04080207 CITY OF CUPERTINO
BUILDING DIVISION PERMIT fiCONTRACTOR INFORMATION
BUILDING ADDRESS: TOM MCAURTHER CONSTRUCION PFl`MITN004080207
OWNER'S NAME: PERMIT ISSUE DATE
VICTOR STEVENS 217-4 A7A T)P
ONE: SANITARY NO. CONTROL NO.
(408) 509-1671
I
CHITERBNGINEER: BUILDING PERMIT INFO
DG ELECT PLUMB MECH
LICENSEDCONTRACIOR'SDECLARATION1 Motley affirm Wt I am licencd under provision of Chapter 9(commencingJob Description ��Section 7")mf Division 3 of the Business orui Prafcssiau Code.and my licenm is ED
llto'andeffet, dH7(;7 REROOF
ense Classr .n lJc.N /t Contractor
nH �/ ARCHITECTS DECLARATION AUG
tl lr� / Z001.
oe< 1 underL¢nd my plans¢yaM,p!used u puhlic records nV tJ T
yU 4eZe A//.l.G
''G 1 Licensed— Posst'onal—n p N R
3 / OWNER-BUILDER DECLARATION DU
which
®I
I 1 herthy.(Bran that 1 1. ucmpe from the Carom,Co e:Any c law for the
p O following reason.(Section]Is3 L5,Business and Profcstion Code:Any city or county
E:. which inquire a Permit to construct,eller,improve,demolish,or repair any structure
poor to is issuance.also require the applicant forsuch Permit o file a signed statement
that he is licensed punuam In the provision of the Contractors Lit..Law(Chapter 9 Sq.Ft.Floor Area Valuation
�f,G (mmmcncing with Scmion]000)of Division3nf NC Business and Profcoinna Cndolor
$ Nat k u exempt Nertfmm and Ne bus far Ne allegtd tacmption.Any violation of
Schon 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 9�M3,1[1"crO 0 Occupancy e
at/o9vre than five hundred damn(S500). P Y zYP
�1,uawnsofthepmpeny,mmyemployeswithwageu NoirsolecW.Be don,
will do Ne woos end thaatru Conine tot s Li Brod La cce,;not apply in an a mer of
property
or
r o ertywh leu Code:TM Conuactofs Lir."•law docs not apply lf an owmr of Required Inspections
propertywho b,pmvirimproves himm,andwhommtihwork himselfor through his
awnemployed,provided pr suchimPs midwiitartnot intendedmaRemd theoer.
however,the building or improvement is mid within one year or completion,Ne owe of
builder will low the burden of proving Nat M did not build or improv for purpose of
' rule.).
❑1,as owner of the property,am exclusively contracting with licensed mnuanon to
construct the project(Sec.7014,Business and Profession Code:)Did ConlsmNrs Li
cease law does not apply in an owner of property who builds or improves dlerton,and,
who contracts for such projects with a convactor(s)licensed pursuant in the Convectors
License Law.
Iameaun/pt/waderseee/_ ,B&Pc Rodumamm
I
wner l��Y//s9'! Data
Y WORK 5 COMPENSATION DECLARATION
I hereby affirm under pwlly of perjury oro of the following declanuon:
I haw and will maintain a CertiBcote of Consent ro self-insure for Workers Compen-
ion,u provided fm by Section 3700 of the IaMr Code.for the performance of the
rk for which Nis permit is issued.
1 love and will maintain Wm4r's Compensation I....as mquimd by Section
00 of the labor Codc,far Ne performance of the work for which this permit is issued.
y Workers Compensation Insurance cameo and Policy number are:
Cartier. Polley FROM
CERTIFICATE OF SATI NINSFROM WORKERS'
COMPENSATION INSURANCE
(nor section need mtlsecompleted little Permit is fmone hundred dollars(SIM)
or Ins)
I certify Nat in the performance of Ne..,it for which Nis permit is notice,I shall out
employ any person in any manner au u to bemme subject in IM Workers Compeuation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Exemption,you should
become subject w the Worker's Compensation provisions of Ne Labor Code,you must
.,O faMwith comply with such provicun or Nu permit shall M ro
deemed oked.
'E " CONSTRUCTION LENDING AGENCY
[—tom I hereby wDm Nat Vert is a construction lendingfor the formancc of
agency per
C' La work for which this permit is issued(Sec.3097,Co.C.)
Cz Iandcrs Name
M z Lenders Address
U Q I Conry Nu I have read this application and some Nat the above infomatiun is
nQ
Correct.1 agree 10 Comply wish all city and county Ordlns end some laws relating to
QU building construction,and hereby authorize representatives of this city tenter upon the
.hove-mentiuncd property,for inpecoms purposes.
H y (We)agree to saw,indemnify and keep harmless IM City of Cupertino against
(q liabilities,judgments.toss and expenms which may in any way accrue against mid City
U rZ in cim".mc of de grinning of Nis comit.
^
APPLICW UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �/zg/
SOURCE GULAT'N��S pp
66//,, ems!/\ 2Nac.Y�l Re-roofs
Siggtlum of ApPlicaut Conoacior Date
(((((( HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store of handle hnardous materiJ
u defined by the Cupertino Municipal Code,Cbap er 9.12.and the Health and Safety
ode. 0y. 5532(¢.) All roofs shall be inspected prior to an roofing material beim
❑Ye Na P P Y g g installed.
Will thea applicant or future building Occupant ase If a roof is installed without first obtainingan inspection,I agree to remove
PP g P ea Air
P
mit hmaNnus air contaminator upcfinctl by the Bay Area Air Quality Management all new materials for inspection.
7.DistriCL?
❑Yes1havemad thehvartlonmaterialsmquimmenuunderChopmr6.95ofthe Califor.
aHealth&Sdf L,Codc,Scedou25505,25533"25534.1undersand dinirthe building
cs not currently have a tenane that it or my responsibility m ratify IM occupant of the
quiremc ts, ch mu me,prior issue.aft Ceniocae of Occupied, Signature of Applicant Date
g'1H db�
Owner
xathorind agent Date All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
N - Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
o207
OWNER'S NAME: PHONE # 4.ig- eZ/ - 3 5925
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin 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
Owner/Contractor Signature Date
Community Development
10300 Torre Avenue
ice" k� Cupertino CA 95014
Telephone(408)777-3228
� UPCITY OF E�TINO Fax(408) 777-3333
fC .
Building De artment
'JOB ADDRESS: / PERMIT #/
P„ASDL ---r ,. cieT o 4-1,b - o 2 0 7
OWNER'S NAME: / c/' C Tc h` S , PHONE # Nog'
GENERAL CONTRACTOR: 7 n T w , FAX #
I am not using any subcontractors: / -7
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
— 1 �
Plastering
Plumbing �,2 &,S j !'>A,
Roofing
Septic Tank ”` f'
Sheet Metal
Sheet Rock
Tile i
Ownei/Contractor Signature _ Date
Community Development Department
ad Building Division
Cityof Cuetino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO 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.
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.
Homeowners Name: I/rr,/G /b- q i<-V C
Job Site Address: SS
Roofing Company Name: //I/I,T(� % t?/�dig
A plican" Signature: Dater ZG!—Gtr(
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY OF
J `�
CUPERTINO PERMIT APPLICATION FORM
APN# ate:
3S6 oL�z S DOvl
Building Address:
2 2 083
Owner's Name: i Phone#:
Contractor: Phone#: _3S S License k
G(74 76
Contact: Phone#: Cupertino Business License#:
eR �rvh Gp� SDq/ -l67/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof d Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
a- Wood Shakes ❑ Wood Shakes J
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 6st4 ❑ Provide I.C.B.O.Report#
ty To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: tJ
Cost of Projec `z �jd� oo 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 BUU-DING
BUSLIC Business License BUILDING
Ji
Zoe , z6