04030230 r CI:!'Y OF CUPERTINO * ^✓^ '�' ;
BUILDING DIVISION PERMIT C®NTRACTOR INFORMATION
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BUILDINGADDRESS: MDR NELSON RAMOS PERMIINO04030230
OWNER'S NAME: PERMIT ISSUE DATE
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ONE: WOO 110 ATTA D422A TDR.- P _
SANITARY OL N0.
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CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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+ LICENSED CONrRACTOR'S DECLARATION
1 hereby arrom Nal I an liennxtl under provisions of Chapt:r 9(commencinglob Description
h SccsiO.'0MafDivision 3 of NC Business and Professions Code.and my license ispull mae.nd effect. REROOFUN 7 Z004,enseClus LieanFContractor
ARCHITECTS DECLARATIONppwa(aA� a /�eI understand my plans shall he used as public records 8tkrjLDj fq W
JyU �tl
3 G G LicmHd Professional
Oat I am exempt
from
mDECLARATIONclo
I hereby.(firm Net 1 1. exempt(rum dm Cessna Co License:AnyC Law tar the
00 following masoa lemic 17113 LA Business and Profession Code:Any city for minty
Q which requires a permit on construct,the i alcor,impmve,demolish,fie.sil my sstuemro
SGG
priormsl issuance,raurequires IW iswbsmforsuchpermitm eekasigned Calomcnl
se-
Italianme cingwiitpmction7 th)provisionsaloft eBusi est Ll anselsw(Chopla9 Sq. F[. Floor Area Valera[on
p�S that he sexem t hin,frun and of basison3 of the Business vpt Professions Gvle)of
_
that he u exempt thcafrom and the bus for Ih alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the.porn st to a civil pc..try Of 3 2'VNMs*gr0 0 Occupancy Type
not mom Nan five hundred dollen($50r.
1,u awns of the propmy,a my employers with wage u Noir sole compcncollon,
will do the work and the swcsum is not mu ndcd oro@red for sale(Sec.]Baa.Business
and Professions Code:The Contractor's Liaise Law does not apply to an Owner of Required Inspections
property who builds or improves daemon,and whodonssmh work himself or through his
Own employ=,pmvidcd that uch improvements are notin i nded ora@red for We.If.
however.the Wilding or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not Wild or imprimis for p orm.of
sale.).
t1,u owner of the propeny,am icei.r cly contracting with licensed cmiri a ors 10
onsuua the project(Sec.70ad,Business and profession Code:)The Con iscmri Li
cense Law does not apply u an owner of property who builds or improve Nemon,and
who contracts for such projects with a conuvaar(s)licensed pursumt to Ne Contraction's
License Law.
lamescmsunder Sec .Bk PCfarthiltreso.
Owner Owd �.��. Date 3/Z(,
3FORKER'TCOMPENSATION DECLARA'pON
1 hereby alarm under penalty of perjury ane of N�IVfb(Iv1.9 rine antlasu:
1 haus and will maintain a Ceniacato Of Consent to mit-insum for Worker's Compcm
sation,as provided for by Section 37M of the labor Codc.for the performance of the
work for which this permit is issaQ
[]1 bars and will maintain Workers Compcnsauon Insurance u required by Section
37W of Ne Labor Code.for the performance of the work far which this permit is issued. .
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OFF EMFITON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompleted if the permit in;forum hundieddollam(SIM)
or less)
I certify Nat in the perfoanane,of the work for which this permit u issued.I shall nut
employ any person in any manner an as to become subject in she Workens Compensation
Laws of California.DO¢
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Workch Compcnsauon provisions of One Labor Code,you must
.,Z foMwith comply wit such provisions or this permit Nall W dcemrd resoked.
ZO CONSTRUCTION LENDING AGENCY
22 l hereby alarm Nm Nen is a construction lending agency for the performance of
Cli 7 tc..,it for which Ni.permit is issued(Sec.3097,Civ.C.)
QLenders Name
Z Lenders Address -
U 0 I certify than 1 have food this application and sum that the above information is
^F cora 1 agrm N comply with all city and county ordinances and state laws misting to
O V building construction.and hereby mthorim opmannuthmi of this city ro color upon the
�W almvc-mensimuA property for inspection purposen.
(We)agae m cost,Inde expenses
and kap harmless Ba city or mCppenst against
F' rg% liabilities,judgments,cos,iand expensend keep
may inmywryaccmeagainssMid City
U in emsequcnce of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON9102�(
INTIssued by: Date
SOU0.CE DTATION$. j
Re-roofs
namrc of Apphcan Ga ?Our
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or futum building occupant stun or handle NrsNous maurial
u defined by Ne Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
cWc.Scttian zss3z(a)] All roofs shall be inspected prior to any roofing material being installed.
D Yes ISINa
Will the applicant or future Wilding occupant u¢equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants u defined by the Bay Area Air Quality Managcmem all new materials for inspection.
District?
❑Ycs
IhavcrcadlCe ,SNousmaarialimgoimmc 5s .irChapadffiwif Nc Wilding
niceNm Ill Safety Code Mmsm5 rials5533and 2533a.l undcfnvnd Nvifthc Wilding
Jas not curmly has,a anon,in..it is my responsibility lo mul'y the Occupant of Ne
mqui menuwhicvchin= cmet pfionto.nouNaofaccnif¢cow O u/ryy ,SI ature o pplicant Dat
Ow)�n]Ld cot w �` Dam All roof coverings to be Class B" or better
Community Development
AM* 10300 Torre Avenue
Ft' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De utment
JOB ADDRF§Sz PERMIT #
lvU1G CRS-SCEn1T �� CuP�Tr�u
OWNER'S NAME• Kr=tJ 1nk)r,- PHO 89-L--LBSR
GENERAL CONTRACTOR: Vk k)E15o> + KAMVS 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 LSbJ S
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner,-11-1� Signature Date
Community Development Department
Building Division
City of Cupertino
I 10300 Torre Avenue
CITY OFI Telephone: (408)777-3228
OUPkTINOEFax: (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: )CEl,- ) WciPJ
Job Site Address: M 76 CGtSCErJT QP (_0CrTrN'Q- CA 25-01t
Roofing Company Name: a IZAjy\ &I
A plicant's Signature: 41-_ (I /� Date:
A \�l/�61NLX�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO v 1tt ' 2-3
REROOF
OF
CUPERTINO PERMIT APPLICATION FORM
APN # 3V3, '_1 i3G Date:
Building Address:
j007G CRE. C&J i M C0 VERX,0C CA 950 I L.
Owner's Name: KFlPhone#:
\I W o 0 89 L_Z86011
Contractor: �E So Phone#: License#:
NIDD. (tAMos �(,so� g3 IL60
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles `A Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
;A Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) 3�0 Ye^H— (ZOA.
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:
REK00;T tC-rkou jKk5-C�JC, Woo U S11hIGlSS nn n CEruKu, w, Y� Cay•W)16
Residential COmmer
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
��� REReoi=
4KPp
li able 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