03100017 CITY OF CUPERT[No
BUILDING DIVISION PERMIT C0NTRACTOR-INF;0RMATION. .:;
BUILDING ADDRESS: PETERSEN—DEAN INC PERMIT NDO 3100017
OWNER'S NAME: 7980 ENTERPRISE DR PERMIT ISSUE DATE
INE: (510) 494-9982 SANITARY NO. CONTROL NO.
ARCHTTECr/ENGINEER: BUILDING PERMIT INFO
BLDGELFCT PLUMB MECH
I1 0 0 0
up LICENSED CONTRACTOR'S DECLARATION JOtJ De�B(I�QgI
b❑ 1 hereby affirm that 1 a licensed under provisions of Chapter (commencing vA��
:Zw with Section 71X0)of Division 3 Ofthe Bu' «andNfuiu V<.andm iccnu is
>>„ inmueClassa {e— REROOFall
s,�? License Class
Date_ Cuntoctor Nov 1
1 ic 2l ARCHITECTS DECLARATION 02003
i a 1 understand my plans shall M1e used as public records
aU
u. LiccnuJ Professional 'C as.
to �� D'N(
g OWNER-BUILDER v '
$ 1 hereby affirm that 1 am exempt from the Contractor's Liecom Low for the
O o following mason.(Section 7031.5,Business and Professions Code:Any city or county
m R� which requires a Monitor mnetue,alter,improve.demolish,at repair any structure
prior n its issurrnce,alsrimmau the applicant plasties permiuo file aligned statement
as that he is licensed pursuant sola,pmisim I the Comnctori License law(Chaptor 9 Sq.Ft. Floor Area Valuation
_Fe (commcnei ag with Section 700())of Division 3 or the B usiness and Professions Cndc)or
a 5 R that he is exempt trades..and the basis for the alleged exemption.Any vinleion of 36221035 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to ma civil penally of APN Number Occup
araC Type
not mom than five handled donors(650Y yP0). P
❑has owner of the propcny,or my cmploycu with wages az their sole compensation,
will do Ne work,and the structure is not intended or offered for sale(Sec.7094,Business
and Professions Code:The Conuaclnri License Law docs not apply m an owner of — Required Inspections
propenywho builds orimprovem Merton.and who does such work Mmol!or through his 307 - INSULATION
Own employers,provided that such improvements are not ntended or offered ler sale.If, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion.she owner-
builder will have the burden of pinving that or did not wild or improve ler purpose of 602 — ROOF PLYWOOD NAIL
m 1.asOwnerofshe 603 - ROOF BATTENS
❑ Sm.704 am exclusively contacting with licenser mmicer Ors m
constun dee not applytoanowneronandrtywhobuidsorimproCOntsnan. Li 6O4 — ROOF IN-PROGRESS
cense Law apes not apply m an owner of property who builds or improves Comm.ma
whocontractsLace for soca projects with a contractor(s)licensed pursuant to tM Comrador'a
License
Lew.
❑ 1 am exempt under Sec. .B 8 P C for this rtason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I have and will maintain a Cenifc re of Continuo slf-insum for Workers Compen-
sation.as provided for by Section 3700 of she Labor Code,for the performance of she
work for which this permil is issued.
A7I base and will maintain Worker's Compensation Insurance.az required by Section
00 of We spur Code,for the performmce of sac work for which Nis permit is issuctl.
My Wor1SCompensation Insurance carrier and Policy number am:
Career: 4Mea (]ggaA— Policy N Z r b D O
CERTIFICATE OF EXEM PPION FROM AR KERS'
COMPENSATION INSURANCE
(Thisseion need am be compmted if tae permit is roaonc hundred dollars(6100)
or less.)
1 unify Nm in the performance of the work for which this permit is issued,I shall not
employ any person in any manner m is,to become subject to the Warmly Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,at making this Cecil Ocase of Exemption,you should
become subject to the Worker's Compensation provisions of the Ichor Cod,,you must
D,Z forlhWlth comply with such provisions or this permit shall be deemed mvcked,
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
x > Its work for which this permit is issued(Sec.3097,Civ.CJ
A Q Lender's Name
1 Lendeis Address
Z
1 certify Nat 1 have read this application and slate that the mase information is
f" mmect.1 agree to comply with all city and county ordinances and state laws relating to
DU building construction,and hereby,mhoriae representatives of this city to enter upon the
W ,hove-mentioned paop,dy for inspection purposes.
y y (We)agree to cast,indemnify and keep harmless the City of Cupertino against
I judgments,the costa and expenses which may in any way accrue against said City
,'� in conscqucn fthe graining of permtl.
