (408)777-3333
CU.PEkTINO
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 buildingxinspector. 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 doom 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 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:
ZA
ob Srte Address:__— -----------.--
_... . . . -
-_ ._.
- - ---- I2oofrrtg Coiiip y Name: —J- - — ----- = -
O
A PP can t's Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
I & REROOF
CUPERTINO PERMIT APPLICATION FORM
APN Date:
#
30- 2 U — o q 1 I
Building Address:
10792 Alder- brook J n ,
Owner's Name:` 5� ��n rl��°res I Phone ,2�2 '715�
Contractor )/� q Phone#: �0 � 9399 I License
(
1 Contact: — a Phone#: Cupertino Business License#:
a zge-, cx 35�c J
Type of Roof Covering:
Existing: Proposed:
• Built-Up Roof ❑ Built-Uproof
• Asphalt Shingles Asphalt Shingles 6"0 y'r Lai n 4 m a t f�
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) )2� Other(Specify) —fl to O S R 9*44
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
XTo be Removed `SZ( Provide Mfgr.Installation Specs.
Will J�
I Have Read, Understand and Will Comply Cupertinoo's Tear Off Policy:
Job Descnp on:
Residential l Commercial ❑
Fire Zone: Yes ❑ No b71 Confirmed with Planning Dot. if 1
//��TT there are any restrictions- LJ
Cost of Proj t:.'S�.�10 / Type o Constructipp: Occupancy group:
� � P/^/ZD 'f
Qty. if
Applicable Fee ID Fee Description Fee Groun
BPERMFEE Bldg Permit Fees I BUILDING 1
BENERGY Enemy BUILDING
_ _ " -- Plan Check-Fee__._. BUILDING
BUSLIC I Business License I BUILDING
I` I
1