04080143 CITY OF CUPERTINO s +c%+
BUILDING DIVISION PERNIIT gCONTRAC3TQR INkYORMATION .
BUIIDINGADDRFSS: WESTERN ROOFING COMPANY PERMITNO.
OWNER'S NAME: PERMITLSUEDATE
ONE: SANITARY iftOL N0.
I
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LO
LICENSEDOatIam licensed dM IngiCLARATION ���®
Z1 ido.7 affirm Nat 1 am licensed under provisions of Chapter 9 fro I feting Job Descriptio
< th Sou T )af Division Sof Use Busi cMalofrssiuns Code.and myliccnsc is
nneumm a A 2� REROOF W/ASHALT SHINGLES
p License a. �7
^-7 Dam cmaraorAUG ZG
SS7W
ARCHf1ECTS DECL ION 2ool.
i K undcrvand my plans shall he mse as, m r.cmds T
J-u m
Licensed Professional airs l B� tt 11] ® ,¢�
OWNER-BUILDER DECLARATION gNfOdtltJ ley � �
1 hmaxo o(Rrm on 1 am exemptfroms an the ContraLectin Carm's License c ty o for the
ix O O following¢ossa Permian]113 consumer,Bolter. and ve d vote Code:Any tiny or county
s m� which mquims a Pmmit m tri=fle, akar,improv.,h Permit t or e a Mi any ummure
u prior miumaued issuance.also
uantto n trovoioonmor wchpermiuoiciense Lnedsua:mem
L'r< LmWishccnsed Pursuant to On of Division
NC Camsinessnd Pref Lions Core)or Sq.Ft. Floor Area ValuatlOn
QFC tha he is erg with Section 70 And
of Division r of 0.Mla,inv¢wd Professions inion of
thin io is 31.5 b any ap li and IW basis far be alleged exemption.as Any violation of
not on 7031.5 five
ury red doll fora permit subjects the applicant m a civil penalty of 3 B��P 7ti1 bgr0 0 Occupancy Type
not more Nan Eve hundrtd dollar($300). P Y YP
El I,Mo-=oftMprapwy,mmyemploycvwithwgvuthe wlecompensedon,
will da tW work end Ne awctuu is not immnded or offered for sale(Sec.]004,Business
and Professims Code:The Ca nnumnea License law dors Out apply As an owner of Required Inspections
pmpeny who buildsorimproves themon,and who docs such work himself orthmugh his
awn employees,provided Out such improvements ort not inmMed araRned her sale.If.
however,the Wilding or improvement is sold within one year of completion,the owrcr.
builder will have Le burden of proving Wil he did non Wild an Improve far purpose of
sal..).
❑I,as awrcr of da:prepcny,am exclusively Miam ing with licensed canawrors no
construct the pmjem(Sec.7(W,Business and Professions Cade:)The ConuactaYs Li
cove law does oat apply m an owner of property who builds or impmses IMman,And
who convects for such projects with a contractor(s)licensed pursunm an Use Chroniclers
License law.
O lam exempt under Sec. ,BkPCfor Oismmon
Owner Dam
WORKER'S COMPENSATION DECLARATION
40 I herby aRrnder penalty of perjury one of the fallowing declarations:
un
I haveand will maintain a CertiGcam of Consent to self-insure for Worker's Compete ,
nation,v provided for by mart 37W of the labor Code,for be Performance of the
.,it for which this permit is issued.
❑1 have and will mainuin Worker's Compensation Insunn¢,u acquired by Sccuon
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wmke/s Compensation Insurance carrier and Polity number vc: OC
PaliEcysNo.:
C IF'j ATEOF EKEMPaROBPROMW KERS'
COMPENSATIlC114ka1NNSURANCE
(TT6scetion need not W completed if the Permit Is forom hundred dollam(SIM)
lea)
I certify Nat in the Performance of the work for which this Permit is issued.I shall not
employ any person in any manner w As m become wbjacuo the Workeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccm1IMUa of Exemption.you should
hecome subject m the Worker's ComPcvation pmvisio m of the Labor Code,you MUM
.J O forthwith comply with such provisions or this Pcrmin shall be deemed revoked.
Z Vy CONSTRUCTION LENDING AGENCY
Ibcmhy affirm that ft.iso couuuaimn lending army for the Pcrfwmaracuf
fY rte-. dm week fm which Lia Permit is issued(Scc.3097,Civ.C.)
1 Q Isnder's Name .
Z Lender's Add.
U Q 1«rdfy Lan I have rad Lis application and sum that the W.adma auun W
Hcorrect.l agree no comply with all tiny and county ordinances and same laws minting to
0U building conawnion,and herebyautharis mpvsenutivv of Lis city to enter upon me
yahovomemidgm propertyset for inspection Purposes ( 1
(We)agree m save,indemnify and keep harmless the City of Cupertino against
t.1z liabiliucs,judgmcnts,cosuoand
g.1 thisvmit. may inany way eccvc against said City
con covequ c of the 6ruting of this permit.
^ APP
LICA NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date '
SOURCE E LATIO S. V 1�
Re-roofs
in o of ApplinnVC isms Dam
HA ARDO S MATERIALS DISCLOSURE Type of Roof
ill ft applican orfigure Wilding oecupam vote or handle lotoor smaterial
A
s le ncd by On,Cupertino Muni Pal Code Chapter 9.13,and IW Health and Safety
Cale.Section 33512(1)? All roofs shall be inspected prior to an roofing material beim
❑Yea a P P Y g g 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
Mit havardov air contaminants u de0ned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �Nui
I have read the hvardousvmaterials requirements under Chapter 6,95 of me Califon
niaHwlth SafetyCodc.Seeuov15505,35533 and 2553d.lunUcrsund thetifthe huilding 7 ,, //7 �/ �j_Q/ '
Joey not c road he.a mnanr,that it u my MA,Mwbility 0 noury the occupant of the .+1/ `-e '`� // Ny / X
mgaimmc tswni nmaM emenpd miatuanec ora c.rtiReatc rasp apancy. gnature ofA buts ' Date
Owner.rautho . a at AD,m - All roof coverings to be Class "B"or better
Community Development
iJ 10300 Torre Avenue
4Wry' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building Department
JOB ADD'qSS• PERtar #0� 0 ?O/
OWNER'S N i / P O # T
GENERAL CO CTOR: F #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Tile ,
Ce /Co act Signature fj- Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
�UPEQ_ INO 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: bA-L) I 'D Letoto fy r�
Job Site Address: �� Q /5/4 V t
Roofing Company Name: ( �°tZ lti. catlg: =r AIJ
Aplicant's Signature: v��_ Date:� /7_p�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
S. b1 AJ XU� ea,.ti 9�oi
Owner's Name: Phone#:
.DA-ul'p L� N
Contractor: Phone#: License#: 6,25 JQ
We/a�
110W-9_q 77
Contact: � Phono� / `�� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
t]-')�iphalt Shingles fa�sphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
o Other(Specify) ❑ Other(Specify)
Nu r of existing coverings C3 Provide I.C.B.O.Report#
C"°be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: � 6 S D / U E
Residential Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with PI e t. if
there are an ctions:
Cost of Project: Type of Construction: ,�� 3
Oc upanc
Qty. if_`
A abl 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
z,6 7 ! �