05020167 CITY OF CUPEWrINO 4, ��
BUILDING Dlvlslon ' PERMIT CONTRACTORINFORMATION
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BUILDING ADDRESS: JIM KRAUSE ROOFING PERMIT N%50201''67
74r rARRTAr.P. 121
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
(408) 779-0704
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ARCHITECT/ENGINEER: BUILDING PERMIT INFO/BLDG ELECT PLUMB MECH
0 0 0
yOj LICENSED CONTRACTOR'S DECLARATION
FF 1 krcby air,,.that 1 am licensed under provisions of Chapter 9(commencing Job Description u�4v�
�ZI
W wiNScction]IXN))nf Division3of the Busineu and Pmfcuions Code,enJmyliccnse is � KJSp,
mfall to..And effem REROOF W/ SHINGLES �R
ov gs License Class Contractor—p Dao: ComDECL 9oav�
ARCHITECTS DECLARATION
ei I undcrwnJ my plans shall k used as public recnrmeiv
Jj pq„
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Licensed Pufcssionel pR
`
OWNER-BUILDER DECLARATION OIn1V//p�\
<y 1 hereby affirm thl I om exempt Tru.dm COntrac.rs License law for the t/t/�/p/`ya
0 o following mason.(Section 703 1.5.Business and Professional Code:Any city or county
X m ff which roquiras a Permit to construct,alter,improve,&mulish.or repair any structure
prior m its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to be,povisions of the Connectors llcors,Law(chapter 9 Sq. Ft. Floor Area Valuation
w'3 (commencing with Seetion 7")of Division 3 of the Businessmd Predications Coe)or
y 3_ that he is exempt Ocrefoon and the basis for the a0tged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 515>93et0 0 Occas ane Type
not ream man Jive hundred dollars(S5U0). P Y yP
C:l
will dome work,and the nucmm is not intended or offered for sale(Sec.7014.Business
and Profession Code:The Contractors License Law don:not apply m an Owner of Required Inspections
property who builds or improves themomand whodoes such work himself or though his
awn employees,provided Nat such improvements are not intended or offered for sale.If.
haw son Or building or improvement is sold within one year of completion.the owner-
builder will have the burden of....inti mut An did not build or improve for purpose of
adeI.
1,as Owner of Be property.am exclusively contracting with licensed contractors to
consumer the project(Sac.7014,Business and PrnfetsiedM COdG)The CnnVlebfi LI-
eenae law doe,not apply to an owner Of property who Wilds or improves thereon.And
who contracts for such pjccu with a contracmr(s)licensed pursuanno Ile Convenor's
leense law.
❑I am exempt under Sec. ,B&P C for Ois.aaon
Owner '� Date 'L—t —2tt
WORKERS COMPEiS ON DECLARATION
I hereby aRmt under penalty of perjury one of the following declarations:
I have and will maintain a Cenifnteof Coment to self-insure for Workers Compere
amino,as provided far by SecOan 3700 of the labor Code,for the pefformaOt of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3708 of the labor Codc,for me performance of the work for which this permit is issued.
My Worker's Compensation Insurance easier and Policy number aa:
Carrier: Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not k complemd if the permit is fmone hundred dollars(5100)
or less.)
1 cenifv that in the performance of the work fm which this permit is issued.I shall nm
employ any pcmon many manner w u m kcomc subjen to dte Workrl Compemation
Laws of California.Date 2 00 1
Applicant r TNG N-. YZrAN 4
NOTICE TO APPLICANT.IL after making this Ccnificate of Exemption,you should
become subject to the Worker's Comperoation provisions of the Labor Codc,you muse
.J2 faMwith Comply with such provisions or this Permit shall k dccmN mmked.
Z O CONSTRUCTION LENDING AGENCY
(~ I hereby affirm that then is a construction lending agency for Jr,tPerformance of
C the work for which this Penni,is issued(Sec.3097,Ci,C.)
W Q lander.Name
Z Lender's Add.
U Q I certify that 1 have read this application and mute mat the above information is
F touter.l agree to comply with all city and county ordinances and sum laws relating to
Q U building construction,and hereby authorim representatives of this city to enter upon the
Gahow-mentioned popery for inspection purposes.
(We)agree to save,indemnify and lump harmless Be City of Cupertino against
,Prot N liabilities,judgments,costs and expenses which may in any way accmt against mid Ci ly
U in consequence of the granting of this scrout.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT _ Issued by: Date
SOURCE REGULATIONS.
1J77iv / . i Snip 2-)�200j Re-roofs
Signmumaf Applican corrosion Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle bwardous material
M defined by de Cupenino Municipal Code.Chapter 9.11,and the Health and Safety
Come,section 15532(a)? All roofs shall be inspected prior to any roofing material being installed.
Ym k]Na
win me appnnanl nr future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air canuminanu as de0ncd by the Bay Area Air Quality Management all new materials for inspection.
Disvin7
❑Yes Nu
1 have read thc hanN(ms maurialsmquimmenu under Chapter 6.95 of thc Califor-
nia Hmith&Sa ciy Codc,scctium 25505.25533 and 25534.1 undcmmnd mm if0c building
Jars not currently how a tenant,that it is my responsibility to notiry the omupam of the
requirements whichusr k mer Our to Mathis ec Of a Cenificau:of Occupancy.
Signature NreofApplican[ Date
i. 2-Z '" z
Owner or authorimagcm Dau All roof coverings to be Class "B"or better
Community Development
« 10300 Torre Avenue
1 ./o Cupertino CA 95014
Telephone(408)777-3228
CITY 0f Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
-774-6 ChfzklA-G C C I KLcL& 0Sc) 2 0 7
OWNER'S NAME: Yn/ �5 Cr- PHONE # a 2-59-417-1;7
GENERAL CONTRACTOR: f {.T" k eyvs E- FAX # 6 _z — to
I am not using any subcontractors: i �' _ 1- Z'2`-' 2-e0
Signature IfDate
Please check applicable subcontractors and complete the followinginformation:
60 1 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
' 6 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E RT I IV 0 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 h 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: MIN [o J SfI"
Job Site Address: .� [e c 1�ji c4 p r IAp e&t 't N O (A -
-Roofing Company Name: firm {.�' pw SC- R-0
Applicant's Signature,:��//)4�"'? .ro>�-3 Date: 2 2-SC
2 oo DS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
'N' REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
35 - o k) — 05 3 2-Z � ZooS
Building Address:
7 746 GA-kkv+ °(, — C r.,3 0
Owner's Name: Phone#:
I N Co 15 - 4a g 2_5-5---41 -7S-
Contractor:
s 5 17SContractor: Phone#: IWO77q_v7�V License #:
Contact: Phone#: Cupertino Business License#:
ING G 49 g l 0 Z r S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ! I ❑ Wood Shingles .{
sd- Other(Specify) 1 s�Y�Q lG1no C h i yl�I ✓�Other(Specify)
Number of existing c venng 7/ ❑ Provide I.C.B.O.keport � p
Qr' To be Removed O�Provide Mfgr. Installation Specs.3�anAx+ i,lc
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
�14F Job Description: ?r.moveex(sf s{+i gz(, Vyvot . rti5t-At1 hew +bhesta4o s)7 � �
l'e- ,its ri n ro
Residential Conifflercial
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: �� �
T e of Construction: Occupancy group:
' Si b2r sh e.
Qty. if
Applicabl 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