05100033 CITY OF CUPERTINO 'ssa
BUILDING DIVISION PERMIT CO%,t NTRACTORINFORMATIONx
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❑UI MIND ADDRESS: CASTO ROOFING PERMIT N0.05100033
A 0T.TTMRLT.4 AV
OW NER'S NAME: PERMIT ISSUE DATE
STANLEY PONCHETTA 1938 OLD MI 2005
NE: SANITARY NO. CONTROL NO.
(650) 961-8922
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUM0B MECH
0 0 0
trop LICENSED CONTRACTOR'S DECLARATION
C w 1 thereby afrirm Out l am limused under proviaons of Chapter 9(commencing Job Description
b
to Section 70N))of Division S of,M Businecsand Professions Code.and my license is
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in fall =flat. 3972z REROOF-T/O SHAKES, INS ��®
p M?
License Clan Lk.N B
arc Dam !/�Con. TREATED SHAKES
rJ' ARCHI EcrS DECLAR TIO I /
£rc� IundcfstanJ my plans ahallkuuJopublicrtmr&
Licensed Professional rrf ai 2005
OWNER-BUILDER DECLARATION -
I 1 hereby It.that I am exempt from the Contractors License,Law for,he
OD following moon.(Section IIAI.S.Business and Profusions CWe:Anycity or county 'J,'="j N 4a
<�_ which seyubes a permit to miduruck atm,.Improve,demolishm V}
.or repair,any sm cb ;,f;;
L proaeu;B;atua.m.mo.Rqu;res the appl;[anl(of ter[h per11111,a RIC lungbed stammenl dLA
—�< that he is licensed pursuant to thcprovisiom of the Commuter's Livcnsc law(Charm,9 Sq. Ft. Floor Area '�+ U Valu lihr4800
y�ta (commencing with Section 7")o(Division 3 of the Business and Professions CWe)or '
y Nat he Is exempt therefrom and the breis for the alleged co mption.Any violation of
Saxon 1031.5 by any applicant fair a permit subjccu the applicant to a civil penalty of APN Number Occupancy Type
am mom than 0ve hundred dollars(8500). 36204009 . 00
❑I.an owner of the property,or my employees with wages o their sole comperes,ion,
will do the work and Ne strocmm is not intended or onered for sak(Sec.1064,Banned, Raired Inspections
and Professions Code;The Contractor's Liceme Law does not apply,o an owner of e q ns p
prolserly who bull&primp eves theaon,and who docs such work himself orthrough his
awn employ.,provided Nat such;mprovvments arc not intended or o1ferW forsale.If,
however,Ne building or improvement is sold within one year of completion,Ne owner-
builder will have do,harden of proving this k did not build as improve far purypm of
sale.).
0 1,as owner of Ne progeny,am exclusively contracting with licensed convectors,o
construct the project(Sec.7W,Business and Professions Code:)The Contractor's Li
cense Law does no,apply in an owner of property who Wilds or improves thereon,and
who contracts for such protects with a comamor(s)licensed puauant tp the Contracmrs
Lim.taw.
❑1 am exempt under Sec. .B&P C for tris moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby efium under penalty of perjury ane of the following declarations:
I have and will maintain a Canifiesta of Comment to self-;nsum for WortrrsCompen-
sadon,as provided for by Section 3700 of the labor Code,for Ne performance of Or
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,ma required by Section
31W of NC Labor CWe,for the performance of the work for which this permit is issued.
My Workers C mpensau/o'a Ins cc camber and Policy number ase:
Cartier. �pa e Policy NO.: 24:2"2 0'ac
s _ CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sem;nn need not kcomplemd if the permit is Fromm hundred datum(51fMI)
or less.)
