04080068 cR[B�oFDPERoNO CONTRACTINFORM
ICNPERMIT ATION
wa ♦ .
BuaolNC ADDREss: PERMIT NO.
CAL-WEST ROOFING CO. 04080068
+ OWNER'S NAME: PERMITISUEDATE
ONE: SANITARY 0. OL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGJ ELO PLUOM9 MEOCH
_pp LICENSED CONTRACTOR'S DECLARATION JobDescription
u 1 hereby affirm Net 1 am limrucu un pmviilons o!Chapter Y(mmmcncing
Z wiNSecuon701p)or Dbvision3of Ne Buri Prssi
afea.Code.and mub
ylicen
qzinfo inden^i.
Leen .m r . 3`j Lie.. S6 ` REROOF
nZi
Dam B(W4a/.•u Cumru
'1
ARCHITECT'S D ATION
ontat� plena um` bit
rtrnrda
�y
Liccnud Pmfcvione
g
OWNER-BUILDER DECLARATION
d 0 y I hereby.. affirm Nil 11. exempt fere tats feamrum at License A.y.Law for the
00 fallowing risen.(Sedan 7031.5.s,ai ter, and sae,de tau Cada:Any city os county
$'n whichitsisrequires a permit re anamq pima improve,demolish,t m e a sig any structure
f z i prior m its issuance.p aim requite the
ovisiapplicant of for suchCon ratter's License
Law(Chapter
autemenl -
< (cohe is mecing wJ pSectiounthe of Dolonsnf Nc Contractor's License law(Chapter9 Sq.Ft.Floor Area Val uat on
F❑� (commencing with Seniors 70110)nf Division]of the Busln" and Prorevinm ade)ar
3 Nat he H eumpt therefrom and Ne bub for Ne alleged eumption.Any vl a o –
SeNon 7031.5 by any applicant fon permit subjects the applicant in a civil nahy ar gr0 0 Occupancy Type
not mort Nan five hundred dollars(3500).
r
0 I,as owner of the pmpmy,er my emplaysra with wages u Noir rete eorapensadblk i
will do the work.anu Nestramum is.,imendedoraared(areak(Sec.70yi;Bminet5 1 / Re �redi S OChOBS
and ety wh Wilds Code:Tic mCorthavesthenen.Linnon Law urea not apply m owner is 17 - J ' q p
own ertywhes, rovided Oatsu Nemprove who dmsamh work himself as his ��.
however.then Wilding
or
pronant such imis mid improvements vire intended ar oQe he rcr,I e
however.the building or den of pment is cold within oto year of completion,tha owes t
Guilder will have Nc burden of pressing Net he did not build or improve for Put se of
C]1,
❑I,asu owner s the Sec.70mraperty.am uness and
contracting with littnud ommrsn es m
mire La des not apply
700e.Business and property
whoWilds
Cade:)The Comrmmr's U.
cense law dao not apply je in owner of pmpeny who Guilds or ant in improves Comeac W
whonse La-
0
acb for such projects with•conuactor(O licensed pursuant re take Conrmmh
License Law.
❑lam exempt under Scc. ,BkPC for Nb rtuon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby sate under peruny of perjury aro of the following dmlantions:
1 have and will maintain a Cudficate.(Conunt to selFluurt Worker's
for Compan.
action,u provided far by Section 3700 of the labor Code.for the performance of the
weak for which this permit is issued.
❑I have and will maintain Worker's Compensation inmrance,u required by Section
7700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number art:
ver. SYS–g,¢�,. j Poliry N..
CERTIFICA OF7E�A1PI7(J�9RextW(' KERS'
COMPENSATION I PRM
(Tib uctice acrd not he camplcmd if the permit is foronc hunNed dollen($100)
car IO4)
I certify that in On performance of Ne work for which this permit is bound,l shell not
employ any person in any mannerm as to became subject to Ne Worker,'Compensation
Laws of Cahlomla,Dam
Appllcant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject to the Worme,Compensation pevidons of On IaIWr Cad.you mum
z forthwith comply with such previsions or Nis pmmbt Nall bra domed uvnk,L _
Z" CONSTRUCTION LENDING AGENCY
[-rr I hereby aarm Nat Vert b a construction knding agency for the performance of
pi ti the work fur which this permit is hived(Sec.3097,Civ.C.)
Ili
Q Lenders Name
.7. z Lenders Addeo
U O 1 modify Nat I have rad this sp iticoion and tum No the above InforreaOm b '
y with all city,and county initiatives and sum laws relating m
0 Wilding ovuction,and hereby audhome mprocnutivei of Nb city m enter claim the
III E mrme�'"I'm 0 comp,
>" W above-nuavaned property for inspection purpmea
F+P. (We)agree in save,indemnify and lump tamales,the City of Cupenino against
f/j liabilities,judgments,casts and expenses which may in any way accrue against mid City
U 7 in consequence of the granting of this permit.
r^• APPLICANT UND�FBSTA .L COMPLY WITH ALL NON-POINT Issued by: Date
SZRC EGIJ'ATION� /9/
/ — X Re-roofs
SilgAillike ofAWlicirdCommuctor am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuu,building decapant entre or handle h.exc or,material
as defined by the Cupertino Municipal Codc.Chapter 9.13,and the Health and Safety
ade.Schon 35533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yo Na
Will the applicant or future building occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haaardnu air commo dfrm
ninanIs cd by NArm e Bay AAir Quality Management all new materials for inspection.
trim?
13 Yea Nu \
Ihave
&S.f.tmid On Ch,Swd. 25505, 553raqu3ldentsundcrChapter d„ m6.95mNe Wilding
cabsnolN&Safety Cwt.recuou355I15,33533 emu 35334,1 undenmnd Notscum Wilding / f
Jas notits.Correctly have a¢rant.Nati nsliility m notify the mcupant of Nc
rcyvimmcnta wh'ch mut bcyre armiuuarceo Ccmfcam of Occum Sl ature Applicant Date
C� ��"/ All roof coverings to be Class"B”or better
Low= than c gem Oa
Community Development
10300 Torre Avenue
�. Cupertino CA 95014
Telephone(408) 777-3228
Cl OF Fax(408)777-3333
�UPEkTINO
Building Department ..
JOB ADDREV PERMIT 0-6—,DN
OWNER'S NAME: PHO
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
T lO�
V//"��/Coritractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
OCITY�F Telephone: (408)777-3228
UPEkTINO 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 Qn 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:
Job Site Address: 14J// &*� J7� of
Roofing Company Name: C�
A plicant's Signature: Date: 02/
. Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# �� Date:
� o
Building Address:
Owner'sName: J/ hone#:
Contractor: Phone#: License#:
8
Contac : Ph ne#: Cupertino Business License#:
T e of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 'Asphalt Shingles
,O'-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:
G�c•w/.t,G // i�
Residential Co ercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
0-D there are any restrictions: LJ
Cost o P �� Type of Cons c 'o Occupancy group:
V 10
Qty,-if
A able 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
D