05090193 CITY OF CUPERTINO tea, ^• x��%"' ' x` '° '
BUILDING DIVISION PERMIT 'CONTRAGTORINFORMATION--,.
BUILDING ADDRESS: PERMITNO.05090193
• 10558 CYPRESS
OWNER'S NAME: PERMITLSSUE DATE
jib ALICE LOAFMAN 09/28/2005
NE:
SANITARY NO. CONTROL NO.
AS
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
COO LICENSED CONTRACTOR'SDECLARATION Job Description
m 1 barony affirm that I am licensed under previsions of Chapter 9(commencing
;ZW with Section9gK)of Division 3 of the Business and Professions Code,and my license is
n`o�'+ in rml mese ane rc_ea Z -� REROOF-REMOVE SHAKE/INSTALL 30 YR. SHINGLES
j z License Clea LIC.a'
�o mo c Conuacmr� CONTRACTOR: JB ROOFING CO
ARCHITECTS DECLARATION
lundcrsmnJ my plans shall Mused as Public records
JyU
k LL LjaCnicd Pm re5510ndI r+.,
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OWNER-BUILDER DECLARATION �t ('{'r(�L—
qy I hcmhy affirm that 11. ucmpl from Ne Cessions o License Law for the
5 p o which ng tures a PecNun AA LS. t.altars and Proimprove,
ma Code:Any canysomCounty - �" >•I�.:,t
m� which requires a Permit w consumer.alms impmw,demolish.or repair any strvnum
prior In its issuance.also rtqunes the applicant for such Permit fle a signed statement
x NatbculiccrmJPursuanuothcPm.isiouofNcContrumr'SUCCnXLw(Chaplcr9 Sq. Ft. Floor Area F gqValua[IiQ1111812O
xt-m (commencing with Section]0110)o(Division 3 of Ne Business and Profusions Code)or aX� Q�tlO
i Nal he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant 10 a civil penally of APN Number U' t �9 Occupancy Type
net ream than five hundred dollars(resco). !' N 'Y �
31630054 . 00 J i hI/
❑huowner of Ne property,mmy employees with wgesas dale Solt eompenution, ��L((,�L/'1. it Vie:11 1
will do tinworks,and the structure u not intended mel@rtd foush,(Sec.7044.Business Required In actions _ V
and Professions Cade:The Contractors Liceme law docs trot apply In an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided thv such improvements ve not intended or.fored tensile.If.
howevu,the building or imprommnm i5 sold within one year of completion,the owncr-
builder will five tfi burden of proving that he did not build or improve for purpose of
ask.),
❑1.as owner of the progeny,am exclusively contracting with licensed contractors to
consumer the project(Sec.7064,Business and Professions Code:)The Contractor's Li.
cense law does not apply to in owner of property who Wilds or improves thereon,and
who contracts for such projects with a contractor(s)licemed pursuant m the Comensi nes
Ljceaa law.
rt
❑I am afempt under See. .B&P C for this ration
owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,am of the following dalamions:
I have and will maintain a Ceniloo eof Cement to self-insumfor Workers Compen-
sation,as provided for by Section 3900 of the labor Code,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance,u requirod by&Coca
37W of the labor Code,for the performance of the work for which this Pemlll is issued.
My Workers�Compensation/_Insurance Cartier and Policy number art:
Carticr,S //if�eL-F'+'wv/s Policy No.:
CERTIFICATE OFMPIONFROM ORK 5'
COMPENSATION INSURANCE
mo,section need not he completed if rk permit is for one hundred dollars(SIM)
lose.)
1 certify thut in the performance of the work for which this Permit is issued,1 shall Caul
employ any person in any member so u in Wcomc subject o the Workers'Componsarion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become saucer to the Workcr's Compensation previsions of the labor Code,you must
�Z foMwith comply with such provisions or this permit Shall be deemed rewked.
zCONSBUCTION LENDING AGENCY
'rte+ Ihereby affirm that there is a construction lending agency for NC Performance of ,
a the work for which this permit is issued(Sec.3097,Civ.C.)
D]
Lord r' Namc
=Z lenders Address
U O 1 certify that 1 hose read LOS application food sum that the about information is
F
coma.1 agree to comply with all city and county ordinances and sum laws relating to
0U building construction,and hereby audwrim ropresemmives of this city 10 enter upon the
},W above-mentioned properly for impaction purposes.
(~(1. We)agree to save,indemnify and keep hamnless the City of Cupertino against
eA liabilities,judgments,cuts and expmasea which may in any way amwo agatml said City
U Z in consequence of Ne granting of this Permit. i
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:91taelca Date T y sip-O e
SO RCE REG LATI
Re-roofs
Slows re of Ap,bCmu C.mwm or Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Of future building Occupant store or handle ha mdous material
u defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
we,Scaann25532(an All roofs shall be inspected prior to any roofing material being installed.
❑Yu 0N
Will the applicant or future building=upon(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
or hazardous air coomminann as definctl by the Bay Arca Air Quality Management all new materials for inspection.
isuict9
❑Yes C]No urs
I have mad Ne havardms materials monomania under Chapter 6.95 of dm Califor.
ria Health&Sultry Code.Scctimrs 25505,25533 and 25534.1 understand Nel iflhe Wilding l /t
dots ret cunently how a lmnam.dem it is my¢spansibilily m /nomy We<upant of Nc _)A,(
rtgmmntents wmtAm 5lk goer ret itivancc era cenifiaam pr fJcmpancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or amhori cd agcm Data
Community Development
P F 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
Lo 5 R Cc SQ QD/4
OWNER'S NAME: PHONE # o S —o
GENERAL CONTRACTOR: 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 C
lJ Ord Q I—Z S'- lJJ .
Owner/Contractor Signature Date
j Community Development Department
Building Division
City of Cupertino
•1�% i 10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U 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.
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.
Homeowners Name: 4 Q.._c ' . ,r,4,
Job Site Address: Io s S g 1�C_�i Iia Q ��•v
Roofing Company Name: –1_ U• IL D A I ., co
Applicant's Signature: ���j E ty Date:61-?_ U—
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
�� CITY OF CUPERTINO
i REROOF os�' °
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # D Date:.
n14 -2 9 - 2coS
Building Address:
S S 2i.
Owner's Name: Phone #:
946-72 70
Contrxto Phne#: License #:
0 5 - I3Z
Co tact: Phone #: Cupertino Business License #:
kos i 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles P( Asphalt Shingles
2. 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:
Jobb scription:
/ p
Residential J Commercial ❑ _._ ...
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type f Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING