05120010 CITY OF CUPERTINO fi % $ s'"� n ° `
BUILDING DIVISION PERMIT ,C RA.&CTC`1,RIF�IF�QRMAT�Ip , .
BUILDING ADDRESS: JNS'J ROOFING INC PpAMITNo. 05120010
206
OWNER'S NAME: PERMIT LSUE OATH
JANE WADLOW 691 W SAN CART-29 ST 12ZO91
NE: SANITARYNO. CONTROL NO,
40827.96171
ARCHT ECT(ENGINEER: BUILDING PERMIT INFO
BLDO EIEL7 PLUMB MECH
j o LICENSED CONTRACTOR'S DECLARATION Job Description
I hemby affirm that 1 am liamad uamr previsions of CMpw 9(commencing P
ith Snetia 70(IU)af DivWpn3ofdm BusimuW ofessioru Codo,aM mylmenmp
+� in fullrameandefir l7 REROOF--T/O SHAKE, INSTALL COMP. SHINGLES
f o:�nm�L� H FI q�E
ARCHITECT'S RA N
I understand my Plans shall h used u
Y u
eta. Licensed Professional
50 OWNER-BUILDER DECLARATION
b nuc
41 1 heathy aRrm this I 1 exempt from the Contmctor'a :MY C Law for the "loot
40 following mason.(Sagan]0314,Bualrcas and Pro(rstium Cale:Any City or cmnty L �1
3 ,(. which mquimr•Permit to counteract.aixe improve,demWlsh.m sepals"y structure $7850
Z''c "Mislwmd processors
rocesex provisions
Of fm"ch Corton OlcasigadautememBid
�< thnhulieeued Purauantmthe ryorlalom Of film Canuacmrk lJcens law(Chapa9 Sq.Ft.Floor Area [ion
9 VU
(commencing with Section 7000)of Division 3 of the Businm and Pnelosoom Code)or ILLAN
—
that he ta eaempt Nemfrotn and the bssu for the alleged assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the appilmot to a civil penally of V Q OdcuffCncy Type
on,mom then rim hundred dollars($50D).
❑L u owner of tim property,or my employees with wage m their wlemmpen"tian.
Mil do thcwon Codex he Commnms I homes Law does
apply
an,Bwinw Required Inspections
proand arty who
Cade:Th Convector's Limos law does ret apply lr m owner is q P
own ertywW bullwarlmpmvssu Werean,addwho dartsmbwark himmlrmthmugh his
ownwer,the building
OutashImpw old stare fiat inun formoffered fm Weed.
however.the ath nc me of proem ta saki MNlnom gutOr mmPktion,the owar-
Wllduvele haw the burden of proving that h did ret halm m Improve fw purpose of
"ICJ.
❑1,u owner of Lha property.am exclusively contracting with licensed mmaclom b
came tert the project(Sec.701,1,amines ark Pmfesd m Code)Ih Contractor's U.
Comes law does not apply b an sumer of property-w1ho Wilds or Impress;thereon,soul,
who cones,far such pmjects with a mnummr(s)licensed pummnt to den Contrsetaes
Llces"law.
❑I ore assmpt under See .B•PC for this mauv
0. Dam
WORKERS COMPENSATION DECLARATION
I hereby Affirm esker penalty a(perjmy ma of the following declarWa¢
I have and will maintain a ceN(iam ofeom et b herr-Insure("Wortds Compen.
7031.010
an,u provided for by Section 3700 of the Labor Code,(a the Forenamed of the
work:for which this permit is i"ad.
1 ban ark MII maintain Workers Compensation Insurance,u required by Section
of Ne Labor Code,fm the performance of the wast fa which this permit is i"ad.
Worker's Compensation Imomxe carrier aM Policy numbct art:
rtier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need not be completed!Ocie permit Is forma hundred dollen(Slee)
or eta)
I cmify that in the performance of the work(a w Ith thia permit Is issued,l shall not
employ any person in any mmrcr se as lob nm 'eettothe m am"
Laws of CalifomiA.Dose _'s^m
Applicant
NOTICE TO APPLICANT:IL after ma pn ca merged,you aha
become subject b the Wohcr's Campe Adm provis of th me Code,you as
.'0 faMwithcomply with ouch provuiou o is Permit shall W deemed revoked
.Zy` CONSTRUCTION LENDING AGENCY
(-v I herby aMm that them u a comvuctinn lending agency for the Performance of
G' > the work for which this permit Is intend(Sec.3097,Civ.CI '
UJE Lender's Name
Z Lenders Add. -
V O 1 certify that I ham mad this application and rex that the above information U
ILr'. catnsa 1 agree b comply Ncounty all city acmty ominamv anrelating d sum law to
SU^ Wilding com uetion."d hereby authodus mpresenukcs,of this City he enter upon dm
[i7 above-mentioned PMPeny for Inspection purposes
a (We)agree to nw:,Indemnify and keep harrmmas tin City of Cupertino against
r'/1 Imbilien.Judgmenu,cow and mpensea winch may m any way Ccctm alalmt rid 0ty
oa
U in Com mof the Amount of this permit.
APPL ILL COMPLY WITH ALL NON-POINT Issued by: Date 2- L—D 4--
s0 ONS.
Re-roofs
ignat afAppli.VC vector Dam
HAZ US MATERIALS D CLOSURE Type of Roof
I the applicant or future Wildingam nom a handm hazardous material
as de Cu nim Muni put 9.12,and the Health"d Safety
ode,section u All roofs shall be inspected prior to any roofing material being installed.
❑Yet ve
Will the applicant or fuLum building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
MR hanrdnm air com mim m,u de0mk by the Bay Ams Air Qualily Management all new materials for inspection.
District?
❑Yes 6JN✓
1 mad materiammqulnemmuunderChapter 6.95orthe Califs-
IZ-1
nix Ho ety Scm 7]533aa17553n.ltuvkruutdthulfthe buildin3
u n c fitly hexa Wuhan.Nu responsibility b floury rix occup"C of rix
alre wbkb muds h reel W or CerdOcam afOccupamy. Sig tut of Applicant Date
( -
Owar d a ant Dam Cogs t0 be Class"B°Or better
Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: Zo61,3 Che,l -pr. PERMIT #
O F- 200 10
OWNER'S NAME: W ad(ni PHONE # 07q-61v
GENERAL CONTRACTOR: JnJSJ FAX #
I am not using any subcontractors:
Signa a Date
Please check a licable subcontractors an c o owing 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
er/Contractor - ature Date
Community Development Department
Building Division
a' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E R,TIN 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 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: Jaw-
job Site Address: ?-0683 Ckez l At-,
Roofing Company Name: JJ oo ti c .
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF 64�2 6°l o
CUPERTINO PERMIT APPLICATION FORM
APN# 3fj Date:
Building Address: 2 0 6 6 3 Ckc r
Owner's Name: I,ate W_ZC1 101PJ Phone#:
Contractor: \1 Phone#: License#:
JNSJ nfi r+.�. voe 279-b1 1 737Q80
Contact: Jim Phone#: { Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles asphalt Shingles
ar__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: ?,,,, (e) Sl„k oaf, thshK yz" oS�/. 3o Ib. A' tt/ iV. skyr a,„e.s&,,1,S
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: E
Cost of Project: Type of Construction: Occupancy group:
't 7 aSo'-
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
s�
2"2
( x'. . 76