'—' APPLIC UNDER ND WIL OMPW Ns. WITH ALL NJp�N-Pp INT Issued by: Date
so J6/ZI'7
Re-roofs
Signature of AOPlicaDam
HAZARDOUS S MATE RIALS DISCLOSURE Type of Roof
Will are applicantmfuture building Occupant store or and
Heirousd Safety az defined by the Cupertino Municipal Codc.Chapter 9.11.end the Health and Safely
Code.Osoon25531(a)� _No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfuturebuilding occupant uti equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha,amntis air ennlaminam az aenaed by the Bay Area Air Gti,my Management all new materials for inspection.
hstHeo
❑Yes No
I have mad the hamNous materials requirements under Chapter 6,95 of the Califor.
niceHealth6 cry crsm
Code, 'hon 05,25533 d8534.1undndshaiftbebuilding
docs not- say h 0 it u re pmosibil, m mmi Ilic aeupant of to J
m be c orertRrivpanpf. /O� Signature of pplicant Date
lane nr amnpd..,d agent DateAll roof coverings to be Class "B" or better
10/02/2003 19: 22 5105303202 LEGALITIES INK PAGE 06
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Community
Community Development Department
Building Division
}: i City of Cupertino
{, 10300 Torre Avenue
i' Telephone: (408).777-3228
CITY.OF Fax: (408) 777-3333
CUPEkTINO
Building Department
rt
Subject: Re-roofin4-'policy for the City of Cupertino
1. Prior to permit issuance;you must agree to comply with 1997 UBC Standards
and manufacturer4 specifications on.re-roofing.
2. New roof coveriri€ts shall not be applied without first obtaining all inspection
and written approtral 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 itispected prior to any roofing installation.
4. To receive a final,54,.-n 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.inst4,led, a ply-,wood nail inspection is required.
6. Any roofing whicl{ is applied without first obtaining an inspection,
will require the rer9noval of all new material down to the sheathing,
so a proper city i4pection can be performed:
IMPORTANT: 5
1. Flat roofs must hail-ea minimum of?'c " per foot slope and demonstrate
that there is no ponding.
�. An I.C.B O. report;s required to be on the job site at the time on inspection.
1 understand and will co4iply with the above stated policy on re-roofing.
i�
Homeowner's Name:
Job Site Address:
Roofing Company.Name:S ,_La
Aplicant s Signature: _nf Date:. 1? Q3
1
Greg. eel
Building Official
Revised 1/30/03 .
Pnnled on Rnc;cled Psoer
10/02/2003 19: 22 5105383282 LEGALITIES INK PAGE 05
/012,
North Bay Permit Service
CITY OF CUPERTINO ..iA ; 3988 Somerset Ave
v. REROOF Castro Va , CA 4546
1 �
�CUPERTINO PERMIT APPLICATION FORM �L s -i23 �-
APN #
36z Z
Building Address: (� f
Owner's Name: iPhone #:
Contr to
Phone #: License #:
Contact: Phone#:So& Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof e ❑ Built-Up roof '
Cl Asphalt Shingles > Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) _ U Other(Specify)
Number of existing coverings_. ❑ Provide I.C.B.O.Report#
❑ .To be Remobed. ❑ Provide Mfgr.Installation Specs.
Have Read, Understand and 1 . 11.Comply With Cu ertino's Tear Off Policy
Job,Description: r �O
Residential .Commercial p
8
Fire Zone: _ Yes. ❑ No ❑ Confirmed with Planning`De t. if
there are an restrictions: i
Cost of Pro'ectp: i Type of Constructi i Occupancy grou
1 .
Qty. if
Applicable Fee;,ID Fee Description Fee Group
1I BPERMFEE Bldg Permit Fees BUILDING
BENERGY _ Ener BUILDING'
t BSEISMIC", — ���Seismic Fee Res BUILDING
BSEISMICQI j, Seismic Commercial BUILDING
BPLANCHK i Plan Check Fee BUILDING
BUSLIC —_, Business License BUILDING
7
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