040401802
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CITY OF CUPERI'IND
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION
BUILDING ADDRESS: _
E ROOFING & CONSTRUCTION I
�RMIb1?040180
OWNER'S NAME:
PERMIT ISSUE DATE
2004
PHONE:
SANITARY NO. CONTROL NO.
.408)925-9995
ARCHITECT/ENGINCER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSE.. CONTRACTOR'S DECLARATION
I M1acby af0r that 1 am licensed unJcr provisions of Chapter 9 (commencing
.IOb De$GrI tl D
with Section ]IXIB)orZ)11�i on3af,Bt1 Business and Profcssimu Code, and my license is
{,In�fl�tl LE 0),
iofullfostendcfrccY' ��
2�IS`l
EROOF Wil �( `1em
/�
Liswnu s ll�� Lic. x
Dam ter
ARCHITP.CTS ECLA
MAY 21a 2004
1 undcrnan my plans shall uuR resp hlia coNa
BUILDING
...... cd Poressonal
OatNEDER.ECLARATION
1 hereby affirm Nat I errem exempt from the Contnaors License Law for the
ng reason. (Section 7f13sul Business and io or Any city or county
which
which requires a permit mnswct, alter, improve, de
improve. li h. fi repair any structure
its re h Permit t
priortosl issuance,alsontquite the am for Conpeemiu0ieIeasignetstatemem
that hoescing wJ pursuant of the Contractor's UcenseLaw (Chapter
the")
Sq. FI. Floor Area Valuation
7to
(commencing with Section ofprovisionsDivision 3 of the mtl Profen or
of D alis vi Cmle) or
...
Oat 7 exempt therefrom and the baso fm the
r and t allegedoumpdon. Any violation of
y
Section
io subjects th
by any applicant for a permit aubjcas me applicam to a civil penalty of
3 5 6 ARN ]NEvuRt
Occupancy Type
than
not more than Rve nOnaroa amiss (stool.
P Y YP
01.m owner of the property, or my employes with wages as their sole compensation,
will do the work. and the structure is not intended or offered for sale sm.7D44, Business
and Professions Cade: The Commucto's Licemc Law daas not apply in an Owner of
- Required Inspections
Property who build, or improver thefeon. and who cessation work himselfmr through his
Own employma. PrDvidcd that Such ;mpnOwnr LLarc not intended or offered for sale. If.
however, the building or improvemun is sold within one year of completion, Ne owner.
builder will have the burden of proving that he did not build or improve for purpose of
-
.Is I.
0 h es owner of the property, am exclusively contacting with licensed contractors to
cmmrom the project (Sec. 7044. Business and Professions Cotler) The Contractor's U.
stns law does not apply to an owner ofpropcny who Wilds or improves diction. and
who command for such projects with a condactor(a) licensed pursuant o the Contractor's
License Law.
0 l am exempt under Sen. ,B&P C for this modern
Owner Date
WORKER'S COMPENSATION DECLARATION
I lteaby of irre under penally of perjury one of the following declarations:
01hoe and will maintain aCcnincamof Cot nuoulf--insumforWorker'sCompcn-
cation, odprovided for by $inion 1]00 Of the I�We Code, for the performanm mf sM1c
for which this peril is issued.
I ban and will maintain Workcri Compensation Insuana, u inquired by Section
IXI of the Labor Code, for the petformanee of the work for which this permii t ,sued.
Wor 's Compens 'an Insurance carrier and Policy n Mf art:
Cartier. Policy No,
CERTIFICATE EXEMPTION FROM WORKERS'
COM ENSATION INSURANCE
Cbis.section need num W completed if the Permit is prom, hundred dollars (510)
)coal
I certify Nat in Ne performance of the work for which this permit is issue4l shall not
employ any penin in any manners r as set Wm rn subject to the Workers Compenaatien
Laws of Cahrom;a. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should
become subject m the Worker's Compensation provisions of One labor Code, you most
forthwith comply with such provisinm or this permit hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hemhy affirm Nat there is a cont ction lending agency for the performance of
the work fur which this permit is issued (Sec. 3097, Civ, C.)
