05090202CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CO NTRAGTORANFORMATI ON
a
BUILDING ADDRESS:
LOS GATOS ROOFING
PERMITNO.05090202
22438 BALUSTROL CT
OWNER'S NAME:
PERMIT ISSUE DATE
FREDA WU
888 FAULSTICH CT
09/29/2005
NE:
SANITARY NO. CONTROL NO.
(408)298-9399
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EIECf PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Nat I am Iiccnu0 under pmvivionx of Chapter Y (commencing
P
with Senion?BTAB of Division 3 of the Business and Professions Code, and my license is
Imm�fbme4nderect. V97
REROOF--REMOVE SHAKE, INSTALL SHINGLES
License Clazs �-5g Lk.•
Date
I f•y
+ t {� �I
TECTContractor
ARCHIS DECV� ATIO
- IL 11L`-f/fl
4fJ Val rR
l understand my plans shall he used u public records
-1005
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm Nat I am exempt room Me Contractors License Law for the
following maxon.(Section Trp 1.5. Bobmax and Profevions Code: Any city or county
hs construct, alter. improve, demolish. or repair any structure
tt�q, (j nr' M
I lJ7 11 �� y tl If moi, ll 4 n ,,$8 3 5 8
which requires a permit
prior m its issuance, also requireaahe applicant for such permit o file a signed suumem
Contractor's License Law 9
1111 II11
Sq. Ft. Floor Area LT�v
� 1�++ p� ry )� '1j�I Val11 a�tti on
that is licensed porm,ail m the provisions (if the (Chapter
4^Y N lt�llaht3' jf Y
u Y
(commencing with Section 70M) of Division 3 of Me Busincss and Professions Codc) or
Net he is exempt dYnafrom and Ne basis for the alleged exemption. Any violation of
r
Occupancy Type
Section 7031.5 by any applicant fora permit subjects Ne applicant ina civil penalty of
not more dun five buMrcd dollars (550B).
I,azowner of the propmty, car mY cmPloYcu with wagnaz their sole eompensmion,
Required Inspections
will do the work, and Ne swnurt ii not intended or ancrod for felt (Sec. )044, Business
and Professions Code: The Contractor's License Law dors not apply to in owner of
property who hurt& or improves thereon, and who doessuch work himself or through his
own employes, provided Nm such improvements are not intended or offered for ale. If.
however, Ne building or improvement is sold within one year of completion. Ne owner-
builder will have the burden of proving dot he did Out Wild or improve for purpose of
aic.).
0 1, as owner of Ne property, am exclusively convecting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Co ntactur's Li.
_
ccnu law docs not apply in an owner of property who Wilds or improve Marcum, and
who contracts for such projects with a co n acmr(s) licensed pursuant in IW Contractors
Liccnu law.
0 1 am exempt under Sec. . B & PC far this seamn
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby Minn under penalty of perjury one of the following declarations:
-
I ham and will maintain a Ccrdfnate of Consent to Ulf-inure fur Workers Compcn-
goon• as provided for by Section 3100 of the labor Code, far the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Comperuation Insurance, az mquired by section
3700 of the labor Code, for Me performance of Ne work for which this permit is issued.
My Workers Com ensaa Imurance tonin and Policy munbberare:
Cartier: N Policy No.: ^-71 O`2605
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section xed not W completed if th< fiction is for one hundred dollars (SIM)
or less.)
1 certify MCI in Ne pefformamc of the work for which this permit u issued, 1 shall not
employ any person in any manner so az at bGnme subject to the Workers Compeneation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this CcniOcate of Exemption, you should
become subject to the Worker a Compensation provisions of the LeWr Code, you must
forthwith comply with such provisinns or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby thi Wt deo is r000tmc. lending agcecy for the performance of
which s
' the work (ser which this permit is issued (Sec. J09'/. Civ. CJ
Lenders Name
Lander's Address
j 1 cenify that I have read this application and sum that the aWm information is
' Correa 1 agree to comply with all city and county ordinances and sou laws relating to
Wilding coruwaion. and hereby authame ¢pvcn inives hf this city to cnuf upon the
.hove-mcntluoctl propcny Ice inspecuon purposes.
(Wc) agree to save, indemnify and keep harmless de City of Cupertino against
j lhdAliva.judgments. ensu and expemes which may in any way acerve against mid City
in eonuquencc of the granting of this Knott.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REG�ULATIONS.
Re-roofs
Type of Roof
1)o-k /
Signature of Applic'anueantnetor Dae
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or future building occupant store or handle hazardous n ial
az defined by the Cupertino Municipal Code. Chapter 9.13, and the Hea ro and Safety
otic. Schon 25512(x)?
❑Ya q'Nn
All roofs shall be inspected prior to an roofing material beim
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or mmm Wilding actrpant nae equipment or cicalas which
..it havardnus air conuminanu az defined by the Bay Area Air Quality Management
all new materials for inspection.
'District
01•cs ON.
1 have mW the Wrafdous materials requirements under Chapel 6.95 of the Califor-
niaHahh&Safety Code, See ions 25505,35533 ano 25534.1 untlersund the if Me Wilding
dress not currently haw a tenant, Nat it is my responsibility in hairy the aeupant of the
reY.L,m�m c mehmug ime( prior inisinaneeofacerdraeof0,upanry.
Signature of Applicant Date
"B"
All roof coverings to be Class or better
ownied agent—�p4
41
Owner/ Contractor Signature
D
.... -1-1-.-,. ,,... .
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
2 Lr3 cr- :�-( LLr y'-Ve ca-
PERMIT #
Op , .L, 2 �—
OWNER'S NAME:
PHONE # Q �'
GENERAL CONTRACTOR: L�� ^ G� /'��
FAX #
I am not using any subcontractors: i�t� — j
Signature Date
Please check applicable subcontractors and complete the following information:
60
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
L 9 -(,V-
Date
Community Development Department
Building Division
` City of Cupertino
1.0300 Torre Avenue
CITY OF Telephone: (408) 777-32?8
C p[ff I IAI® Fax: (408)777-3333
ff\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.
Z) In -progress inspection. approval.
3) Final inspection approval.
a) Spark arrester installation.
S. If p]3- ood 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:
-' '-—Roofirig Cofnpany Name:
A pbcant's Signature:
Greg tee]
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date:
s
9
9
CM Or
CUPERTINO
CITY OF CUPERTINO
REROOF a SZ `l d Zd Z
PERMIT APPLICATION FORM
APN # 35� -O3�-oil
Bldo Permit Fees
Date:
BENERGY
EnerQ
Building Address:
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Owner's Name:
Phone #: r AS 43 2/
Contractor: Phone #:
U
License #:
�00 �0
Contact: �- Phone #:
a
#:
Cupertino Business LicenseIle
Type of Roof
Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt ShinglesAsphalt
Wood Shakes
Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles n
Other (Specify) /6 SSB, , SF�QC�
Number of existing coverings �_
—
❑ Provide I.C.B.O. Report #��Y
Jam`{ To be Removed
Provide Mfgr. Installation Specs. �r
I Have Read, Understand and Will Comply With Cu
rtino's Tear Pff Policy:
obDscription:
Residential Commercial Ej
Fire Zone: Yes ❑ NoConfirmed
with Planning Dept if.
there are any restrictions: u
Cost of Pro ct: 2 C Type o Construct, Occupancy group:
JJ le
o
;I
Qty. if
Applicable
Fee M
BPERMFEE
Bldo Permit Fees
BUlI DING
BENERGY
EnerQ
BUII DING
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_.- ..__BIDING--••-----.
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING