04030064 CITY OF CUPERTINO =>>=KK .� .;�.h✓r» ;<..'t §n� :*'^ ;�=
BUILDING DIVISION PERMIT C®N=TRACTOR�INFORMATION
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BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PTffL"D'04030064
AP T)p
OWNER'S NAME: PERMITLSSUEDATE
BENNETT MI
)NE:
SANITARY NO. CONTROL NO.
(408) 925-999c;
ARCHITECT/ENGINEER
08 925-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°OiJ LICENSED CONTRACTORS DECLARATION IbDescri two
U 1 hereby affirm Nlicensed
Net 1 are under previsions op
of Chap or 9(commencing
wish Section 70M)of Division J of0e Business aM Profcamoo;Code.and my license is �'pq ��Ew®
^ in full to eand e1Yt.rj2%,jI C3Gt 13 REROOF
�,-z License Class Li
n k,§ Dam sq I - Can —
q AR H17EC1'SDEC APR 0 6 2004
W U I onderasind my ph. I bo used u mdr
a
L,D; Licensed Professional BUILDING
�
^D OWNER-BUILDER DECLARATION p.�1 AIB ®�p0^
3 F I hereby aRrm that 1 Me exempt from the ComramaYs License Law for the BU ` NG
v O following season.(Section 7011.5,Business and Prefessiam Code:Any city or county
$9 which requires a permit o construct. her.improv,,dcmolim.or repair any structure
F i y prior ions issuance,also ro uires me applicant for such permit to BM a signed moment
< that he islicenudloommttothe pom,miovnfsheContractor's I-Mcnmlaw(Chapla9 Sq. Ft. Floor Area Valuation
��$ Mommening wish Section 70M)of Division J of NC Business and Pmfesaions Code)or
mat he is exempt th,rtfvm and the basis for the allegrA assumption.My violation of 1N[�T,.y�ss
Sectors 7071.5 by arty applicant for a permit v1spece.the applicant to a civil penalty or 3�' U O WDItyCrO Q Occupancy
not mom than fn hundred doll,m(ssao). p Y Type
L she work. cid pvpcny, is intended
wish sale(Sm.
compensation.
will dr howork.and she structureCont isnots Uumosmow ca footle(Sec.an in Business
and property bis Cade:Than ns theme,and
Law aces not apply lf in ownv of Required IDspeCllOHS
own
who builds or Moistens theme,acid who ares suchworkh himself oor ffered
his
ownemployer,ping or imatsuchimpm id within one
awMWmo0croa forthe ease.own If.
however.the building or improvement is sold within ane year or unions.for
the owner
builder wi0 Moe the buracn of proving WI M Did rmt Mtile ar improve fm puryo¢of
sale.).
Ej I,as owner of the propcny,am exclusively convecting with licensed contractors to
construct the pmlen(Sec.7014,Business and Professions Code:)The Contractor's Li-
cents law docs not apply to an owner of property who builds or improves themes,and
who contRma for such pmject5 with a comV9cmr(s)I ctrund pursuant to the Commences
License Law.
0 l am exempt under Sec. ,B@ P C for this reason
Owner Data -
WORKER'S COMPENSATION DECLARATION
1 hereby a1Bum under pevlly of perjury one of the following declarations:
1 have and will mainwin aCardlicate of Covent to self-inure for WorkefsCompo-
sation,as provided for by Section 57M of the Labor Code,for me performance of she
.it for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
37 ofde Ua CM,formeperrormaneeorthewmkforwhich NisMmitisissued.
My Werkees Compensation Insurance carrier and Polis,number art:
CmM'..ST1`rT k I& Polity No.: 51 t-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMssectionneednot W completed ifft permit as fortune hundree collars(SIM)
or less.)
I terrify than in me perfmor.of the.,it for which this permit is issued,I shall not
employ any person in any mannerao as to become subject to the Workers'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject w be Worker's Compensation provision of IM Labor Code you most
.,O forshwish comply with such provisions or this Permit shall be demned mocked.
z "" CONSTRUCTION LENDING AGENCY
[-ham I hereby affirm that mere is a construction lending agency for the performance of -
Dl the work for which Nu permit is issued(Sec.3097.Ci,C.)
Q Undoes Name
=z Lender's Address
U Q 1 certify Net I hove rod Nis applicvion and sate Net she above information u
U,F comet.I agree m comply with W city and county oNinnces and state laws relating to
O U Wilding construction,and hereby summon reprvenutns ofshis city to town upon the
abovome judgm pmpeny for inspection purposes.
Fy liebilit(We) g nts.core.indemnify
and keep
maymanhoss y weCity
ac of Coperrims nstsa.,City
U Z in eoveefucnce of the graming of this permit.
AP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
OUR ON .
D b Re-roofs
-SigenusearApplicantACoommuor Date
H,ZAADOUS MATERIALS DISCLOSURE Type of Roof
Will sheappBont to future building occupantatem m MMI,huardan matetal
as."aca by she Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
nhle.Semon 255324)?
❑Yrs ?"f - All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
colt to sudev it conuminane.M fined by me Bay Area Air Quality Management .-a new materials for inspection.
District?
❑Ye Nu
Ihevc sod me Mratdtms materials rtquiremcne.under Chapter G95 aim Glifor
ria Hcalsh& chaMM4msm5w05,25suimmen534.1u Chal,wWWtifth iofcr-
not menty no ten t' u y nexpmuibility m Wollym,ecaupentofthc
Iachconst ml " r u ascemfiealeoranon 'Slgna�ure.of.Applicant Date
Owmer or imhuriveda o,te All roof coverings to be Class "B"or better
Community Development
e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS PE
O o �UZ�
OWNER'SNAME: till�llh�1 YhS�rrt PHONE, I�O�- u — SZ9
GENERAL CONTRACTORjaoUY i 9 FAX #
I am not using any subcontr ors: (u u
Signa Date
Please check a licable subcon ors and compete the followinginformation:
66 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
—LzIle
/ (0 (0�
OWN'Ief/Eon&ctor Signature Date
- I
Community Development Department
Building Division
Il City of Cupertino
xi
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPERTINO
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.
Homeowner's Name: J"l�rl n i -�Juv-
Job Site Address: �0 J>INS
Roofin7nesSiE
ame: ba IN
A plicSign
VOL�— Date,—31 IU Ql�
jGregTteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERrINO PERMIT APPLICATION FORM
APN#��Z o � 1 Date:
� tu�oy
Building Address:
SIM 162 Na? -bR,
Owner's Name: Phone#-
RakLl, btNN6f � - yob
Contractor Phone#: License#:
�euY-lt� A-ul -�l2.q
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt 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 Description: µ6,y b'XK1ftUcf t V gkaA, d`F W002 KKr
WiTALL 00.n) BIZ" U44 A5 T K 'fI_tir
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LI
Cost of Project: 12 6 u W Type of Construction: Occupancy group:
21
. t
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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