03060041BUILDING DIVISION
j BU auinu AUUnma:
10296 ALPINE DR
1&W NER'S NAME:
AM HOLMES
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PERMIT
9 (commercial
Ad my license is
1 underaand my pans alull W used u public recmes
Licensed Professional
OWNER. BUILDER DECLARATION
1 hereby aRrm that 1 am exempt from the Comramoes License law for tite
following moon. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to wnstruc6 alter, improve. demolish, or repair Any structure
prior in its Imam , also requires the applicant fmaueh permit te file a signed suamcnt
mu be is licensed pubse nt to dte provisions of the Contractor's Name law (Chapter 9
(oommemmmg with Section 7000) of DivW.3 of the Business and Professions Code).
that he is mmpt therefrom and the basis fn the alleged examplian. Any violation of
Section 7031.5 by any applicant fm a permit subjecu the applicant to a civil penalty of
not mom man In hundred dollars (5500).
❑ 1, as owner of the property. ar my employees with wages as their tole compensation,
will do the work and the anuctu , Is ant Intanded maRered far sale (Sec. 7016. Business
and Professions code The Co messi e, Liame law don rot apply u an owner or
however, she building or Improvement Is mid union
builder will haw the burden of proving that he did
"A.).
❑ 1. u owner of the progeny. am "elusively contracting with Raved ce"we on in
consuecl the project (Sec 70x. Business and PofessioN Code:) line Contractoes U.
Abnsa law data not apply be an sinner of prepany who builds or improves theraon. and
who contracts for such projects with aconuaelor(s) licensed pnn"m to the f mumm'.
License Law.
❑ l Ann exempt under Sm. BI: PC for this moon
Data
WORKER'S COMPENSATION DECI-ARATION
I hereby Affirm under penalty of perjury am: of the following declarations:
❑ 1 haw and will maintain aCM111ate of Consent as self -IVUM fa WarkeriCompen-
.11., u provided for by Section 3700 of the IoW, Code. for the performance of the
work for which this permit is issued.
r 1 haw and will maintain Worker's Compensation Insurance, as implied by Section
W of the labor Code, for me performance of the work for which this permit is issued.
(This sectlem need rot m completed if the permit Is fmane hundred dollars ($100)
or lest.)
1 Ability that In the performance of the work fm which this permit is issued. I shall not
employ my person in my manner an u in become subject to me Women' Compensation
L4.3 of Califomis Date
Applicant
NOTICE TO APPLICANT. If. after making this Cenincate of Exemption. you should
become subject to me Worker's Compensation provisions of mo Uttar Code, you must
forthwith comply with each provisions or this pormit shall be damcd ranked.
CONMUCf10N LENDING AGENCY
I hereby affirm that men Is a avtmetian lending agency for me performance of
the work for which this permit is issued (Sec. 3097, Clv. C.)
Lender's Name
Lender's Address
1 cenify that I have mad this application and who that the shove Informatlm, it
corracL 1 agree as comply with all city and =my oNinances and lute laws mating m
building eonmunion, and hereby anthorim rapresanutives of this city m enierupmn me
WAY
annunnr nu. wnluuu nu.
ornwmu I...l louv
Job Description
REROOF 11=9N A UU=g3
JUN 1 7 2003
BUILDING
307
- INSULA$eA)1t_dInspections
601
- ROOF
TEAR OFF
602
- ROOF
PLYWOOD NAIL
603
- ROOF
BATTENS
604
- ROOF
IN- PROGRESS
to save. indemnify and keep harmless the City of Cupertino against \
meow and expenses which may In any way aceroo agaimu Wd City
the granting of this permit.
DERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:
Date
rtC )J X{ Lf —_�S (o'V l Re- roofs (/
A ApplicanUConuacur - -� Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Hding uecupant more or handle hazardous material
led by the Captors. lost Code. Chapter 9.13, and this Health and Safety
iectian 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant At future building accupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
Vines air conlpbiJ)a�Bys defmcd by me Day Ara All Quality Management all new materials for inspection.
i (/ NO
❑Yn ONO
amewismquiremcnuunder Chapter6.95 of the Califon
t75505.25533 an,125534-ruQcnestrad that ifthe building A / ✓1�/��`
that It ls my responsibility min " h upmt of the f v''"01,r/V
proruissuanAbors certin ate m an Signature of Applicant Date
1 clot"_ �a -a . All roof coverings to be Class "B" or better
Ovte
CITY OF
CUPEI�TIN0
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777 -3228
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
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: yq' /' et %'-S
Job Site Address: V / fLF NV
Roofing Company Name: Q U' 2 d
A plicanYs Signature: //��U%
Greg eel
Building Official
Revised 1/30/03
PHW.HA n P.—I.4 P.—
Date:
0
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: yq' /' et %'-S
Job Site Address: V / fLF NV
Roofing Company Name: Q U' 2 d
A plicanYs Signature: //��U%
Greg eel
Building Official
Revised 1/30/03
PHW.HA n P.—I.4 P.—
Date:
0
I
I
[7
t
CITY OF CUPERTINO
D' REROOF
CUPEkTiNO PERMIT APPLICATION FORM
U jpblaoV/
APN # —I Z�2 _ D
PERMFEE
Bldg Permit Fees
Date: j'
cp
L C) 3
-T
Building Address:
Seismic Fee Res
BUILIDNG
Owner's Name: C ry" 1 1 ^ I
c, lC�
� 42 S
Seismic Commercial
Phone #&
Contractor:
Cas
License #��
Contact: 1938 Old Middlefield Way
�S Mountai
BPLANCHK
Phne f�
cY l
Applicant/Contractor:
Building Permit Info:
Bldg Elect
Plumb
Mech
Job Description:
Residential: \
L4-,r2
W
Commercial:
Sq.Ft. Floor ea: /�r�
7
$ /Sq.Ft.:
Architect/Engineer:
Business License
BUILIDNG
Valuation: O
Type of Construction:
Occupancy oup:
4 �
if Qt * A„r(I;rabclr 1 Frr. m
Fee negcrintion
Fee GrouD
40 D7, 0
PERMFEE
Bldg Permit Fees
BUILIDNG
BSEISMICRE
Seismic Fee Res
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BMITIGAT
Housing Miti ation Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG
0
40 D7, 0