05100229 CITY OF CUPERTINO A-va`,C
BUILDING DIVISION PERMIT 4c_ NTRkG-TOR INFORMATION
71
BUILDINGADDRESS: CORTEZ CONSTRUCTION PERMITNO.05100229
10488
OW NER'S NAME: PERMIT LbUE DATE
DEANNE DONALD KLAGES 1459 WOLF
NE: SANITARY N0, CONTROL NO.
(831) 970-3094
ARCHITEC MNGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0
iap LICENSED CONTRACTOR'S DECLARATION
fC 1 Web,affirm Nn 1 am Maenad under provisions of Chain.,9(commencing Job DBSCiIptlOn
G iNlleet.andl) (Division Jof NC Business and Prafessiaru Cole,aMmyliceve is
±Za tnranforcea.c".L REROOF-REPLACE (EZg jTya�`�La�h, TP WEIGHT TILE
=p Dam m Cantraclar a� •TS/• ® 't✓+� �{
4 w 7W As moll Cr50ECLARATiO
U I undersand my plans shall he used As public rtnrlu
e
Bt; Licensed Professional 3 I1
`05 OWNER-BUILDER DECLARATION lUUV
<f 1 hereby affirm Nal 1 am exempt from Ne Cmum,sits License Law for the Y
p o following mason(Baum]UJ L5,Business and Professions Code:Any city or county _
E which o quiets a pemlil to coral alter.improve.dcmnlisb,or repair any structure i' j: +\� !' C As $5200
_Z6 prior m its imumee,als.requires Ne applicant for such permit to rile a signed statement
s that hculicensed pursuant tothe provisions ofNeContractor's Ucc=Law(Chapter 9 Sq. F[. Floor Area •• ;>U ' 1y Valuation
,fin (commencing with section]ODO)of Division 3 of the Business sold Professions Code)or VI ams/
— WI he is exempt therefrom and the hasu for the alleged exemption Any violation of
Section 7031.5 by any applicant(m a permit subjects Nc applicant to a civil penalty of P Occupancy Type
not more than,five hundred dollars(SSW).
01,aowrmrorNeproperty,armyemployeewithwageu Neumiccom =dan,
will Pr NeworL and the he ComurmlNandcd araw nnot apply also,
Required Inspections
and Professions Cade:The Comtumfs License law dean
oe not apply m an owner of q P
property who builds pro or improve thermn,and who do hamhwok himudrarNmugh his
howas owever.due iprovided Nal veh improvementsartmlieeMMmolrerW forde Ole e-
builder.due wilding or den Of pmvltg at1withinoro year ormmovefortheownv-
.1.).r Will have Ne burden of provin6 Nal he did not build m improv for puryoa of
salt.).
O h As owner of on,proper,am eaduaivdy contracting with licensed mnuavaa to
construct on,pmjca(Sec.7014,Busirm and Professions Cade:)The ConNacler's V
cove Law doe not apply to an owner of propertywhobuilds or improves Nueon,and,
who contracts(match projects with a contractor(A)liccved pursuant M the Conesctofs
Leena law.
❑lamvemplunder See .Bh PCfmthismvon
Owner Dae
WORKER'S COMPENSATION DECLARATION
1 hereby aa7irm under pointy N perjury nam of the following decuouov:
1 ham and will maintain a CCNBcate of Consent to selr-insure for Workcfa Compen.
Otian,u provided for by Secsian 37M of the labor Cade,for Ne performance a(Nc
work far which this permit is iuucd.
❑T have and will maintain WorkeYs Compensation Insurance,As required by Section
We(the labor Code,for thd performance of the wok for which Nis permit is issued.
My Workcer pe anon) eNce mitt and Policy number Are:
Umer.—1- 1 � poRq Na.: 7�J OOI2�i3
CERTIFlCATEOF CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU section treed not beeamphoed little Permit Is forme hundred dollars(SIM)
or iris)
I certify that in the perfnmmc,of thc work for which this p.i,is issued,l shall not
employ any peon in any manner An u N become subject to the Workeri Compevaum
Law s of Caliramia.Dam
APPlicant
NOTICE TO APPLICANT:If.aMr making his Certificate of Eachninum,you should
become subject to do Workers Compensation previsions of the Labor Code,you most
.,O forthwith comply with such provisions or this Permits alt be d¢med revoked.
Z M CONSTRUCTION LENDING AGENCY
[+ I hemhy a1Brm Out Ncre is a caunmum lending agmey for the pedmonar.of
athe wish th
fur which is Permit u issued(Sec.709],Civ.C.)
Uj Q Lsndefs Namc
Q. lender s Addtuu
U C) I certify Net 1 have mad Nis application and sum that the above information is
la, f"' corcm I agree to comply with all city and county Ordinances and state laws relating In
0 U Wilding cavuuction,and hereby authotine reproxnuuea of Nu city to enter open Nc
r C alave-menumved Property for ivpecuou purposes.
(We)agree to Ove,indemnify and keep hamicas the City of Cupcnina Against
HrA liabilities,judgmcnu,costs and capecav which may in any way accrue against said City
U,Z, in consequence of the granting of this permit. fy /
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J
SOURCE RE TIONS.
l I
HARe-roofs
Sig of m twat Dam
ZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oecuPantemre or handle bavardous material
as&rLncd by the Cupertino Municipal Codc.Chapter 9.12.and the Hea1N and Safety
Ade.Section 15532017 All roofs shall be inspected prior to any roofing material being installed.
❑Ye ON.
Will the appliamt or future building..,.t sea Amoinnew or davlees which If a roof is installed without first obtaining an inspection,I agree to remove
mil hanNous air concerns nanO As&flood by Ne Bay Arca Air Quality Management all new materials for inspection.
ld.,OQLCU�my
istrict?
❑Y ON.
I have mad the huatd�ws mamriab rtyuirtmenu under ChaPmr6.95 of the Califo )/
building baseamans.distitumytespomihilityanotifydeoccupantofNeyuremcnts wh' �heand prior adtran=of a ccruficate of Occy army. Signature ofA can[ Dale
flr �cs
owner ar oa amand Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
1✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
OL c e-
OWNER'S NAME: --e-S PHONE # Po 30&
GENERAL CONTRACTOR: FAX # / qa
I am not using any subcontractors: Or
ignature 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
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
OUPEkTINO
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.
e 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: �/r
Job Site Address: czz 3 co ��.^
Roofing Company Name: (5N S
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # �Zb f 7 g Date: /d 3 0J_
Building Address: 7 p
a LC-
Owner's
s pit / c/ ✓ iA b S rO�y
Owner's Name: `� a / C P ne#:
r ,
Contractor: , Phone #: License #:
-�e� ( y i.,5 � ffl!- 70 5 09 K 7399zo
Contact: - b Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
'—Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles J /l / t--
❑ Other(Specify) ❑ Other(Specify) Li h `✓ T 7,1/
Number of existing coverings ❑ Provide I.C.B.O.Rep6�t# 6
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1
, o✓ a c.e_
Residential Commercial ❑
Fire Zone: Yes ❑ No ® Confirmed with Planning Det. if
there are any restrictions: LJ
Cost ofoject: 6P Type of Construction: Occup ncygroup:
oa
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
A BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
3� 75
/ 211, Y