04100084 CITY OF CUPERTINO
BUILDING DIVISION PERMIT €C!, T9, T,ORStINFORMATION 1a.
a s ;
BUILDING ADDRESS: nRA GER CONSTRUCTION INC PERMIT N0410
0943 CANYON VISTA DR
OWNER'S NAME: PERMIT ISSUE DATE
ak RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST 10/13/2004
lot ZONE: - SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEERPERMIIINFO
BLDG ELECT PLUMB MECH
o 0 0
Lop LICENSED CONTRACTOR'S DECLARATION p
U F 1 h by affirm that 1 am licensed under provisions "!k of Chapter 9(commencing Job De�enpUo I
<a wuh Sen nn 7( Anf Division Jof the Businessand Po.essiona Code.and my Meso.is0 rd
'_pre inrnurar aerreet. ✓ 7 . REROOF W/ DURA LAST Ap
�>- Liccnun Lic.x '
—p Datc � _ Cunlractor s
~w ARCI CTS DECLA ATION /OQ�
wU , crs.anl�ii yplansuuJ as public nrV_< as�� t
t o H L,censcd Professional �q@//®y
OWNER-BUILDER DECLARATION qq
a p 1 hereby al'frm that I am exemptW
from e Contractor's License Law for the // a
p 0 fallowing mains...(Section 7031,5,Business and Professions Code:Any city or county
K m which requires a pennil m construct,alter,improve,demolish oI egA�`la�d4•+•r repair any structure 1 0 10 0
FzcPrion.its issuance,also requires the applicant for such Permit file a signed statement
Ihat he is licensed pursuant o the provisions of the Cornocon's Licens Law(Chapter 9 Sq. Ft. Floor Area Valuation
yFp (cum menci ng with Section]IXXp of Division 3 of the B usiocas and Professions Code)or
y Wal he is exempt WereGom and We basis for We alleged exemption.Any vinlntion of
Section 7031.5 by any applicant for a pennil sub)eeu the applicant o a civil Penalty of 17C OCCII
not more Iran fin Occupancy hundred dollars(S500). P Y Type
D I,as owner of the property,or my employees with wages as their sole compensation,
will do We work.and be struma is not intended or offered for sale(Sec.7041.Business
and Pmfessieme Code:The Contractor's License law does not apply to an owner of Required Inspections
property who builds orimpmvea,hercan,and who docs such work himself or Wmugh his
own employees,provided that such improvemenu arc not intended or offered for sale.If.
however.she building or improvement is sold within one year of completion.the owner.
builder will have We burden or proving that he did not Wild or improve for purpose of
sale.).
D 1,as owner of We property,am exclusively contracting with licensed conlruch rs to
construm the project(Sec.]Om,Business and Professions Code:)The Comraaori Li .
cerise law does not apply to an owner or property who Wilds or improves thereon,and
who contracts for such pro)ecu with a contractor(s)licensed pursuant to the Contractor s
License law.
D I am exempt under Site .B&P C for this maze.
Owner Dat
WORKER'S COMPENSATION DECIARATION
1 hereby affirm under Penalty of perjury one of the fallowing declarations:
D I have and will mai main a Certificate of Consent to self-insure for Worker'sCumpcn-
sxtion.as provided for by Section 3700 of tit labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
37M of NC Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance aria and Policy numhcr are:
Cartier: 1 Policy No.: ('01,
— CERTIFICATE OF EX "ION Fft0 ORKERS'
COMPENSATION ENSU CE
(This section need not be completed if the permi,is for one hundred dollars(Ella)
,it less.)
I certify that in the performance of the work for which this Permit is issued.1 shall not
employ any Person in any manner m u ut become subject o the Workers Compensation
Laws of calidmis.Dat
Applicant
NOTICE TO APPLICANT:If,alter making this CcniReme of Exemption,you should
become sought,to the Workers Compcnsmion provisions of the Labor Code,you must
�7 forthwith comply with such provisions or this form i uhall W deemed mvnked.
Z OCONSTRUCTION LENDING AGENCY
'F- I hereby affirm Wm the to is a construction tenth ng agency l or the performance of
mit
CL > ,he work for which this peris issued(See 3097,Co.C.)
(t) Lenders Name
= z lenders Address
U 0 1 certify that I have read this application and Sue that the above information is
0 U buten.1 agar to comply with all city and county ordinances and Cute laws relating e
pU ahunngconswmon.and hereby amhonprposescnutivcs or this city to enter upon We CCG__
a M1avc-(We)
to S fortuity for inspection keep ha
F 2 (Wt)agme m save,indemnify and keep harmless the City of Cupertino againsti,I ���
Z in consequens. ce
of uh the graving captions this
may in any way accrue against mid City
U2, inconsequence orthegrSTANmf Wis permit. /�
^ APPLICANT UNDFFF���STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
$OyRCE fU`Ar '
)OIR
Sg ` fAp caH Dat`
HAZARDOUS Type of Roof
Will We applicant or future building Occupant store or handle hanrdoue material
defined by the Cupenino Municipal Code.Chapter 9.12.and,he Health and Safety
Code, [3 Year 25532(u)p y All roofs shall be inspected prior to an roofing material bei.
[3 Year y7 No P P Y g g installed.
Will Ih.o"heant or future WildingoCoupon,uscquipmentordevices which If a roof is installed without first obtaining an inspection, I agree to remove
emit havaddous air cnntumimo�th av doWcd by the Bay Arca Air Gushy Management all new materials for inspection.
DYcs T
I have read the harzNous mucdalsoh,incmorns under Chapter 6.95 of We Califnr- 1
Of.Heal W&Saicty CMa.Sec...35505.25533 and 25531.1 understand Chat if,Wilding' 1yy \ f� _1 3 /5 L�
docs not cutout y have a ten d, i,is my reslxrnsiuil ily m null ly the occupant of be
V
requite enIlv11 us,W n n.nnisan,mtenrac<rtifcatorptapunty. SightureofApplicant Date
nod ar aamarladagtnt Date All roof coverings to be Class "B" or better
Community Development
IM 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRES PERMIT'' �j l
1 943 c�� li r' / 0-T-)0
OWNER'S N • PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: S - C L
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
Owner/Contractor Signature Date
Community Development Department
" Building Division
City of Cupertino
s 10300 Torre Avenue
CITY Of Telephone: (408)777-3228
��I�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.
S 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:
Roofing Company Name: T r c \'rti�tiS�
A plicanYsSignature: �_ Date: 1(, J-3 Cl-I
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF
�CUPERTINO PERMIT APPLICATION FORM
APN # S Q z ` Date:
�0 c.
Building Address:
10 q Ll 3 Cti ) .
Owner's Name: Phone#:
Contractor: Phone#: License #:
I 13 , b ,Ia
Contact: Phone#: Cupertino Business License#:
201
Type of Roof Covering:
Existing: Proposed:
'15,,Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑'&4 Provide I.C.B.O.Report It TSI)Cc,, [A S�
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
I i t M - w
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
100�`—
Qty. if
A li 1 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