04080081CI1'Y OF CUPERTINO
a��
DIVISION PERMIT
BUILDING
„CIQNTRACT0R'INFORMA'PION
BUILDING ADDRESS:
MAXIMUM ROOF CARE CORP
PERMIT N0.04080081
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY Pro. COMAOL NO.
ARCHITECTEENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
hereby affirm Nat 1 am Been.] TOR
I of Chapmr 9 (commcaing
- lob Description
provisions
with Seedon 7WB) of Division J of Jus Buvnesa ami Profcssium Cock. and my liccac is
Y �I
in full tons and cffc
REROOF
License el :tielras
AUG
Dare !d COncror —
RCHITELTS DEC
2
20p/�
1 untlersunJ my plana shall M used as public mcnrJs
Licensed Professional
OWNER -BUILDER ER DECLARATION
1 hereby affirm License law for Nc
11. •crop, from the CnnbactCo
,`,Vtl/ll_fwl
Code: Any city or county
(Socio, ]..,urn5. Business and :
reaso on
ve. denoa
whichfollowing urns . pair any awcmm
which pori) re CnnaraL improve, ticermitt,
;J 8000
fie
its le n such permit to file a signed wd stateChap, ant
poor Rr its censed Calm requires the applicant
me Contractor's uecnuvwsCru
Sq. FC Floor Area
Valuation
ovisio s of the erg
of
that nein Bing=ed pursuant In the of Division Professions Codoo of
(commencing ofDivision J nRhceged
ea•ant
: thus he ix evempt thcmfmm and Ne buts for me alleged exemption Any violation of
1. Crag 11thel,ioo and
3 GTN9,01"grO 0
Occupancy Type
N
Section 70]1.5 by any applicant for a permit subje applicant to a civil penally of
not more man Eve hundred doll.. (SSW).ects
r
❑ I, w owner of the property, or my employees with wages as Heir sole compensation,
Required Inspections
will dome work, and me structure is notlneMed or offered for sale (Sec. 7014, Busiass
and Proposal.. code: The Conlncoses Lt.. Law day oar apply to so be, of
property, who buildsor improves thercon,and who doessuch work himself or through his
own employees, provided that such improvements ve not i^mnded or offered far sale. if.
however, the building or improvement is sold within one year of completion, me owner
builder will have me burden of proving Nal he did not build or improve for purpose of
sale).
❑ 1, as Owner of the property, am =elusively convecting with licensed Contractors to
,
convect the project (Sec. 70a1, Business and Professors Code:) The Convenor's U
me Law does not apply us an owner of property who builds or improves dcroon, and
who Contracts for such pmjccm with a conmctor(s) licensed PU.U.aI to Ne Convutofs
License Law.
-
❑ 1 kin eaempt under Sec. . B & P C for this
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby ^fart^ under penalty, of perjury One of the following dccosat pa,
I have and will maintain a CerdEuste of Consent to self-intim fop Worknfs Compen-
,
Minn. az provided for by Section 37M of for labor Codc, for the performance of Ne
work for which Nis peril is issued.
0 1 have and will maintain Workers Compensation Insurance, as required by Section
1X1) Of Ne labor Codc, for the performance of Ne work for which this permit is issued.
My Worker's Co easeron lnsumnc artierpand Policy numbefart:
.—
Cartier. AMriolicy NO:
.
CERTIFICATEOFcXMU4 ibN FROM WORKER
COMPENSATION INSURANCE
(Thu sermon need not becrosi,sc ed if a fermi, is porcine hundred dollars (SIM)
or less)
I certify Nat in the pc,fnran,C of Nc work for which Nis .it is issued, I shall nuc,
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: IL after making Nis CenlE=m Of Exemption, you should
become subject to ,he worker's Compeneadon provisions of the labor Code, you most
foMwith comply with such provisions or this permit shall he deemed evoked.
j CONST, NLENDINGAGENCY
1 Worth,owhich thi that mere is agency for the perfurmence of
is sem
s ed (Sec. 7, Civ,
' Nc work for which ,his peri, is issued (Sec. J('P, Civ. C.)
lender's Namc
Lcnticr's Address
j I Certify Nat I have read Nis application and sMc that the above information is
' COMM 1 agree to Comply with all city and county on ianees and sum laws relating to
Wilding cmuwction. and hereby au,hone representatives of this city to enter upon the
ahovo-mcntlonod pmpeny for iteration purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j hall litice,judgmcn., coxa aad=paracs which may in any way a cc. against said City
/
in c.nsequence of the gmn5ing of Nis permit,
APPL ANT UNDEgSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU GULrQ't�Ns.
"�
Re -roofs
Type of Roof
�/� ��j�.
Signe.of A,dicabloCrindi Dae
HAZARDOUS MATERIALS DISCLOSURE
Will dm applicant or futum building occupant store or handle hafendous material
az dcfned It the Cupmino Municipal Codc, Chapter 9.13, and the HcaW and Safety
code. seedes zssu(a)+
All roofs shall be inspected to any rooting material being installed.
❑Y }rya
prior
If a roof is installed without first obtaining an inspection, I agree to remove
wn the a licantar fuwre builJr gees an, are n tar devices when
pp s v aAi,Qn
it hvardnus air contaminants u JcfincJ M1y the Bay Ama Air Quality Manageme^f
all new materials for inspection.
Disain?
Ycx
6.95 the Calif.,
ihavcmet them= Scenes maurialsm33
0.of
it 554.1oChapmr
SSJJand355J4J 1. Wiring
niaHealthurSafety cute,scam.2ltit
CNe
us
doesnot Currently have a moan mal it u my mpmsihillly lU nutilY Nc acupanl of the
mor, the
LeA/—"=/1`
���
CrlUl([mc 4wI1 ll mUSl bC p orwissuancc ora Ccrtificam Of Occupancy.
Scp rgna re ofAp licant Date
a
All roof coverings to be Class "B" or better
owner
m
mons agent Doc
� F
CITY OF
WUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB AI>DRESS:pp
(f �ItM^�� S ��1N�-
PE$RIIT #
UIf
OWNER'S N r"
PHONT~ #
GENERAL CO ACTOR:
FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
on/t`actor Signature
2-j I -0�(
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
1 3
Septic Tank
Sheet Metal
Sheet Rock
Tile
on/t`actor Signature
2-j I -0�(
Date
CITY OF
UPEkTINO
% <L
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.
is 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: `Zoyeg--i703 v\1S
Job Site Address: e?\ 3\\ CO (W-YOOL X� l t-R—
..11J. 9 as 1,. A . f1 . a/.
A plicanYs Signature:
Greg teel
Building Official
Revised 1/30/03
Printed on Aecvcled Paper
l:
CITY OF
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #6 Z 3
b '� d
Date:
Building Address:
BENERGY
3
,
Owner's Name:
Seismic Fee Res
Phone #:
q -O
Seismic Commercial
c - 1 co -ata
Contractor:License
MCtx u D� �(n �Q Phone #: �DS qy I Qq 3`5
l
#:
Contact:]
Phone #:Cupertino
y (DHO
Business License #:
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
W Asphalt Shingles
A Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
it Other (Specify) NA_ R,9- (03L1 lily
Number of existing coverings 1
D Provide I.C.B.O. Report # _ _ ` r
XTo be Removed 1
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: l3
Job Description:
; � � AA t tjLn 05 $ t 3 elf r—ewj 4 eres: dGr>C�I "f ( _
1 r+1
Residential
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Blan to ng -Dept. if
there are an. l..trictions:
Cost of Project:
Type of Const on• v Occupa cy groin
L 6o
u0o�
Qty,: f
ADOItcable
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