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J CITY OF CUPERTINO
BUILDING DIVISION PERMIT
raC0WRA&T,OR INFORMATION
. �<>:__.,�s$6. �&—_.✓ice, ..a�� '
BDILDING ADDREss: _
ANTHONY ROOF SERVICE
PERMITNo05080053
1027 CARTWRIGHT WY
OWNER'S NAME:
PERMIT ISSUE DATE
VINOD MENON
910 S MCGLINCEY LN
OB/08/2001;
NE:
SANITARY NO, CONTROL N0.
(408)265-5147
HIECffENGINEER:
BUILDING PERMIT INFO
lUc�dxxc
BLDG EI.ECr PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
P
withSection 7") of Division 3 of the Business and PmActronm Code, and my license is
l to= and of ea
REROOF--T/O SHAKE/RESHEET_IOSB &
gat
REROOF 30LB FEL^T tt�& _PRESIDENTUAL TL
co nr
ARCHRECTS DELLA TION
IJ ltl kN'✓ vkamt!.ELj/
I understand my plans shall he used as public records
Licensed Professional
UILDER
Ce
Oat
LLL r 2005
mptfrm CimbaON
lam exempt
1 hexhy .(firm Ilial 11. exempt from the Contranoh License Law for IW
following massa. Cat: Any city or county
ID3L5, Business and fie.
p pp
which requires a peals t demolish. pair any mucare
Permit cnnswcL alts im,pnt
ILJ) LI II R 0
FOB
for such
re h Permit t fie
prior to heclsiensedpulmmgoims the applicant the Conpermilmficuse signedgarmentIIW
Nal lim escingwiit pursuant to the provisions of Nc Contractor's Littnx Law(Chaptr9
17 Ntl
Sq. Ft. Flodi:AFe_ai La tke10
till ll.7 $IIj0840
V @9" Valu
(commencingwithgeniandofDivision l of the Business and Profession Code)tar
m andd the buss fm the illcgcd exemption. My violation of
WW u s exempt therefroa
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of
not mom Nan five hundred dollars (SSO B.
31642003.00
❑ 1, as owner of the property, or my employees with wages as their sale compensation,
e
Required Inspections
will do the work, and the stvcsurt is not ntended or offend for sale (Sec. 7014. Burliness;
License Law does not apply an owner of
Proportions Code: The Conrori m
and Professlsx
q P
progeny who builds or impmms thereon. and who does such week himself or through his
own employees, provided that such improvements art not intended v offered for sale. If.
however. the building or improvement is sold within one year of completion. the owner,
builderwill ban the burden of proving that he did not Wild or improve for purpose of
sal.j.
I, as owner of the property, am exclusively contracting with licensed contractors to
contact the project (Sec. 7014, Business and Profc siov Code:) The Contracmr's Li.
rue Law does not apply to in owner of property who builds or improves daemon, and .
who contracts for such projects with a conuxsor(s) licensed pursuant to the Curvacmfs
License law.
❑ T am exempt under Sec. . B & P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 Wreby inn under penalty of perjury ox, of the fallowing declarations:
1 haw and will maintain a Confession of Covent to selforgare for Worker's Compcn-
un, as provided for by Section 37M of the Labor Code. for me p.rformanec of the
rk for which this permit is issued.
171cerdac7itencedej
I have awill maintain Worker's Compensation Insurance. an required by Section
or Ne pcddrman ofthe work for which this permit is issued.
yWorkefsComwau0' I_aunn¢ a crandPolicynumberart:
rrier. Policy No."Xy9 R61'
CERTIFlCA OF (EMPIION FROM WORKERS'
COMPENSATION INSURANCE
(Thisuction need not W cemplewd if IW Femnil is passe hundred dollars (SIM)
toss.)
I mmfv Nat in the performance of the work for which this permit is issued. I shall not
employ any person in any manner x as in become subject o the Workers' Compensation
Laws of California. Dem
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
beemn subject m the Worker's Compensation provisions of the Labor Code, you mug
forthwith comply with such provision or this permi,shall be deemed revoked.
ON 1.ENDlNG AGENCY
CONSTRUCTION
1 thereby is a c lending agency for the Performance of
thi that Themis •
rwhich ed (So,.3n
the work for which this permit is issued (Sec. 3097; Co. CJ
nder's Nam.
� 4ndcr's Address
I 1 codify th.I I have read this application and salt than the aWve information is
correct 1 agree to comply with all city and county ordinances and sate law$ relating m
building construction, and hereby authorim mprcumns ives of this city to crier upon the
1 above-mentiuncd property for inspection purposes.
(We) agree to save, indemnify and keep hamlless the City of Cupenino against
j liabilities,judgmcna, ensu and expenses which may in any way a.. .,.lost said City
in consequence of due granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCERE u 0 S' -US
Re -roofs
Type of Roof
Signature, of Apr Contractor Dat
AZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store at handle hmadous material
as defined by the Coleman Municipal Code. Chapter 9.12, and Ne, Health and safety
ode. Sceh", 255331ay!
All roofs shall be inspected prior to an roofing material being installed.
P Y
❑yea [.lure
P 8 g
If a roof is installed without first obtaining an inspection, I agree to remove
W01 me appE.am tar ¢lure building occupant use equipment or deices which
iI x.mm, air contaminants as dcMcd by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑Yes 0 N
Ihawread the its unser
mad he ha
Chaparfih5 ofth. Gldling
/
ria Healtham
ic. Secous ods 255 5.M5ls
Sceuov 25N)5.85J3 anJ 25under
M533 add understand that ifthc Wilding
does not currently horn a tnanL mat it is my respo ouhility m notify the occupant of Ne
zszz/ _
¢quire cats whicb st met prior¢ ismanueora Certificate of Occupancy.
Signature ofA[Jl can[ Date
` l' AI I roof coverings to be Class "B" or better
Owner i
or out agent Dat
t
Ic
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
?.3 '-aI-1 I^; 0- V
PERMIT #
OWNER'S NAME: J
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: E -aa -O
Si ture Date
Please check applicable subcontractors and complete the following information:
Owned Contractor Signature
Date
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�ow
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owned Contractor Signature
Date
CITY Of
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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.
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: 611 /J z4k 7/tyKI
Job Site Address: !9C)�L LQl/'l I.Jf-i/J4h IAJCL-t1
g Company Ant />
Roofin Com an Name: 7 lll�-1 dC)
Applicant's Signature: Dater
Greg Casteel
Building Official
Revised 11 /2/04
Printed on Recycled Paper
�1
CITY OF
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
90123 z,
BSEISMICOM
Owners Name:
BUILDING
Phone #:
rl6 , ✓
BUILDING
-2
Contractor:
Phone #:
License #:
4o 5t t
f �q C — /
1=
/+
Contact:
Phone #:
Cupertino Business License #:
\
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
I Asphalt Shingles
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:
9z,X --
_
- d0F ,�vi9 f ,�4 __JrZ I
Residential
Commercial ❑ _.
Fire Zone: Yes ❑ No[�
Confirmed with Planning Dept. if
i5
there are any restrictions:
Cost of Project:
Type of Construction: Occupancy group:
Qty. if
ADDlicable
Fee ID
Fee Descrintion
Fee (;mnn
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
BLZLDING