05030174 a CITY OF CUPERTINO ^**x•t- "3 ' N-a �'
BUILDING DIVISION PERMIT r CONTRACTOR=INFORMATION �=3
BOILDING ADDRESS: - --\__. _ - APACHE ROOFING PEI4Mrr"5030174
7 RETT TM n17
OW NEWS NAME: PERMIT ISSUE DATE
RA
.ONE: SANITARY NO. CONTROL NO.
408) 363-0205
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Its O i Q Q Q 0
Loa LICENSED CONTRACTOR'S DECLARATION b e fife.H.65
F 1 kmby,affirm that I am 14cvctl under pmvitiom of Chapter 9(commencing Job DesenpbUon f/�� %
�;W withllto n]OfIU)nf DiviaionJofNC Busincu'df{ukJsi(�. n e.antl mylicenu is R B t61p` Iy^�
oy inroBrnrceanaef&e4Z 9 ' z{ / REROOF W/SHINGLES ''}0
D N'? Licevc Cl ss C/•' g
Z'' Da¢ Myt 4 3,/
n [
FuEry ARC =DT DECLARATION 47tl�)
K I understand my plans shall he used ss public records I,
J p U ��//{{,�� qq
Licensed Professional
aaffirm,
17^Y\ :t y� glgl¢
5 OWNER-BUILDER DECLARATION �L44::YY ®®{Eye I1tcJ/f� �
1 hereby affirm,Nal 1 am exempt from thus Contractor's License Law far the \J
00 fallowing mason.(Section 7W 1.5.Business and Pmf sioos ewe:Any City Of county
m which requires a permit m ve
construct,alter,impro ,demolish m m
repair any oelure
F26poor N its iaauanee.also requlftl the appliCLll for inch Permit an file a signed statement
that k is licensed pursuant o the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
�Fo (commencing with Section 7")of Division J of the Business and Professions Code)or
i 3
that be is exempt Ih omfrom and the basis for On.Ilmgcd exemption.Any violation of
Section 7031.5 by any applicant fin a permit aubjecia the applicant to a civil penalty of 3 61F2TAQ13h%ri0 0 Occupancy Type
m
not mom an five hundred dollars(1500). P Y YP
0 1,u owner of tie propcny,or my employca with wages u their into compensation•
will do mo work.and Neawcmm is nutintended or.5m al for sale(Sec.]044,Business
and Professionds Codc:The Courthouses License law does not apply as an owner of Required Inspections
progeny who Wilds or improves thereon,and who docssuch work infraction through his
own employ.,provided that such improvements are not inCrded.,offered for sale.If,
however,me building or improvement is sad within one year of completion,the owner-
builder will have the Wrdea of proving that w did not Wild or borrow for purpose of
sale,).
0 I,as wmc,of the property am eaclmiwly Cramming with licensed eonuKbR la ,
construct the pmjecl(Sea 7614.Business and professions Code:)The Cod am er's Li- .
cone law does Out apply to an owner of progeny no bunds or improves demo,and
who contracts for such projects with a ornamentals)licensed pursuant to Ne Contractor's
License taw.
0 I am exempt under Sec. .B&P C for Nis reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury One of the following doclaratimu:
1 ham and will maintain a Certifiam of Continuo self-insure for Workees Compcn.
tion,u provided for by Section 3700 of the labor Code.for Ne performance of Ne
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,u required by Section
M or the loner Code,for Ne performance of the work for which this permit is issued.
My Worker's Comepemommm Insurance carrier and Policy ry/tmpy�r art:
Cart .) g4+w�a
CERTIFICATE OF EKElvl MON FROM WORKERS'
COMPENSATION INSURANCE
(]his section wed not W Completed lithe permit is reform hundred dollars(SIM)
of ksa)
1 cenifv Out in the performance of No work for which this Permit is issued.I shall not
employ any Person in any manner sou to become subject o the Workers Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If.after making this Comficate of Exemption,you should
become subject to the Worker's Compensation previsions of me tabor Calc,you must
.J O fonhwim amply with inch provisions or this perm'sshall W deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
I hereby aBlrm that them is construction tending agency for Ne perrurmanme or
a? No work for which this permit is issued(Sec.3097,Civ C.)
