04060171 CITY OF CUPERTINO
BUILDING DIVISION PERMIT %CONTRACTOR INFORMATION
BUILDING ADDRESS: PLATINUM ROOFING INC PERMMN004 0 6 0 17 1
10159 N BLANEY A
OWNER'S NAME: PERMIT LSUEDATE
PROMETHEUS CORPORATION 1853 S 7TH ST
ONE: SANITARY NO. CONTROL NO.
(408) 280-5028
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOo LICENSED CONTRACTOR'S DECLARATION MIb Description
I hereby affirm Nlice
al 1 am nsOOSCTIp
ed under Provisions of Chapter 9(commencing with Seetion]tlfp)Of Division 3af NC Buanessand R.fessions Code.end mylieenseu
% inmRfareeoadOffecay e 7C4ot REROOF W�SHINGLES
j�z License Gas Lw .
Comment, I n
?qtr ARCHITECTS DELARATION
understand 1 understand my plans shall h=it u public recard;
a
Say Licensed Professional
5 OWNER-BUILDER DECLARATION
.� 1 hereby AM.Nat I em eumpt farm de,Cnaa
nctots License Law far the
00 following moon.(Section]fq 1.5,Business and Pmfcasians CoJc:Any oily nrcounty
m which".a.a permit to emon.t,elle!.imprnw,demolish.ar repair any structure
prior m its ksmance,also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the previsions of the Contnclor's License Law(Chepter 9 Sq.Ft. Floor Area Valuation
'I=-$ (commencing with Section 7")of Division 3 of the Business and Pr.fcasions Code)or
5_ ones he u conmpt thcrtfrom and to buns for Ne allcgcA etempdon.Any violation of
Section 7031.3 by any applicant for a permit subjects thc applicant o a civil penalty of
no more than law hundred dollars(ssooy a Occupancy Type
m
❑I,As owner of Ne property,or any employee with wage As Heir to compensation,
will do the work,and the structure is not intended ar offered far of.(Sec.]ON,Business
And Noressm.Code:The Conncme.Liaise Law docs ret apply m an M.of Required Inspections
property who Wi lda m int pai rms thereon,and who doessuch week himself.,through his
own employees,provaac l Out such improvements art oat intended or Offered(orale.If,
however.Ne building Or improvement is sold within ane year of completion,the Owner- `
builder will have the burden of proving Nu he did not build or improve for purpose.r `T-v
nth.). / t
1,u.ww of ct Sec.property,,B exclusivelysand convening with licensed rnnaazmss m
construct the,project(Sec.]Ord,Business end ny who Wi Coon)The Contra on.Li-
ccme law cats oat apply je an owner of property who sed p or impto de Bte¢om and, I'
who contracts for such projects;with aeonvzemr(s)licensed purswm m the COnwnaYs X
License Law.
I am exempt under Sec. .B&P C for this rtunn
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Fealty of perjury one of the following declarations:
I haw and will maintain a Certificate of Conant m aelf-insure for Worker'sCompen-
-an,u provided for by Section 3]00 of the Labor Code,far the Performance of do,
work for which this permit is issued.
❑1 haw and will maintain Worko's Compensation Insurance,u required by Section
l]OOof the Labor Cade.far the perfonmma of Ne work for which Nis permit is issued.
My WOrkees Compensation(nsun1l�carraer and Policy name,am:
QCarriers can A)AI Policy No.: `1 YJ UOI q O
CERTIFI ATE OFEXEMPION FROM WORKERS'
COMPENSATION INSURANCE
mus sec0on need not he committee if the permit is for.aOlim and dollars(SIM)
or las.)
1 unary that in Ne performone of Ne work for which this Permit is issued,I.Nell net
employ any person in any mannerm az to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,arm,making this Certificate of Escmption,you should
become subject to the WarkcrS Compcesstinn parvisimn of the Labor Cook.YOU must
.J Q forthwith comply with such provisions of this permit Nall IN deemed mated.
Z " CONSTRUCTION LENDING AGENCY
H Ihereb affirm than dere its construction leading far the F y Pagcncy Ncrfurmana of
Rei she wad fur which this pcmit is issued(Sec.309],Cr,C.1
a Q lender's a
=z larders Add.Add
ardress
V 1 certify No 1 have mad this application And rote that the show inforeaJon is
correct.I agree to comply wish all city and county oreiwmes and mute laws relating in
Ot) Wilding construction,and hereby audamm MPmsentatiws Of this city to enter upon Ne
W shove-mcmioncaproper for dex,xoaen purrawhich ms.
C (We)agree m arc,indemnify and keep harmless the City of Cupertino against
h inconsequeec Of aci.the cowing Of thisumit. may in any way eccruo against aid City
V z APPLICANTeUNDERSfAN Of this
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE/R/raCULATI��
Re-roofs
/ wort ofA iVCf Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or rotor building onupanumrt ar handlehvallou mamnal
as defined by shc Cupertino Municipal Cove.Uaptar 9.13,and the Health and Safety
.do.Scctlon 25533(a)?
❑Ya �'1N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
craft crasakt?ardous air conzaromma As dc(incd by the Bay Arta Air Quality Management all new materials for inspection.
❑Yes )S�No
1 have mad Ne hataNtws materials requirements umkr ChaNmrd95 of thc Calif.,,
nia HcalN&SafetyCode,Secaou25505,25533md2553a.lundcmwdthaifthc NilJinA S O
does not cuncndy haw a tartan,that it is my nsihilitY m noaly the vxupant M m / !�
rtyuiremcnawhich muv tenor misses ore Ccrtiricao,of cupan J
/ ignature f Applicant ate
0 2 0
noronmh a<a.gemData All roof coverings to be Class "B"or better
ao1 Community Development
J r 10300 Torre Avenue
rs Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT# o � o o �/
\ O15�l
OWNER'S NAME: r o u3 N a n PHONE
GENERAL CONTRACTOR: qqy so 4::ti C FAX #
I am not using any subcontractors:
tl ignature Date
Please check applicable subcontractors and complete the followinginformation
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
Mr
Community Development Department
' Building Division
City of Cupertino
10300 Torre Avenue
CITY OF
Telephone: (408) 777-3228
I U P E IST I N O 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.
Homeowner's Name: Y a< c.F`�e-J
Job Site Address: \ D 1 5 C J •
Roofing Company Name: � ✓r� i
A plicant's Signature: / Date:
G
. Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF Sy
• Tr
CUPEI�TINO PERMIT APPLICATION FORM
APN# Date:
3\ C. Z3 b 44 1
Building Address:
10
Owner's Name: Phone#:
�voYv� tfln4vl �.o� vr �n C(oS 0 �s`14 -5 3a c7.
Contractor: Jn/ r Phone#: License#:
Contact: nn Phone#: Cupertino Business License#:
lo(,.o tDv `Io1r- (p fl o - 2(e S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles * Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles i ❑ Wood Shingles
* Other(Specify) ✓l �l Ei �( ❑ 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 Desc iption:
G ' S A-4)0 fe 1ALc Lr3 Yin �v r S
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: U
Cost f Project: Tye of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bid& Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING