04070156 CITY OF CUPERTINO r�y'Mf -` ' '" w
BUILDING DIVISION PERMIT .�CONTRACTQR INFO � AION ,a
zUILDINGADDRESS: MONKS ROOFING PERMIT1%4070156
758 V
OWNER'S NAME: PBRMIIISUEDATE
Aih NELLI VASON 794 BERRYESSA ST --.. 07'
ONE: SANITARY NO. CONTROL NO.
(408) 262-4797
A0.CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION
I hereby aHtrm that 1 Am licensed under previsions of Chapter 9(commencing Job Description
wiOF th Section 70(X1) f an3of0m eu4nesa �LlrofesslumC tlo Ad yliccnse is
full fo War t.
:_ Lle Le. REROOF
z i- Dam Comracmr �>` n -
p� un sad ARCHrEMDEC N
0 U my uNall be oath upublic records \ , � � \I f+•_
6
LO<Fy Licenced OMI
-1 OWNER-BUILDER DECLARATION /� .I '• I full 11 \\I
I I Mothynaso Affirm ren 1 am exempt from she Cssions Yt Licence Lew for 1W U
D o following recon. emit i RG 1.5,Business and ova,de Professions h,or Any city or county
$ which requires a permit re cnnumcL apple=,
Improve,demolish,or mPAlr any nroclure
t•
thaprior t
hoitaiuumce,ahant to ma thehovisios offe,ochpormitlLinn: nth stas,mom
Ogggg�e that hebOcenmg Purwion 70des 0)of Diviam=thee0 uarmst Lkcnmlaw(C ode)or Sq.Ft.Floor f: Valuation
R Zl'he b exam with thereon]and Division r nNho B ed axe od Preon.An vi Code)or IL )
$ met he W exempt therefrom and We basis for the alleged exemption.Any violation of I
Section 7071.5 by any applicant fer,a permit subjecu the appilcam m a civil penalty of 3er0 0 Occupancy Type
not more than Ow hundred dollen(5500).
❑1,As owner of the property,or my employs,wish wages As limit into compensation,
will do the work and the atroctue is net mounted oroneced fm sale(Sm.7044,Butinesa Required Inspections
and Profamlaes Code:The Consomme,Lieuse Law does ret apply m an owner of q P
property who builds car I mproses thereon,end who docs such work himud u dunugh his
ownemPloycee.provided thatsuch impmamennan not intended m offered for sall if.
however.the building or impmvemem is mid within one year ofcomplumn.the owner.
builder will have the burden of proving that he did not Wild or Improve for purpose of
sash.).
❑1.As owner of We property.Am exclusively conuMing with licensed contractors m
rennet the project(Sec.7044.Business and PrefessiaM Cook:)The Commeota V.
caro law does not Apply to an awner of property who builds or imprew thereon,and
who contractsfor such projects with a conuacora)licensed pursuant in the C numeoh
License Law.
❑1 atn exempt under Sm. .B k P C for this meson
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby alliin under peeslty of perjury sem of the following declarations:
Ilow andwillmalnuina CeWRcemof Conontmmlf-Inaumfor Wort $Compere
sation.u provided fm by Sudan 7700 of the labor Cade,for We performance of the
.it fm which this permit la issued
0 1 ban and will maintain Worker's mpemtion Insurance.u rcgoirtd by Section
7700 of the labor Cuda,for the puf attee of the work for which this permit ie ice
My Warts 'y�vt///{Wu 'm and Polity u bar
Carrier• /' "� Polity N.
w '
CERTIFICATE OFEKEMPnON FRO W RKERS'
COMPENSATION INSURANCE
Thissection need not W completed Hthe Permit W for one hundreddollsn($100)
or loss.)
I coolly that In the puformmce of We work f whl h this permit is Issued,I&hall not
employ any person in any manner m u o heca nuc just to the Warkcri Compensate.
Laws of Celifomla.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Coolness,of Exemption,you should
become subject to We Worker's Compensation provisions of the labor Code,you most
,JO forthwith comply with such provisions u this permit shall Wdcemcd ranked.
z^ CONSTRUCDON LENDING AGENCY
E 4 I hereby adust therem
ure dis•us%ioam lending agenry for me Performance of
6i> the wort for which this permit is issued(Sac.357.Civ.C.)
W Q Undoes Name
a z Lender'sAddmas
U Q 1 unify that I ban mid Ws application and sum that she above Inform W un is
L4 f^ outran 1 agora to comply with all city and county ordinances and sum lawn relating in
DU building concoction,and hereby authors=representatives of this city o enter upon the
D7 ahovn.mengowd prepeny for inspection purposes.
LL cs agree i.uses indemnify and keep harmless We Clay o Cupenit against
rA o uses u eofthecoming expenses may in my way accmc against mid City
C.1�z" APPLIa ANT UNDe gnTtAing of this permit. COMPLY WITH LL 0 OI Issued by: Date
SOU R GU A S.
_ _ Re-roofs
Ignuurt of Apple HAZARDOUS MATERIA ISCLOSU® Data Type of Roof
Will the applicant or Nom Wilding oceupan,sore or handle huatdous material
As deOmd by the Cupeniw Municipal Cade.Chapter 9.12,and the Health and Safety
Ideas
k.Sudan u5yz(U7 All roofs shall be inspected prior to any roofing material being installed.
❑res q a
Will o,applicant i future building by the Ba este"pop
An Qu or devices
which
If a roof is i stalled without first obtaining an inspection,I agree to remove
b District? s air eonsminanu defined by Uro Bay Aree Air QualllY Management all new m erials for inspection.
nricR
❑Yes u
Ihavc mad thehmSum VIM,smgmrod2554.1undWPand Ulu if the Califar. _ JG%%/ D V
HcnW styhe.A tenant,met it ]5533and219lity to csswm thulfthc Wilding I%/!/A
not c tidy how•mnan4 Wet IL u m respaesihility onogfy the upent ofuire which must of.Ccnificate cu ry ignature of Applicant Date
Ow r am omeda ent Ll All roof coverings to be Class °Bw Or better
Community Development
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408) 777-3228
Cl OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADD) S: ^ PINXIT # 6
OWNER'S N / oSf p PHONE
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
d
/Contractor Signature ,2 Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
44 CITY OF Telephone: (408)777-3228
U PEkTI NO 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.
r
Homeowner's Name:. ) ) C. f-/ ,l �(,�) / 1/ l N
Job Site Address: �� �✓ /d v Y ,/�iyyy�
Roofing Company Name:
A plicant's Signature: Date b
ti
Greg ZLI
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o
REROOF o o
CUPEKTINO PERMIT APPLICATION FORM
APN# 2, Q Date: 1 ,1
Building Address: 0 V
Sv E .
1w=e: to
SO _I Phoyr �,' /
Contract 6 r�V` Phone#�6�_(J)� 7 LiceSnse#:
C to t: v h Phone#: , I �1 Cupertino Business License#:
Type of Roof Covering: 'L
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles cd�K, Asphalt Shingles
--0 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings O 1r{_. ❑ Provide I.C.B.O.Report#
CnS—To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
,� IFf S eke Ss�b� 4 wup ssti11 Go
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wi arming D t. t
there are restri 'ons:
Cost of Project: , / Type n: Occupan group
Qt t
ApAcable 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
3