05080232 CITY OF CUPERTINO �
INFO
C
BUILDING DIVISION PERMIT �NTRACTnRrRMATION
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BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT N0.05080232
J
09(19 C'ANYnN VISTA nR
OWNER'S NAME: FERNU T ISSUE DATE
COMPASS MANAGEMENT
INE: SANITARY 4. CONTROL NO.
(408) 536-0420
ARCHMh7f1ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
uop LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
with Section 7011U)Of Division 3.f Ne Business and Professions Code,and my license;
to fall fameadd e em.
17 41el seClass Lic.N
REROOF-OVER LAY W/DURO-LAST ON A BUILT-UP ROOF
�? Licen
Lip Date contractor r v
—3G1—(57 ARCHITECI-SDECLARATION-
n•J lundcomm m plans shall W used as public records
JnU
;Qy
Licensed Professional
OWNER-BUILDER DECLARATION
0 0 1 hereby (Sec Nat 1 1. exempt tram tie Cairns Co License law far the
pr, following retin a.Permit
IIl3str Business and Professionscode:Any city or county
m which requires a permit m ennswm,alms improve,demolish.or repot any struemrt $7821
prior to its issuance.also mquirs the applicant for such Permit to f le a signed statement
�i< that he is licensed pursuant o the provisions of the Consrn:tori License Law(Charter 9 Sq.Ft. Floor Area Valuation
o�sF� (commencing with Section 7000)of Division 3 nfthe Bminessand Proressimer Cade)or
i that W is except therefor.and the bas;for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of .3 AVIR
not more Nan fw hundred dollars(5500). r Occupancy Type
T,as owner of the propcny,or my employes with wages as their sole compensation,
will do the work.and the swsure;out intended woReced for sale(Sec.7014.Business;
.it Professions Code:The Contractor's License law dos rest apply to an owner of Required Inspections
pmpeny who buildsor improves Nemon.and whodoessuch work himfctfor thmugh h;
own employees,provided that such improvements are not intended or offered for We.IL
however,the building or improvement is sold within one year of compledon,the owner,
builder will haw the burden of proving that k did not Wild or imprew for purpose of
sale.).
❑1,as Owner of the propeny,am exclusively contracting with licensed conuactos to
convect the project(Sec.704A.Business and Pmfessiom Code:)The COntracmrs Li
cease Law dos not apply in an owner of property who builds or improves demon,and
who contracts for such projects with a contnemr(s)Iiccased pursuant m IW Contractors
License law.
❑1 am exempt under Sec. .B h P C for this moon
lcl-lycl
wn Date
WORKER'S COMPENSATION DECLARATION
I hereby aRum under penalty or perjury One of the fallowing declarations:
1 bare and will meimain a Ci nifiam of Consent to self-insum for Worker's Compcn.
on,u provided for by Section]700 of the tabor Code,for the performance of the
W
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,ss mquimd by Section
0 of the labor Code,for the performance of the work for which this pemd,is issued.
Workers 1Compensation Inwnnce carrni�er and Policy number arence PsrA nvrr�Gv�•(tom,Orae\'hPclloy No.: LU 116 33',I Z
CERTIFICATE OF EXFMON FROM WORKERS'
COMPENSATION INSURANCE
flit;section need not W completed If the permit is foranc hundred dollars(SIM)
nr less.)
I cenih but in the peffuonetme of dte work for which his permit;issued.I shall nm
employ any posed in eny manner x as Or become subject to the Workers Compensation
Laws Of Califomia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ccnificae of Exemption,you AWW
Wcome subject to the Worker's Compensation provisions of the labor Cold,you must
.,O roMwith comply with such provisions or thio parmiuhall W decidedtevOk
ed cd.
'P'•' CONSTRUCTION LENDING AGENCY
[-+ IWr by which thi par mert;aed(See 3W7,Cm agcrry for tits perfurmana of
Ne duh for which this permit B issued(Sec.J09T,Civ.CJ
IA Q larder's Name
= z larder's Addm..
U Q 1 certify that 1 have mad this application and able,that Nc shout information is
corms.1 agree to comply with all city and county onlinances and sum laws¢lacing to
0U building convection,and hereby auNorim reprcremniwa of this city to enter upon the
above-mentioned property for inspection purposes
f, gy (We)agree in saw,indemnify and keep harmless Ne City of Cupcnino against
fq
liabilities,judgmcnu,eosts and expenses which may in any way scenic against said City
U.Z in consequence of the granting of this permit. f•—
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCy REGULAAONS.
\\1_. C 5 2T-O S Re-roofs
Signature of Applicard Contra mr Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future Wilding occupant smut or harMlc hilarious mamnal
as dcrined by the Cupenino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it brovilnus air concomitants fin
as deed by the Bay Arca Air Quality Management all new materials for inspection.
DisVict? p� '
0 Yes i
IK ew real Ne hvardnusmamrials aquirtmenu under Chapter h.95of Ne Califor-
niaH.Il &SafclyCode.Sccuom2SN15.25533a dn534.1un&r nd Nvifft Wilding
does not cunve tly haa tenant that it is my responsibm ility nodl'y the occupant or she
ohra �cndhichmtty»pmek w;:w,naor.cerdfamar�c2Sy. of- Signature of Applicant Date
/ Owner Or authorised agent Date All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408)777-3228
�
CITY OF Fax(408) 777-3333 UPEf�TINO
Building De artment
JOB ADDRESS: PERMIT #
,:�-G Z
OWNER'S Njj-k PHONE # 3300
GENERAL CONTRACTOR: ` nn 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 c0. 1 -7
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
' Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408) 777-3228
U P E kT'I pp'�V® 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
afi
pproval 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 Raid 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: � S r
Job Site Address
Roofing Company Name: �rnvc, .% to
v
Applicant's Signature: .,
3, Q� Date:�J GS o�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
vS'v�U z3Z
U-14-
CUPERTINO PERMIT APPLICATION FORM
APN #3_�K 0� Date:
bb
Building Address:
Owner's Name: Phone#:
�o WU 3 00
Contractor: Phone #: License#:
r - 6 rn, 1 0
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑. Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) X 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:
Residents Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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