Lender's Name
-
Lenders Address
1 certify Nam 1 have read this application and a.m the the aW.e inftamad. is
— -
Correct. l qct to comply with all city and county ordinances and its. laws slating to
'
building coneuustion, and hereby aahoriu representatives of this city to enter upon the
entionrA property for inspccsionput,
(We) agree to save, indemm fy and keep harmless the City of Cupenine, against
"bsjudg nd. costs and expenses which may in any way accrue against said Ci ty
I.rmiN ofthis permit.
L COMPLY WIT ALNON- 1Ni
Issued by: Date
MOUR.IONS.e-roofsVComracttirAZARDOUS
Type of Roof
MATERIALS DISCLOSURE
Will ban applicant or fusion building Oodradnl amore or bandit haardous material
az defined by the Colscrono Municipal, Code. Chapter 9.12, and the Hcaldt and Safety
Code. Section 25532ta)? /
Dyes C0No
All roofs shall be inspected prior to any roofing material being installed.
Will mea applicant or future building occupant use e m
pr. seequipment rte devices which
If a roof is installed without first obtaining an inspection, I agree to remove
g
emitict' saircomaminand ErirmJbytheBayAmaAirQualityManagemcm
District? �
❑Yes No
allnewmaterialsforinspection.
lhave mad thchavarcdOM2mrials5533 ndc 534.dcu Chapter 6.9 of the Califon
ria Hc'gtth&Satny CUJc, Sccaord 25505, 255)7 ant 255}q.l unJcrsmndth ifd Wilding
'%�\�� `/�\) '/\�(_`Iy II
f
dw not c ro am. Nam I upom0., m netify me pant of the
reyuimmcO .e an n O„o p nor.sen;rtamortppan�ySigna[ure'ofApplicant
V
Date
Owner orauthorimd agent / t�
All roof coverings to be Class "B” or better
D„�
Community Development
* 10300 Torre Avenue
4✓" Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�UPEkTINO
Building Department
JOB ADDRF,§O: 12-2-9 �A
PERMIT #C) 0 �
OWNER'S N Vl Y N-oj
ONE # %-�I5_111
GENERAL C NTRACTO ti Roof -IN(,
FAX #
C0�ST71ut,Ti u}J i�
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
4l2`i l v
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
i
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Wit t lk4`S l NC •ATFLtt
Septic T
Sheet Metal
Sheet Rock
Tile
4l2`i l v
Date
�CIN OF
UPEkTINO
9
t
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.
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: CL- I ff 0,1" Ad l ^_ II /l
LSQz
Job Site Address: 2z 2 ` 2° S hi Z ,C
Roofing
Greg CgXteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: 4421 k4
Il"L c -
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CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF Oq
PERMIT APPLICATION FORM
APN # 3� O .Z /
Bld Permit Fees
Date:
BENERGY
Building Address:
222 'A1J�h
I,tKC��
Owner's Name: C
Phone #:
40k-4%- 6Y17
ContractorPhone #:
(, �utlY lug h
/License
12S_ 1" h
#:
TZ�51
Contact:i I Ute' �uPhone #:
CIN
Plan Check Fee
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed: 7-1) v
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
�r�I Wood Shakes
)0<,
❑\-Wood Shingles
L3 Asphalt Shingles it
Wood Shakes \t
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings I
❑ Provide I.C.B.O. Report #
0� To be Removed
CI Provide Mfgr. Installation Specs.
I Have Read, Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Description:�ItFl�4s l LAqo—
w Vn6 1N -4A -Lt, 1jL-,J
I
N lu�li UeL.I
Residential Commercial ❑
S11 KK�
Fire Zone: Yes
Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Pro' ct. 6 Q(} N_ Type of Constructio Occupancy group:
��
Qty. if
Appli bll)
Fee ID
Fee liesrrintinn
P.(:rnnn
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
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