05090116 CITY OF CUPEWrINO
BUILDING DIVISION PERMIT CONTRAC�TOU-INFORMATION '
rakeY'Y ^'FSSxx4;='in e ,.a dg-
BUILDING ADDRESS: PERMIT NO0 5 0 9 01161
10410 ANN ARBOR AVE
OWNER'S NAME: PERMIT ISSUE DATE
JOHN TRACY 09/16/2005
ONE: SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ups LICENSED CONTRACTOR'S DECLARATION O O O O
W
F I hereby affirm mace 1 am licensed under provisions of Clone,9(commencing Job Description
ZW with Seelimi1000)a(Divixion Sof NC Businesxand Professions Code,and my Been.is �(1 11 A rpt mea
=„ in mue,reand erreat. REROOF-T/O SHINGLES, INSTA'L`L SHINGLES
Z License Clay Lic,p Uf 'V/�--`t\ l{ /1
—p DO -w CaU.1ar a/ 4 I`/
ARCHITECTS DECLARATION
¢-r I understand my plans shall be used a public records
C i3- 2005
k G t; Licensed Professional
5 OWNER BUILDER DECLARATION 11p11A��
.�i 0 1 hereby.(Sec on I em exempt from Be Contractor's o Liccnx Law for IW n I �
O O following ereby ftion(Section t I LS,Business and Profs tiara Calc:Any oily or county l rr�(
2 m which requires a permit to construct,alter,improve,demolish,or repair any Structure $500
y—se poor it) rs its issuance.also requirthe applicant for such Permit rile a signed stawmcat
-Z< that he is licensed pursuant to thepmvisionsnf due Contractor's License Law(Chapter 9 Sq. Ft. Floor Area 'Valuation
y1-$ (commencing with Section 7")or Division 3 of the Business and Professions Code)or
y — Nat he is exempt sMmfrom and dte buil for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty of
not mom man Brc hundred dollars($500). r Occupancy Type
❑1.asowner of Ne property,or my employcm with wages as their to xi n,mad.n.
will do Be work end the structure u not intended oraf Bred fo sale(Sec.7011,Business
and Profeviom Coda:The Communes License Lav,Coca: nal apply w an owner of Required Inspections
progeny who Wildsorimproves thereon.and whodoessuch work himselfor through his
Own employees,provided Nat such improvements an,not intended in oRercd for sale.IL
however.the building or improvement is sold within one year of completion,the owner-
builder will have Nc burden of proving that he did not Wild or imprave for purpose of
sale).
owner of the to y,am exclusively conuacting with licensed contractors to ,
onswet the pro ct Sec. 011,Business and Professions Coil The Contractor's Li-
Law to Owner ofpropeny who Wilaorimproves thereon.antl
who contnctsf S hp jaeu with a cmwmswr(s41,�� ursu rat w Be Canmeunex '
Ll"we
law.
❑lam este u &P C for Nis reason
net
/ O ER'S COMPENSATIO - FQ ATION
1 hereby aRrrn under penalty of perjury one of the following declarations:
1 have and will maintain a Cenificale of Consent to self-imum for WorketsCompen-
'ration,ax provided for by Section 37M of the ISWr Code.for are performance of the
work for which Nis peril is issued.
❑I have and will maintain Warknr's Compemadan Imursne.as required by Sceuon
37W of the Isbor Code,for the pi forance of the work for which this permit is issued.
My Workers Compensation Insurance drier and Policy number arc:
Cartier. Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Thiascdion seed no pCc p ted if Ne peril is for one hundred dollars(SIM)
lora.)
1 ccnify Nal in Ne perforant of c walk for whic this mil is issued.I.Hill not
employ any parson in any r as
n at ompensation
Laws of California.
Applicam
NOTICE -0 APP of making Nis Oniric of Exemption,you should
become subject to Ne Worker's ompcnvtion previsions of the Labor Cade,you must
.,O forthwith Comply with such provisions or this permit shall be deemed mvokcd.
'Z "-' CONSTRUCTION LENDING AGENCY
I hereby alTr Nat thea is a conauuction lending agency for the Performance of
P/. Ne work(tar which this permit is issued(Sec.3097,ON.C.)
W Q Isndcr's Name
D'
D Condo's Address
[)p 1 ttnee Nal I ply read All
i City
and County
and state Nos fficand
salve information u
Iy U cores 1 once w comply with all airy and caunly oNimncn and curt laws relating he
0 V anon-gcotioned mKrty M1c¢hapee oriareprescntauvcs of this city mcnwr upon Nc
,r rill ahorc-mwe agree In so y/!d,'cx mpec on purposes.
we agree lox , rens andkecpharlemthe Coyof Cupeninoagaimt
`�..'y liabilitox.judgmcna,c IrV z APPLICANT UNDurtO SToANhisDrWILL COMP WIT ALL NONPOINT Issued by: DateSOURCE REGUON
Re-roofs �j 6
SignatureicanUCanuach" Data
HAZARD S MATERIALS DISCLOSURE Type of Roof
Wi111Wapplicanlur tax builtling ucupant more or handl hanNous mawriil
ss dermed by IW Cupenin Municipal Code.Chapter 9.12,and Ne Health and Safety
ado.SD Ya 25532(x)? g0,.p�\N.a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuluk buiWiag occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it W/,odnm air contaminants as defined by Oc Bay Area Air Quality Management all new materials for inspection.
Uisuicl?
El Yet No
jh d ehm Nmsmawrials requirementsunderClupwr15.95ofNcCalifao-
niallaI Cade Seetiaa 25505.25533 and 25536.1 understand that ifNe Wilding
Dorsmharcrcqui chmu Wmelpriorwissu o Ccrtifa of upanay. Signature of Applicant Date
Gwnerura mai, agent Dale All roof coverings to be Class "B"or better
SO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #eU
D D A4,2 fieg d12
AjF-
OWNER'S NAME: PHONE # s/Z6
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 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
'he,,Rock
sll'1� 6
er/Contractor Signature Date
Community Development Department
Building Division
w City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
4UPEkTINO
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 I.C.B.O. report is required to be on the job site at the time on inspection.
1
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: d1✓ L]-i,/] /�
Job Site Address: � �(� //yV A/ {"/Y C*, Y(Ju0'
Roofing Company Name: �Z
Applicant's Signature: Date: Z/ 0
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# d 2—(v
(o Z?)o >b Date:
/6 D�
Building Address: v /O
Owner's Name: r — Phone#:
Contractor: 6ZYv��`/ Phone#:_ License #: a&� / 1e
Contact: Phone#: !j Cupertino Business Lice se #:
C5� /i� 5_121L
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof EI Built-Up roof
Asphalt Shingles q!Asphalt Shingles
EllWood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) O 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 Cu ertino's ITear Off Policy: ❑
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No L] Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project � Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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