Q Lmou,s Nauru
z Lemicr'b Addreas
L)Q I ttnee that I have rod thirty and County
and nam Nat the above information u
j Curren.l agree to comply with all city and roomy mdifmcea and sum lawn relating t. //U/
pU building conswni.n,and hereby mthorim repreuntauvss.f thus city lacnmrupon me
�a abow-mentioned property for inspection purposes.
(we)agree a saw,indemnify and kap harmless the City of Cupertino agairm
liabilities,judgments,costs and expensca which may in any way accuse against said Ci Ly
<Jz inconsequence orthe gSTAN of this permit. 3�/ �o�
^� APPLICANT NDERSTANDS D WILL OMPLY WITH ALL NON-POINT Issued by: Date (�
SOURCE ULI)TIO
V, Re-roofs
Signature of A,tilicso/C.Ounctur Dan,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future Wilding Occupant slam or handle houdous material
as defined by the Cupertino Municipal Code.Chapter 9.13,and eche Health and Safety
aigaLCOO..Scaiex zss72(a)] All roofs shall be inspected prior to an roofing material being❑Yes ay P P Y g g installed.
Will thea applicant or future building acre ant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pp 6 p 4uipmcn
7mquinetwo
ll buounieua air contaminst u defocd by de Bay Area Air Quality Management all new materials for inspection.
rot
Yes �i'���I/W�V
I haverecd the Wn c)usmawriatsequimmcnsunderChapter6.95ofthe Califs-
Halth&S'CYCo'Sccdoru 15505.355]]and 35534.1 undcrsCnd thazifthc Wilding
s not cummnlly haw a Craft,mat it u my responsibility to notify me recto mt of dm
whichmnnhefret r.Cm e.(.Cntiricae.rOcm an.y. Signature of Applicant Date
./
ant Darin All roof coverings to be Class "B"or better
FROM : RPRCHE ROOFING CO FRX NO. 1-408-363-1801 Mar. 15 2005 04:54PM P1
Co:'•�airo':;c;alvyaw,:
I O'�001'vnt.Avm;;:e
(/`;'• Cuputno CA 93014
® ��-,. Tslr,,hFm(408) 779.322)
C'tYU1� Fmc 1408) 777->S3t
:UIpE' TINA
Buildi
Pepartment
IF !rata: --
jUB ADDRESS: pS^U-3 a 7'
' ON'1VER'SNRME: PIiCNEIt O
x tE v RAL Cp�r7RP CID& CJl]�L' AX A .:.1
1 ain n'o`t using any subcontractors: Date
'lease checker linable subcontractors a-id complete the:al!owi infor dm' _
SUSCON7RA-CTOR BUSINESS NAME BUSINESS LICENSEIL 2E, I
C eat+inets&MfUw�ork —.
_ '•,
fiUnole=/' WoodI Ulm/ Gin
I–
�- � Q�lptlta15110Ct.�V1Cta1 _ .�-�
r �Prunt-nE w'llpapel — --- '-- —�
Sheet Rock
Dare
t6%;B•o3
Community Development Department
Building Division
e, City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
U P E IST I N O
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 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:
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: 2r
a,
FO
job Site Address: 0 O 7 �Roofing Company Company Name:
Applicant's Signature: —R. Date: 3 /G/O-S
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
+�- REROOFCITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # 3 / q _ Z - L _ l`� Date: „ / S
lD l I 3�//G p
Building Address:
8d 7
Owner's Name: Phone #: t/ 46
Contractor Phone #: License #: U
3 63-ozos 75 //9 F1
Contact: n Phone#: S Cupertino Business License #:
JK�-r 23o z5
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
`5t 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 De cri tion:
T o Z)
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: i5
Cost of Project: �o Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Grou
l BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
I BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING