05030211 CITY OF CUPERTINO ,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: PERMIT NO,
05030211
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY 112BOL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
coo LICENSED CONBACDWS DECLARATION
F❑ I hmmby affirm Nal I am licensed under provisions of Chapter 9(commencing Job Description
iW wiNSadan7O )OfDivision3oflhe BusineaearWProfettians Code.and myli<mnx is
n
Nfunfmma anee&t. L'�Y REROOF
j to License Clans � S� Lic.N
Dam -I—L-1 oc Can CONTRACTOR: BETTER BUILT ROOGING
"f ARCHITECTS OECLA A 101
'2 1 understand my plans shall W used AS public records
3WU
G�
Licensed Pmfcssionaf
OWNER-BUILDER DECLARATION
y C C 1 hcrchy.(T that 1 1. exempt from de C.nuactCo License Law for the
m p a which
re mason.Permit
t 1031.5.Business and Tafessions Cade:Any city or ucounty
seum
x m which requi¢a a permit m,flaso a Applialler.cant
improv,h Permit t m file.Ai,any umeum
u�'^ pat the its i insed puman to ane the applicant for tech lmrmi'm cense Law
(Chapter
tea (comm iscing wit purstion 7the of Divionsnf theContractor'sBuaclar'slucnselaons Cods)of Sq. Ft. Floor Area ValL at�1�1000
QFC (commencing exempt
pt Oban from and the
Division]or the a eged ass and Professon.Anynvi Cale)tar
i�� Na(he u eacmpt therefrom and the beau for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant(.a civil penalty of APN Numbdr* Occupancy Type
not mom than five hundred dollars(SM). al
❑I,as owner of the pmpmny,or my employees wish wages AS their sole compensation, 3 6 9 2 0 0 2 9 . 00 ( H .4r
will do dm work and the swcmre is not intended or offered for sake(Sec.]Ba4,Business o
and Pmaions fosCoda:The Conuxe aars Lt..Law donot apply ban owns,of D Regalredih pect70ns
property who buildsor improves flcmon.and whomes;such work him ctf orthrough his
awn employes,provided that such improvements art notinmrWW or offered for sale.If.
however.the building or improvement u sold within ane year of completion.Ne owrmr14-
builder will have the burden of proving Na(he did not build or impmae for purpose of 2jy
vs
❑I,as owner of ct property,,B ,mess and Predications with )The Cnoaccontraction i NO
License
construct Nees not (Sea]014,Business and Profusions Code:) pro Comncmai Li _
who Lawdoesfnotapplyto ean ownerofproperty who buildsorimpmva thereon,antl
whocontractsL.ts for such projects with a conuaclor(s)licensed pursuant ro dm Canuutor'a
L lam Law.
�il em exempt under Sec. .B k P C for Nis renwn .
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aftson under penalty of perjury arc of the following dcclvauons:
1 hue and will maintain a Certificate of Contin to self-insure fes Worker's Cumpen-
sation.as pmvidcd for by Smuon 3]00 of the labor Code.for dm performance of the
work for which this permit is issued.
O 1 have and will maintain Wurkeri Compensation Insurance,u requited by Section
7]00 of the Labor Code,for the performance of the work for which this pemtil is issued.
My Workers Comlens mlas a artier and Policy number art:
Cartier. Policy No.: j �C
CERTIFICATE OF EXIIENIFTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus section need not M complecd Rthan(moot is foram,hundred dollars(SIM)
.r les.)
I Beni fy that in the performance of the work for which this Permit is issued.I shall not
employ any person in my mannerse As to become Subject o the Workeri Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Comficam of Exemption,you should
become subjmct in the Worker's Compensation previsions of the fable Cadc,you mus(
.,z forthwith comply with such pmvisiom or this permit shall be deemed invoked.
ZO CONSTRUCTION LENDING AGENCY
,L. I hmuby affirm that Ncae its construction lending agency for the performance of
G'
the work fur which Nis permit is issued(Ser.309],Civ.C.)
Lender's Name
Z Lenders Address
U O 1 minify that 1 haven read this application and sum that de above information is
D.F correct.l agree to comply with all city and county ordinances and sum laws relating to
0U building construction,and hereby euthoriae mpresenmivu of Nis city m enter upon the
r fJ.l abovomemiuned property for inspccuodi purpose.
G (We)agree(o save,indemnify and keep harmless the City of Cupmim against
o-F.t rq liabilities,judgments,costs and expenses which may in any way accrue against aid City
U in consequence of the granting of this permit.
APPLI¢¢��NT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURlO�
3 'Z 1 r� Re-roofs
SignuureauDO OaDataHAZA
HAZARDOUS MATERIALS DISCLOSURE' Type of Roof
Willy t applicant ror mforum building occupant nom or handle Health And
ss
defined by the Cupertino Municipal Code.Chapter 9.13,and Nc Health and Safety
AMICade. 25532(a)?
YeAll roofs shall be inspected prior to any roofing material being installed.
❑ y u
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
mi(harardous air contaminants in afford by the Bay Area Air Quality Management all new materials for inspection.
Wrkl?
C3 Yea [3Nu
1 ham mad the hooscous materials requirements under Chapter 6.95 of the Califor.
nice Health 6 Stl.,,Code,Sections 25505,25533 and 25534.1 undcrswM Naz irlhc building
dols arse by le x a mnml Nu its my msponsibuity m hurry,de tecupanl or the
requi rot c I t.amm«or.cenirt .Tarp Signa[ureofApplicant Date
-Z �s All roof coverings to be Class"B"or better
Owner tar milum'rcd agual Dam
.. Community Development
10300 Torre Avenue
i ! - Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408) 777-3333
UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
0,5o 3 0 211
OWNER'S NAME: '-I— zw PHONE # 26 q-YaZ- i s w
GENERAL CONTRACTOR: [4 FAX # 2� ej P,37- -t 1 o 1
I am not using any subcontractors: ` 3 - L3--C>5-
Signature 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 l L j-,L-+ 9 .0
Septic Tank
Sheet Metal
Sheet Rock
IMP
§-W
Owner/Contractor Signature Date
Community Development Department
f� Building Division
J . City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
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.
a6,1 Any roofing wtuch 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:, , _,7
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.
Name:
lob Site Address: All 2 6`f 2.
Roofing Company Name: Z v
Applicant's Signature: Date:
. . Greg Cast eel
Building Official
Revised 71/2/04 _
Printed on Recycled Paper
/u3,-�D
CITY OF CUPERTINO
,��,�j' REROOF
zil
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Buildingd(Iress:
Owner's c: Phone #:
Oy- C - 150
Contractor: License #:
Q
Contact: Cupertino Business License #:
v
'type of Root Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Buih-Up roof
❑ Asphalt Shingles XAsphalt Shingles
X, Wood Shakes ❑ Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
❑ Uthcr(Spccify) ❑ Other(Specify)
Number of existing coverings l ❑ Provide I.C.B.O. Report#
AY l'o be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Ofr Policy:
.lob Description: �
Residential � Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if'
there are any restrictions: LJ
Cost of'Project: Type orCo� traction: Occupancy group:
9li/SIf—
DQ
Qty. if
Applicable Fee ID Fee Description Fee Group
- BPERMFEE BIdg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRL Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCI IK Plan Check Fee BUILDING
/ BUSLIC Business License BUILDING
° 3 7
2 7Z . S