I certify Nat in the performance of Ne work for which this permit rs issued.I shall no,
employ any person in any manner in as in become subject to Ne WOrkmi Compensation
Laws of Califom;a.Dam
Applicant
NOTICE TO APPLICANT:If,aper making this Ceni Rale of Exemption,you should
become ounces to the Worker'a Compensation previsions of Nc tabor Code,you must
.J O knOwnh Comply with such provisions or this permit shall k deemed revoked.
z N CONSTRUCTION LENDING AGENCY
I hereby aMum that Nae lsa combustion leading agency for Ne Perfurmaae of
Use wink fur which this permit is ismed(See.309'/.Civ.C.)
Lender's Name
z Lenders Addmss
U O 1 certify Nat 1 have read this application and sum Na,Ne Move information is
IT, f" Correct.I agree,o comply with all city and county ominanees and sum laws mladng m
0t.1 building construction.and hereby auNarine mpresenutives of this city w enter upon the
r U aWve-memimrcd property for inspection proposes
gy (We)ghee to save,indemnify and keep harmless Ne City of Cupertino gaiot
H(n iab111tiea,judgmen6,casts and expenses which may in any way amore Mains,said City
C)Z APPCof Me Nof tpermit.
LICANTUNDERSTADSAND WILL COMPLY WITH ALL NON-POINT Issued by:S— Date l� S-OJ
S
OURCERE ULA N / S
D Re-roofs iL4
AppB'- o ter Dam
/HAZARDOUS MAng Occ a DISCLOSURE Type of Roof
C ppbcant^r Towne oilding occupant sone or handle haous material
the Catena.Municipal Code,Chapter 9.11.and the Health and Safety
15531(a)1 �NoAll roofs shall be inspected prior to any roofing material being installed.
thea Rant nr mom Wildin aaa ant us e ,m xv;aa whianIf a roof is installed without first obtaining an inspection,I agree to remove
pp g p yuipme^us air contaminants as Jernned by,he Bay Area Air Quality Management all new materials for inspection.
❑Yes [:3 No
I have toad Ne hvam res materials myu;mments under Chapter 6.95 of Me Califon
ma Hmith&SaretyCode,Seeuas 15505.25533 and 25534.1 understood!Nat ifthe Wilding
does not currently have a ten I,is my suporsihilitY On modify the aeupan,of Ne
myvi¢menu whichm me, ' r
in issuance of a Ccmfiam ofOccupancySignature of Applicant Date
L
All roof covering's to be Class"B"or better
nor. author". gem Dam
ItsCommunity Development
i `O` 10300 Torre Avenue
i Cupertino CA 95014
^ Telephone(408)777-3228
CITY OF Fax(408) 777-3333
®UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
yl 6j.> Q 0z rJ / v6 6 ,7 3
OWNER'S NAME: S+r,,\ loop c�iC -4Q PHONE # & Sc S 6
GENERAL CONTRACTOR: Co oto i2a>F•vg 2k L FAX #
I am not using any subcontractor • 7 �/710
%gignature 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 Qbt-o �000 ZKC, 19S972Z3
Septic Tank
Sheet Metal
Sheet Rock
Tile
J' /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.
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 LC.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: S-k�.r pool c. c:1�
Job Site Address: 21`1 31 Col uk�bk_& CI✓e
Roofing Company Name:
Applicant's Signator : Date:�ry s
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
��. CITY OF CUPERTINO J;3REROOF
Yof
CUPEIkjlNO PERMIT APPLICATION FORM
APN # ° Date:
1�� � ° Ic DS
Building Address:
a I L4 31 CoIurnbus Avf-
Owner's Name: Phone #:
sir,nisonc he 140? -9qu $0-13
Contractor: rn^ T License #:
Contact: v" 6!009Gi
Cupertino Business License #:
'( oSoU25 ��'�izz Ca
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
XWood Shakes 6P1 Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Numher 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: 10
Job Description:
Te e, 0 F4 5filnroot - I 5VoJc-,_S
Residential Commercial
Fire Zone: Yes ❑ No ® Confirmed with Planning Dept. if
there are any restrictions: i9
Cost of Project: Poo Type of Construction: Occupancy group:
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
BPLANCI-IK Plan Check Fee BUILDING
BUSLIC Business License BUILDING