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CITY OF CUPERTINO�
BUILDING DIVISION PERMIT
-4CONTRA.CTOR INFORMATION
..
.
aILDINGADDRESS:
91 CANTY.RT TM -IT WV
ROOFNIASTER OF SANTA CLARA
PERMIT "b5020055
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY NO. CONTROL NO.
408 741-4900
ARCHITECT/ENGINEER:BUILDING
PERMIT INFO
BLDG ELECT PLUMB MECH
(�
LICENSED CONTRACnOR'SDECons of CON
1 a)Blm Net I am licensed under provisions of 9 (commencing
lob Description'
riff o
withSectionon?IXX3)af Division Sof the Business and Professions Code. and my license is
ion? Code.
in lull mine and L L
"c
REROOF W/COMP. SHINGLE
Littnu Class Lic.p
Dale Contm uu
sypS�ly
F
ARCHITECTS DECLARATION'R
I understand my plans shall he used u public records
/P►
Licensed Proessimil
OWNER -BUILDER DECLARATION
I bathe alum Na, 1 am1. exempt Imre pr Convectors Literate Law county
followire reason. Scourm(malt 70]L; Business and Code: Any tiny or county
�
which requires a permit re ennmwm, alto improve, demolish,
which vet demolish,
whichrepair any structure
��
file
prior m s l censed pursuant also inquires the applicant for such permit m Rle a signed Catment
the (Chapter
of NCConusinesand
thanbe escingwidpedan
Sq. Ft. Floor Area " Valuation
of Division Proelaw
7 and Pmfeuinns Codc) or
(commencing with Section 70W) of Division 3 of the
Ines
be is exempt therefrom and the bub for alleged Any of
alleged currant
be
SOurec to it Penalty
Section
36Q2Q9L5aei00
Occupancy Type
P y YP
thLSbyany reddnnlforapermitsubjecatheapplicantmacivilpenaltyof
not more than Rss hundred dollen (5500).
C3 L az owner of Ne ploperty, or my employees with wages az Their mile compensation,
will do the work, end the stmclure is not intended oroffered forsale (See. 704/, Business
Required Inspections
and Prefessimu Cade: The Co...,', Liars Law does nal apply to an ..or of
pmpeny who builds or improves Thereon, and who does auch work himself or through his
Own employees, provided that such improvements ase not intended or offered for main. If.
however, the building or improvement is sold within rete year of completion, the owncr-
builder will have the burden of proving that he did not Wild or improve far purpose of
sale.).
❑ I, as owner of the property, am exclusively con rm ing with licensed contractors to
construct the pmject (Sec. 70", Business and professions Codc:) The Contractor's U.
cense Law does no, apply ,o an owner of property who Wilds or improves drereon, and
who contracts for such projects wit a conuneum a) licensed pursuant in On ConOamors
Lkenm Law.
0 I em exempt under Sec. . B A P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby M. under penalty of perjury orae of the following declarations:
I have and will maintain a Certificate of Consent m self -insure for Worker aCompen-
r m , u provided for by Section 3700 of the Labor Code, for the performance of Or
rk for which this permit is neu ed.
137'
I have and will maintain Worker's Compensation Insurance, az required by Section
08 of the Labor Code, for the performance of the work for which this permit is issued.
y Worker C rope Tin Insrance camicr and Policy'�num1�be��r a'mp�rtier.
Policy No.: Mi.
CER ICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Itis section need not be completed if The permit is foronc hundred dollars (SIM)
or less.)
1 ccmfv that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner m u in Income subject o the Wmaers' Compensation
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject m The Worker's Com pcnution provisions of Oc Tabu Code, you mum
forthwith comply with such provisions or this moor shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hcmhy alErm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ, C.)
Lenders Name
.
Lender's Addreu
1 certify than I have mind this applicmion and main than the shove information is
bunco 1 agree to comply with all city and county ordinances and Cute laws
building rcprescna,ivu of this City to enter upon the
and hereby r upon n
minnednpro
above- (We) are propene for inspection purpous.
action p
(We) agree m save, indemnify and keep less dm Ciny of Cupertino against
liabilitiu,judgmcna, toss and expenus whichm in any way accrue again, said City
is permit.
APPLICAL COMPLY WITH ALL NON- DINT
inconseque�99
�O
Issued by: Date
il;
SOURCE
Re -roofs
Signawr of plicaCon on' S MATERIALS DISCLOSURE Dat
DOL
Type of Roof
Will the applicant or future building occupant nom or handle havardous material
az defined by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety
code, Section zsslz(a)?
All roofs shall be inspected to any roofing material being installed.
[3 yes _zW
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
-min hazardous air contaminants in defined by the Bay Area Air Quality Management
all new materials for inspection.
DisOicn?
❑Ycs u
1 have read the ha zrdnus materials m4mocom nus under Chaplcr6.95 of the Califor-
niaHwlN&SafctyCodc dons 21505,25533 and 25534.1 understood thatiflAc building
does n cumendy h ant my re ibiluy m nodly the Occupan of the
s
aIm
requirements w' m Pd., cissa em,iof cu ey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner
pf ip ted as n ,e
L
e ontractor Signature
DAA
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
e ontractor Signature
DAA
Community Development Department
Building Division
;6 !!'; City of Cupertino
10300 Torre Avenue
CITY C!F Telephone: (408) 777-3228
U P E t�T 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.
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: C. (a 1rW l,. � I (a N Z ez-F
Job Site Address: LLIZI_A. C
Roofing Company Name:
Applicant's Signature:
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Date:
11
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # •3 / � 2 � �
Bldg Permit Fees
BUILDING
BENERGY
Date:
Building Address -
BSEISMICRE
Seismic Fee Res
BUILDING
)191 CANJL> i A
Seismic Commercial
BUILDING
BPLANCHK
Owner's Name: j
BUILDING
BUSLIC
Business License
Pho e #:
CP1RaZSO
contractor:
� UP
#:
7 � Lj
0�
License #: �,i v 1(e
04 S .0 .
tPhone
Cot:
Phone #:
Cupertino Business License #:
A
Type 6f Roof Covering:
Existing: f/
Proposed:
❑ Built -Up Roof
❑
Built -Up roof
,Ok Asphalt Shingles
-A
Asphalt Shingles
❑ Wood Shakes
❑
Wood Shakes
❑ Wood Shingles
❑
Wood Shingles
❑ Other (Specify)
Number of existing coverings Z
❑
❑
Other (Specify) f
Provide I.C.B.O. Report # _It- )c xrp Skl N pl
To be Removed
❑
Provide Mfgr. Installation Specs. �f
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Policy: ❑
Job Description: RFOr�u': C4P
(Z
1 n1
. 3(� �b - 1 O r% 0-16 {
Residential Commercial ❑
Fire Zone: Yes ❑ Noda
Confirmed with Planning Dfft. if
there are any restrictions: LJ
Cost of Project: 5 /� 63� Type of Cons
ction:
Occupancy group:
1A I
Qty. if
Applicable
I=rX
Fee Description
Fee Groun
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
LP