04080201 CITY OF CUPERTINO 7:g'n`"° i:
BUILDING DIVISION PERMIT 'ONTRACT®R INFORMATION:. -
0UILDING ADDRESS: PERMIT NO04080201 4080201
1391 C01,ll1d2lJ2 A.11
OW NER'S NAME: PERMIT ISSUE DATE
PATRICIA GREELEY
NE: SANITARY O. C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
oO' LICENSED CONTRACTOR'S DECLARATION
a�C IWrcby )of arat1amfi eBuunderprovisionsof Chapter. Y(mmmc=is lob DCSCrlptl0 '` II /� D
�zw s"'d' on]t1dJ)ef Division Sof the Busirev arq Rafessiuns Code.antl mylicusx is 11I1111(� lel\\Utllllla////^W\tl
in to
and,e{uT«t. .�a�43Pq REROOF
a Z Liccnsc Itis /STC?9 L. N
es Da�Cunvutot' CONTRACTOR: ELLIOTT ROOFING SEP
1�agg
ARCHITECTSD ATION Cf.P Z0�4
1 understood my plans shall he tried , lie records SE 0
Jas,
0.� Licensed Professional tt II I1
<f as.Iam exempt frm DECLARATION : 'I f'I�D�t� n�
1 hereby affirm Nm I am exempt from the RATIO oh License Law for the U 'I\\.-.n
Q o following reason.(Section](131.5.Business and Profem'uu Cmle:Any city or county u \`Vtl�
K m which requirea permit to construct,alter,improve,demolish,or repair any svunum
Fly prior m its issuance,also requires the applicant for such permit to Ste aligned statement
< that he is licensed pursuant m the Provisions of arc Contractor's License Law(Chapter 9 Sq.Ft.Floor Area VaIu$tjo3T900
asa (commencing with Section 7")of Division 3 of the Business and Professions Cadia or
i quit he is exempt therefrom aria the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not marc Nan foe hundred dollars($500).
El I,u owner of the property,or my employees with wages u their sole compensation, 3620400 . 00
will do arc work and the structure is not intended ar offered far WA(Sm.]lla4,Business -
and Protections Code:no Contracmri License Law docs not apply to An owner of Required Inspections
progeny who builds or improve thereon,and who does such wark himself or through his
own employees,provided doosuch improvements arc not intended oroffered for sale.If,
however.the building or improvement is sold within ane year of mmplcuon,are owner-
builder will tum the burden of proving Nat k did not Wild or improve for purpose of
.1,1
❑1,as owner of the propeny,am exclusively contracting with licensed contractors to
construct the project(Sea 70 4.Business and Professions Code:)The Contractor's Li
cense law docs not apply to an owner of property who builds or improves roman.and
who contracts for such pmjecm with a contractor(s)licensed pursuant m the Convacto's
License law.
I am exempt undo Sec. .B h P C far this toxo
Owercr
Data
WORKERS COMPENSATION DECLARATION
I hereby anon under penalty of perjury ox of Ne fallowing deeleratiou:
1 have and will maintain a Certificate of Consent self-insure for Workcts Compcm
nd ,u provided far by S.M.3700 of the La W,Code,for aregi
ponaro me,of are
work for which this permit is issued.
❑1 lave and will maintain Worker's Compensation Insurance,As required by Section
3)00 of the labor Code,for are performance of are work for which this permit is issued.
My Worker's o mation Insurance carrier and Policy number are:
N o y No.09*0ae —
CERTIFICATE OF EKEM NFROM WORKERS'
COMPENSATI INSURANCE
(Thuacction need not W completed if the permit isforane hundred dollars(1100)
Ices.)
1 unify Nat in the perfammn¢of the work for which Chia permit is issued.I shall not
employ any pecan in any manner so As to Wcome subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,aDcr making this Cenifuale of Exemption,you should
htteme subject to are Worker's Compensation previsions of the labor Coag,you must
.JO forthwith comply with such provisions or this permit shall Wtlecrued revoked.
Z h CONSTRUCTION LENDING AGENCY
�-... I hereby affirm that thcra is a construction lending agency lot tic Performance or
!Yi the work for which this permit is issued(Sec.309],Civ.C.)
U]Q Lender's Nam.
Td. Lender's Add..
5z
V 01 certify Nat 1 banmad this application and state that do infotmatim is
D., — correct.l agree to comply with all city and county oNinancesand sure laws rtrating m
0V building construction.and hereby Martinet,mprexnuties of this city or enter upon the
r 1U Move mentioned property for Inspection purposes.
G. (We)agree to save,indemnify and keep harmless the City of Copcnino against
r N liahillacl,judgmenu,costa and expmAaA which may in any way neem against said City
V zs Permit.
APPLIC UNDERSTANDS At
NT AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU
UL'Zef- S.
Re-roofs
Yfe toff'oficant1comf1fet., Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding arupant scam or handle hazardous material
u tlABned by Ne Cupenino Municipal Calc,Chapter 9.13,and the Health and Safety
code.Section 255320)+ All roofs shall be•inected prior to any roofing material being installed.
❑Yes /�1Na / /
r If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which i
Amit hvardou air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District? /
by. /Y.1Nu
Ihave mad tc hvar try 25M5.srcquircmcnts under CbaPeda. Lifarc Wlldin. \ is
nice Hcalthhsafcty Ca�Scci9ns 25N)5.25533 end255.1. undcrstana arvrif tic Wilding —!
dna not currently mvva as u t o it o my respouihility m m my tW occupant of the
rcyuimmcpta -car iso face F, o(0,pam:y. ' (Sature of Applicant - e
owner car aatWnve •s t Dae U All roof coverings to be Cla s'B"or otter
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEI�TINO
Building De artment
JOB ADDRESS: PERMTl V 6
OWNER'SNAME: i ZeI , g PHONE #
GENERAL CONTRACTOR: _;�,�� 4rr�o rr FAX #
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
/Contractor Signature Date
Community Development Department
_ Building Division
%' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
IqU P E IST I N O 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:
Job Site Address:
Roofing Company Name: �' , �A
A plicant's Signature: Date: AL,,Z 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO Uv Z o I
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# /Z U ff D D Date:
Building Address:
Owner's Nam
J./!7'2�C1/� Cs/Zcz� `fib -ZSR 24
Contractor: Phone#: License#:
'703 1j.;7_3 acs7�'
Contact: Phone#: !_ Cupertino Business License#:
��t �fdTl
Type of Roof Covering:
Existing: Proposed:
yq Built-Up Roof Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
sa 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, Unders d and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description' �Z v/i�- as.g.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De
t � 1 frit[-
Cost of Project: T of Construction: Oc panty grou
/L Pow
Qty. .
AppxlcqbbIf 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