05050141 CITY OF CUPERTINO ? r>�5 - *-'�r "
BUILDING DIVISION PERMIT COART,
RAC'�TOR INFORMATION .
BELDINGADDRESS: TRI-CITY ROOFING PERMIT 1105O5O141 -
OWNER'S NAME: PERMIT ISSUE DATE
SOMA
.ONE:, SANITARY NO. CONTROL NO.
(510) 797- 901
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION
yyy r� o 0 0
yVC a m76 y.r wiIIam licensedMeBu under od Pmessof Chepur9(commencing Job Df � ��
1-m with ScI MaayAf Africa
Outo am the Busies and Professiof hDealt,pter9Rod co lme'Conci is 1(1/""
in full rone"m Ceres -Z REROOF W/COMP.
5 q i License Gass Lic.N
qty AR HITELTSDECLARATION U\
a�a 1 understand my plana shall W=it As public¢cords
DiU
C�
Licensed Pmfcssaffir sY ar
.� 5 OWNER-BUILDER DECLARATION Hpl4-0tlry
<0 1 hcrehy.(Seth 1 em exempt froms an Nc Contractor's License Any c Law for the
C,o following mann.Permit
(Section 7031.5.Business and improve,
der um Code:Any city or county
., ILDIN
$O which rets ism a pemir re airs me alma nt fors:,h Permit t fi.,air any ommncot
C,i< prior of its carved m.assnmquime me applicant forsuch se Law amtamcm
that hic(commescingwitpSection
esuemtothepmvisionsofNCCanusiness ndProptaw(Chap¢r9 Sq. Ft. Floor Area Valuation
C,t-$ Met M is exempt
geni ern Rod
of leads
3 of me Al Business and m.Any vi Cade)or
y�_ Nal be is exempt therefrom and Ibe buffs far the alleged exemption.Any violation of
Section 7031.5 by any application for a proah subjects the Applicanno a civil penalty of 3 2W4tT "crO 0 Occupancy Type
not mom Man fivehunamddollars(Vi Wk P Y YP
L u owner k.the propuny,m my cmptende with ..dfar Heir mer c0mpenuneas
will Prfodo OR work,endo: hie Contractor's
noti License
it for salt(Sec.]Odd,Business
Amo Professions Coat:The improves Mercer.
License IoW dors not apply lf an owner of Required Inspections
Avon employrty builds, rovidod Met such
who Am
in work himselforthrough his
own employers,provided mat such improvements in not lensed oro@ren,the forsale.r-
Wilde,hcrwe�r.NeWildingorihonof m nt i.is saidatdid ooeyear orcapnoveto,meowncr-
builder will have dm Wrdcn of pmvin6 mar W did not build or improve far purpose or
salt.).
❑1,as miner of OR property,am uclusively contracting with licemed contractors to
contract me pmject(Sec.]ado.Business and Professions CDdc:)The Contneror's Lt.
Came law dors not apply to an owner of prepcny who builds or improves themon,and
who contracts for such projem with a conuacror(s)licensed pursuant as the Cmnuatemra
LKeve Law.
❑1 am exempt under Sec. B h P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby AMOCO under poly of perjury one of dm following declaravoru: .
I ham and will maintain a Ccnificme of Continuo self-insure for WorkctsChmpcn-
7arg-,-
ion,u provided for by Section 37M or the Laor Code,for me perfutmanco of the
rk for which this permit is issued.
and will maintain Workers Compemauon lasurvtcc.As syuired by&coon
W of the LAW,Cade,far the performance of Ne work for which this permit is issued.
y Workers Co�`mavonImuran ca c na Polity num hr amrticr:7l3t'P�Tk 1 rPolicY
CERTIFI ATE OF UEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section recd not the compiemd him pcmrb is foram hundred dmlan(glad)
or less.)
1 cenifv that in the performance of the work for which this permit is issued,I shall not
employ any person in any mannersa as in become subjec0o me Workers'Compcmation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeniGcam of Exemption,you should
become subject re me Worker's Compensation previsions of me Labor Code,you must
,Jz foMwi in comply with such prnrisimns or this rermitahall be denied revoked.
Z7) CONSTRUCTION LENDING AGENCY
IA Ihemb affirm that there is a construction lending acct for F 5: - Y a 8 g cY perfurmancc of
CL 25 tW work fur which this permit is issued(Sec.3097.Civ.CJ
1 z Lenders Name
a z Lender's Address
U O 1 certify that I have read this application and sum mat me above information is
ly f^ coerce.I Agree to comply with all city and county ordinances and sum laws relating in
�U Wilding construction,and hereby Romano,repmsenmmas ofthis city m enter upmn me
C above-memunned progeny far inspection Purpose.
(we)Agree to save,indemnify and keep harmless me City of Cupertino Against
F'y liebllifiu.judgments.costs and expenses which may in anyway accmc against mid City
U z in eontiqucnee of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGULA ONS.
15�2-410-5_ Re-roofs
Signature mr Applic fo
concmr Data
AZARDOUS MATERIALS DISCLOSURE Type of Roof '
Will me applicant or future building occupant smut or handle hacsucous ma trial
az dented by Nc Cupertino Municipal Code.Chapter 9.13.and me Health and Safety
We.Scrtian us3z(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will mea licant or NOM building Occupant am,a If a roof is installed without first obtaining an inspection,I agree to remove
PP s n o Air Qu ate devices which g
it haxaranus air Contaminants u defined by the Bay Arta Air Quality Management
isvictl all new materials for inspection.
❑Yes rfl.
Ihaw&Sart mehasarCd 25505.25533mte 534.dcr Chrround set fee WheCaln,
nim snot urSafetyhave a Comm,mthat it is
respin553d.1 understand em cap Wilding -y V
docs not currently have t ten .that it is my respora ce tta m may du poncy. t of the L
myuirc cntswhichmustbemapar uanccafaCcnincamof aapano. Signature ofAp cant Dat
el
2 L o _ All roof coverings to be Class"B"or better
Owner M authodre em Da¢
, Community Development
f 10300 Torre Avenue
p Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #63v1�
OWNER'S NAME: H Z PHONE# 5)
GENERAL CONTRACTOR 1��— C'. FAX#
I am not using any subcontractors:
ignature Oate
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
Ofzner/ Signature Date
Community Development Department
` Building Division
CICity of Cupertino
EE�� 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
IUPEkTINO
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.
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: D, ``� d \N
Job Site Address: 0 7 U C P
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF f I
�CUPEkTINO PERMIT APPLICATION FORM
APN # 2 / v Date:
l7 s Z O -
Building Address:
v�7o Coy
Owner's Name: Phone#:
5 -,rte o, do 0 -- Sze
Contractor: Phone#: License#: Zl
Contact: Phone#: Cupertino Business License#:
?- 35'0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ^9i Asphalt Shingles
Wood Shakes /❑_ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings b Provide LC.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:
V,/00)
Residential Ef - 'Comniarijal
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
'1 ? 0
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