05030092 CITY OF CUPERTINO .z;
BUILDING DIVISION PERMIT ,CONTRACTORINFORMATION "`'
BUILDING ADDRESS: HAYEDE NIUFAR PERMIT"65030092
!R791 ARATA WAY
OWNER'S NAME: PERNUT ISSUE DATE
AdMIL H
ONE: SANITARY NO. 9 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOo
LICENSED I am ONnRd underSDisdous ATION
fChap
I bemby affirm that l am f ft Bu antler provision of Chapter 9(commencing lob Description
with Seedon 70fp7 of Division J of the Business and Professions Code,and my license is
ea tn in full farce and effect.
5}�? Liccose Class Lic.N REROOF W/SHINGLES & ADD SHEETING
F p Daro Ci manor
SS'Jr ARCH17EC1'S DECLARATION
C I undersand my plans shall W used as Public records
JyUt
;up Licensed Prufcasional
OWNER-BUILDER DECLARATION
on
.� y 1 hereby affirm Nal I em exempt firm the Contractors License Law far IW
00 following mason.(Section 7031.5.Business and Professiuv Code:Any city or county
yg which requires s permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such Permit o file a signed statement
�r< that he is licensed pursuant to the provision of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
ne a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
— Nat le is exempt therefrom and Ibe bask for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant an a civil penalty of 3 7)UW I9u'3%e0 0 Occupancy Type
not mart than five hundred dark.($500). P Y YP
1,as owner of Ne property,or my employers with wages as their sole compensation,
will do the work,and On structure is not intended or offered for sale(See]014,Business
and Pmfwos ioCade:The Conuacmri License Law does not apply to an owner of ((BrrsssRequired Inspections
property who Wilds mimprot such improvements
m rove who daysuch work himulfar through his p �t��
hwri oweer.theu,ping or improvement
such is wmenuarcnetinmrWWmpletin,oroffitand for Owner- tyt q(f /�®
however.the building or improvement is hath within one year of completion,the owner- (�y�'0��
Owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
We.).
❑1,as Owner of the property,am exclusively contracting with licensed eanuactars to
consvuet tW projecs(Sec.7044,Business and Professions Coda:)Tha Conuscum's Li
cove law fines not apply m m owth aner ofeon pro Y ho W Rha Or improves thereon,and 11 al
who contracts for such projev wieo ianxg pursuanuo the Conv¢
Lmh
I exempt under Seo. .Bit PCfor this on w
Owner Data
WORKER'S COMPE SATTON DECLARATION -
1 hereby aRmr under penalty of Perjury one of the following declarmiom:
I hsve and will maintain aCe.iOale of COusent to self-insure for Workcri Compen-
sation,as provided for by Section 3700 of the Labor Cade,for the pedonnanx of the
work for which this Permit is issued.
❑1 have and will maintain Workch Compensation Insurance,as mgvirod by Section
3700 of Bic labor Code,for the pe tfarmanee of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(This section need not v completed Bthe Permit is for one hundred dollars($100)
or less.)
I mnifv that in the performance Of the work for which this permit is issued.I shall not
employ any person in any manner set as to hecome subject no the Workms''Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Bacmpium.you should
become subject to the Worker's Compensation previsions of the labor Code.you muss
.JO forthwith comply with such provisions or this permit shall be deemed rcvekcd.
z to N LT ION LENDING AGENCY
[-� "cooly. that Neel acovwetinn lending agency l'nr the performanec of
tY 7 the work for w h9mrit k rd(Sec, 09T,Civ.C.1
1 A Lendcr'sN
z UOdeesA rut
U t� 1 nify that 1 ad this applic io and store that the above information is
14 F correct.r a reply with all city and county oNinancn and sum laws relating m
O V building ecourunian,and hereby smirminc repmsenutives eif this citymcnter upon Bac
liaovetms,judg d property for inspection
arc narcoses
which
F y (We)agree m M.indemnify and keep harmled;de City of Cupenino agaivt
N
liabilities, of the craving oaycrvumit. may in any way accrue against mid City
U Aconsequence ofthegmnling of this permit.
r. APPLICANT UNPfRSTARX AND WILL COMH ALL NON-POINT Issued by: Date
SOURCE EG ION
�/1 2 n 7-1-9_ Re-roofs
9
signal plic COnuaet� Dam
MA2ARDOUS MATERIALS DISCLOSURE Type of Roof
Will IW applicant or future building occupant score or handle hvarduus material
U
defined by the Cupertino Munici r Code,Chapter 9.13,and the Health and Safety
code.xetirnzss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant Or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
isuic?
0 Yea CyNu
1 have real the harardnus mamrials mquimmenu under Chaprerh.95 Of the Califon
nix Health&Safety Codc,SCNuv 25505,35577 and 15531.1 ungcrsynJ thatifft Wilding
does not cimemly haw a tents rcspovihility tun (ly Neacupamnfthe
circmcnta which aabe no mi.0 «nracerd0 .rampancy. Signature of Applicant Dale
�D All roof coverings to be Class 'B"or better
Owner or sum recd;gem ! Dam
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. — 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
be performed
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
erformed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: Date:
Job Address: Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
i
r,
City of Cupertino Building Department
CITY OF 10300 Torre Avenue
C O P E kT I N O Phone: (408)777-
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 vourself 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 of 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
i Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEQINO
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.
e 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:
I.- 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:
Job Site Address:
Roofing Company Name: C e—
Applicant's Signature: ate: —0
Greg Casteel
Building Official
Revised 11/2/04
PdWnd nn Recvcled Paper
CITY OF CUPERTINO
(Ira? REROOF c>
CUPEkTINO PERMIT APPLICATION FORM
APN# `3 7S /Z D Date:
3-2 oS
Build*i 511,e�ss: 24f 4
Owner's Name:11 f/� "' �` Phone #:
k �� rt
Contractor- i Phone#: _ License #:
Conta Pho e#: Cupertino Business License #:
Ty a of Roo ..
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
� Asphalt Shingles ElAsphalt 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 Cu ertino's Tear Off Policy:
Job ition:
Residential I Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
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