05080196 CITY OF CUPERTINOa9 '
BUILDING DIVISION PERMIT CONTRACT-OR�INFATIORMOON k
BUILDING ADDRESS: LO ROOFING PERMff N005080196
10380 CASTINE AV
W NER'S NAME: PERMIT ISSUE DATE
PETER & BARBARA JONES 888 FAULSTICH CT 08/22/2005
DNF: SANITARY NO. CONTROL NO.
(408) 298-9399
ARCHITECfrENGINEER: BUILDING PERMIT INFO
BLDG ELECT LUM
PB MECH
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LICENSED CONTRACTOR'S DECLARATION
w 1 hereby affirm Nal l am licensed under provisions of Chapter 9(commencing Job Description
i with Scctinn70lk1)of Division 3 of Be Business and Professions Coda,and my license is
^Z mmnfoaaneerj t. QD d 7 REROOF-T/O SHAKES, 30 FEETiIINTERLAYM ,
� o oaten 1. - Commcwr INSTALL CLASS B SHAKES Hill VALM
hJ' ARCHITECTS DECLARATION,
1 undmimnd in,plans shall he usedm,uhliemcnNs
;OH Licensed Pmfcuinnel
a• 3 OWNER-BUILDER DECLARATION d
<x I bercby affirm Out I em exam,,from,hc Cantncwr's License Law for the
O 0 following reason.(Section 7031.5.Business and Professions Code:Any city at county �f�f II tl n rs
which myuires a permit to construct,mer,improve,demolu .or rt,w,any structure
Fit
poor it)its issuance,also requites the applicant far such permit o file a signed suemen, C, U O
< thin he is licensed Pmremu rtheprovisionsof0.COnustan.Licame, aw(Chapter9 Sq.Ft. Floor Area VII LValuii[
,FG (commencing with Section 7000)of Division 3 of de Business and Professions Com)or
i $ Na,he u exempt therefrom and the naris for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant w a civil penalty of3ppL7 N0uTher00 Occupancy Type
not mart Nan five hundred dollars(S500). ZZbb&&I 4
❑I,is owner of tie property,or my employees with wages as their sole compensation,
will do the work,and Oc suucture is not intended or offered for sale(Sec.704,Business
and Pmfeariam code:The Conlncw's Ligase Law Gnu at apply wen no,or - Required Inspections
property who builds or improves thereon,and who daEsuchwark himself orthrough his
awn employees,provided that such improvements are na,intended oro0ered forsale.If.
however,the building or improvement is sold within one yearof completion.the owner.
builder will have On burden of proving that he did not Wild or improve for purpose of
sale.).
❑I,as Owner of t o propcny,am exclusively contracting with licensed conmewrs to
mnsuuct Be,project(Sec.704s.Business and Professors Code:)The Conuacwri Li-
ecru Law does not apply to an owner of property who builds or impm as themon.and
who concocts for such projects with a con0actor(s)licensed pursuant to the COmarai
License law.
❑l am exempt under See. ,B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby anion under penalty of perjury one of the following declarations:
1 bare and will maintain a Ce tificew of Consent to self-insure for WorkeesCamper.
7037.'00
ion,u provided for by Section 37011 of the labor Code,for On perfarmantt of the
rk for which this permit is issued.
I have and will maintain Workcls Compensation Insurance.as required by Section
of Ne Labor Code,for the pedmmanm of the work for which this permit is issued.
yWorker C rep nsauon lasuranc amer and Policy�nnum.bbaerrr55ary(. ��JJ' �oia: r Policy No.:ab_.ra i�7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if the Permit is forom hundred diohum($IN))
or loss.)
1 mod iv Nm in the performance of the work for which Nis permit u issued,I shall not
craflay any parson in any manner m ss to become subjccuo rte Workers Compensation .
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Cenifeale of Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Cade.you must
.JZ forthwith comply with men provisions or this Permit shall be deemed mvokcd.
zCONSTRUCTION LENDING AGENCY
(-+� Ihereby arfom that dere is a construction lending agency lot the performance of -
lx the work for which this permit is tuned(Sec.3097,Co.C.)
W Q
Under'a Namc
7 z Lenders Address
U 0 I certify that 1 have mad this application and suss da,the above information is
I,. ounces.1 agree,o comply with all city and county onlinanas and sou laws relating in
0 building construction.and hereby audoriM aprncnu,ivea of this city at enter upon the
r[S7 above-mentioned pmpcny(in inspection pugwees
(We).gra to save,indemnify and me,humlest the City of Cupertino against 42
rq ')
Iiabili,iu,judgments,costs and expenses which may in any way accrue against said City
U^ his Permit.
APPLIeUNDERSTANDSt
concoction.
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2A
SOURCE REGU}.ATIONS.
�e_=/ F-1-2 Re-roofs �1✓�.92
sigi g Of plicanUConwaor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future building moupantstore or hmwlc havar0ous material
u defined by the Cupertino Municipal Code.Chapter 9.13,gad the Heald and Safety
AMLFode. Yzss3zta)7
Y. QNu
All roofs shall be inspected prior to any roofing material being installed.
❑Y
ILWill the applicant or future building Occupant me equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
i,havardous air contaminants ss defined by the Bay Arca Air Quality Managcmcm all new materials for inspection.
C3 Yes -01
I have mad the annolous materials reyuimmcnts under Chapter 695 of On Califm-
ria Health&Saely Code,Sections 25515.25533 and 35534.1 understood that if the building
does not currently naw a tenant,that it is my responsibility to notify the occupant of the _
rcyuim�ycru whichm tEc mm�"ort 'ssuana of Cerufcarc of eupaney.
f� .Cr h-- GZ ` Signature of Applicant Date
Owner m m,horimd agcm Data
All roof coverings to be Class"B" or better
z z1w Community Development
10300 Torre Avenue
Cupertino CA 95014
H Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
/ ,// Building De artment /
JOB O,M SC4,*,V9W(1< lu PERMIT 5 ? b
o 'ZS o
OWNER'S NAME: .1167-kAa,.c1 PHONE #
GENERAL CONTRALTO rs5 4 ,"Fqg4FAX #
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
` City of Cupertino
y 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
8:UPEkJ1N0
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.
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: T)neS
_ ._._----__._.--jobSite.Address:- —.______�Q.,3-�d-_.
Roofing Company Name:
A phicant's Signature: ; /%l Cll/� "` Date:
\il/�WD�XI
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO0D v l
REROOF h
CUPERTINO PERMIT APPLICATION FORM
APN# 32-6:7- 4J—
221/v- 4I 024 Date: 6 /9 7 �,
Building Address: 0-Fe67 (/�
Owner's Name: (i Phone#:
Contractor: Phone License #:
�Cs oOQ707
Contact: Phone#: Cupertino Business License#:
I ` -
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof - ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes �` Wood Shakes (2 la S s g
❑ 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. /Q „
I Have Read, Understand and Will Com ly With Cupertino, Tear Off Policy:
J b Descy ption: 5ait30 e //7 ei-ptr ,i e
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions:
Cost of Project: ,/ , / Type of Construction: Occupancy gr up:
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
/ 76 s-