05090114 CITY OF CUPERTINO �^ � a Axa• �✓ ° '' �`
BUILDING DIVISION PERMIT C0NTRACT0R INFORMATION '
Ji.�i
BUILDING ADDRESS: T D ROOFING PERMITNo.05090114
1285 ASTER LN
OWNER'S NAME: PERMIT LSUE DATE
JULIA FU 3540 MARGATE AVE. 09/16/2005
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o t�
u o o LICENSED CONTRACTOR'S DECLARATIONWU Job Description
1 ion 0(B of that I am fthe Bumixed under and
Prof sons ons Code, 9(Commencing P
��� with Section ltlfkp o(Division of NC Business and Profcuinna Code.and mylicenu is
_2,„ imm�mnean er t c e ( REROOF-T O SHAKE INSTALL LANDMARK COMP.
z Liccnsc Class Lk.N S ( /
pFp Dale C ITECTS CLARATION /
dy C 1.0 I undcrsssnd my plans shall he used as public recnNs IIfII��R
ED
aapr' Littnutl Pmfcssional x+ Il ��sl
g OWNER-BUILDER DECLARATION s.�
2q I hereby al'Enn Nft I am exempt from Contracmrs License Law for the q�
C 0 following mason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit m construct,alter,improve,demolish.or repair any structum 6 Mfg $7300
_ito prior a its issuance.also miuims due applicant for such Permit file a signed summon,
<
that Misliccnsedpontoon,tothe provisions ofthe Camucwr'sLicense Law(Chapter 9 Sq.Ft. Floor Area If��p.ss fl APt.1np -Valuation
E
li-0 (commencing with Section 7")of Division of the Business and Profusions Code)or
i that he is exempt thcmrrom and the basis for the alleged exemption.Any violation of rlY M I'1 �j t`f 7 LSO 11
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty ofv V If r U
er 5 LJ LI(Occas
nos more Nan five hundred dollen(1500). _P�ane Y Type
❑1,as owner of she property,in my cmployms with wages as their sole compensation,
will Pr the work.and Ne he Contractor's
not intended or offered for apply
In an a mer of
and ort,wh otts Code:The thersa License law does not apply f an owner of Required Inspections
..employ Wilde i impro rs Hemprove who am net doesinic
tendo himselfw for ameugh his
owneer,theuiprovided pr mcM1 improvements;wittannot ear ofcoroReredfarowner-
M1uilder will
for,burden
of vinissoldedidnotWildofcompletioaHrposeo-
builtler will have the burden of proving that W did not Wild or improve for purport of
tile.).
O 1,as owner of He pmpeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7064,Business and Pmfessimns Code:)The Cormacmt's Li
cents Law does not apply to an owner of pmpeny,who Wilds or improves Hemon.and
who conmcw for such projects with a contractor(s)licensed pursuant to the Contractor's
License,La .
❑I am cumpt under Sec. ,B h P C for this mason
Owner - Data
WORKERS COMPENSATION DECLARATION
1 herby affirm under penalty of perjury one of dee fallowing dedamtionic
1 have and will maintain a Certificate of Consent o self-insure for Worker's Compere
sation,as provided for by Section 3700 of He Labor Cade,for He performance of the
work for which His permit is issued.
1 have and will maintain Worker's Compcnsnion insurance,as required by Section
of HC Labor Code,for He performantt of the work for which His Permit is issued.
My Workers into cation Itt c iw and Policy number apn:'� �
Cut Policy No.:
CERrIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This it..need not hecompleted if he pctmit is formic hundred dollars(SIgB
or lesa.)
1 certify that in the performance of due work for which this permit is ismed,I shall not
employ any person in any manner u as las become subject o He Workeri Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT.IL after making this Certificau of Exemption,you should
become subject to the Worker Compensation previsions of tic labor Code.you must
.JO forthwith comply with such provisions or His Permit shall W deemed mvaked.
'Z CONSTRUCTION LENDING AGENCY
't•+� I hereby alarm that Here iso eonomction lending agency for He performance of
lY the.,it for which His permit is issued(Sec.3(197,CO.C.)
W Q Lenders Name
.7 z Lenders Address '
U 0 1 cenify that 1 have mad this application and some that He above information is
II,r correct.I agree to comply with all city and county on inances and auto laws relating to
0U building construction,and hereby auNorne reprcunutires of this city to cnwr upon Inc
}� ahwe.mentionedpmperlyfor inspection purpose-
G. (We)agree to save,indemnify and keep harmless He City of Cupertino against
fM rA liabilities,jANTI
and expenses which may in any way ampic against said City
Uz inconuqueing of this
permit.
APPLICANOS AND WILL COMPLY WITH LL N .Poir Issued by: DateSOURCE R
L� '6 o ) Re-roofs +
Signature o Applicant Commmum am
HAZARDOUS MA LS DISCLOSURE Type of Roof
Will she applicant or future building Occupant mom or handle hmardous material
as dcOned by the Cupeninm Municipal Code,Chapter 9.12,and He Health and Safety
ode,Section e'255J21a)? ®ea All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future building occuWnt out,equipment Or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
is hazardous air contaminants as defined by the Bay Area Air Quality Management all new material for inspection.
District? ,.ty/,;�
D Yes N/o ( /�
I have WHe hvardm,imamrialsmquinmentsunder Chapmr6.95 ofdre Califs-
iia Health& cry ctitsm25M5,25533and25534.1uMcrswdthuifthc building
dots not cu rely to tenant,mat no
t is my mmornot iloy o nudly acupant of the
myuiorre n1 rets uaneenfacertiBeammr span . Signature of Applicant Date
i q 16 0�
Owner or author cd agent Doc All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
L
:'✓ Cupertino CA 95014
Telephone(408)777-3228
CIiY OF Fax(408)777-3333
OUPEkTINO
ByRding Department
JOB ADDRESS: PERMIT #
I H S S-1 AStcb 6 9 d l l�
_. OWNER'S NAME: �•l ' ti� ��0. PHONE,# y v S ) C)0 (
GENERAL CONTRACTOR: i D IXL-16 IL FAX #
I am not using any subcontractors: i 9 16 1 6
_- Signature Date
Please check'applicable subcontractors and complete the fo bwin 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
Sheet Rock
Tile A n
I \ %
/ 1/\ 9 ' I G ' 6
Owner/Contractor Signa l Date
Community Development Department
aaw
Building Division
City of Cupertino
10300 Torre Avenue
elephone: (408)777-3228
CITY OF
U���j'�� 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 fora 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 1.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: (X_
Job Site Address: A sAL�-
�1n
Roofing Company Name: A,OrL X-
Applicant's Signature: / ' Date: 9 —
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
J CITY OF CUPERTINO
'�- REROOF vs'u y
CUPEkTINO PERMIT APPLICATION FORM
APN# 3G 6 - 1 _ 10S Date: /
Qt 16 � os
Buildingdress: A s4
,.2/3s- 7Te r l`
Owner' Name: Phone #:
A J-"(,+ a l _ C) I I -A
Contractor, D Phone J:9 8 $ License #: $\-I S S
Contact, Phone Cupertino Business License#:
C«vC q,38 6y 6 . B -5 SO
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
X 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 Description:
CL ?0_9_ _ Cid.�1 �JO l� LCIIl j Wk Cv\(�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: 15
Cost of Project: 3 Type of Construction: Occupancy group:
t-a o
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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