04020073 CITY OF CUPER'fINO 0 ' -- h 77775Z7_11_11 -' '-
BUILDING DIVISION PFRNIIT L£C0NTRAC"T0R3INF0«�R'�' L ITIWt;
BUILDING ADDRESS: J & J ROOFING PERMRND04O2OO73
1 0578 E ESTATES DR
OWNER'S NAME: FERMUISSUEDATE
RADHA CHAND
ONE:
SANITARY NO, CONTROL NO.
(408) 738-2314
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Loa LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm that 1 am liavcd under provisions of Chap.,9(commencing Job Description
t� with Sectio OMA of Division 3af me Basinras dProfessinvC do ad my license is
n a a full force of ^�
zgzimemeCfsss_ '"e ec 7Ln(•.ylZ REROOF
Contractor T/O EXIST. SHAKE/RESHEET 1/2 "OSB PLYWOOD,
ARCHITECPS DECION
z lundarsmndmyplans.h.11WusedisIjRDE!i records 3OLB FELT 7 30 YR. ASPHR1
�yU
O t; Licensed Professional
OWNER-B UILDERDECLARATION
<� 1 hereby affirm the I atm exempt from me Contractor's License Law far the FEB 1 3 2004
n O following maznn.(Section 7131.5,Business and Professions Code:Any city or county
which requirei a permit to consuum,Sher.improve,demolish.or repair any structure
Zi
prior 4)its issuance.also requires me applicant for such Nonniuo file a signed 9atement
< Ba kislicensed punuantaddoeprovisions ofthe CormacmrilimnuLaw(Chapter 9 Sq. Ft. Floor Area IpPq� IIk�e� luation
SFO (commencing with Section 7")of Division 3 of Be Business and Professions Cnde)or `�'���®�I�I
a. Nat he is esempt thcref o.and the Ensu for the alleged caereption.Any violation or $7000
Sermon 7031.5 by any applicator for a permit subjects IW applicant to a civil penalty of APN Number Occupancy Type
not mom man Ove hundred dollars(5500).
❑1,as owner of Ne property,or my employees with wages as Meir sole compensation,
will do the work and me Structure is nutimmialed or offered foraale(Sec.70,14,Business
and Professions Code:The Conuacrors License Law dots not apply m an owner of
Required Inspections
property who bui Ids or improves thereon,and who docs s uch work himse If or through his
own employers,provided thmsuch improvements are not intended oroffered for ask.IL
hmrever,She Wilding or improvement is sold within ane)ear of completion,me owner.
builder will have IW Eurden of proving Nat he did nm Wild or improve for purpose of
sale.).
❑1,as owner of the propany.am exclusively conuscom,with licensed mnvacmrs to
conation the project(Sec.7044,Business and Professions Code:)The Cardamom.Li-
cane Law docs not apply to an owner of pmpeny who Wilds or improves Oemon,and
who contracts for such projects with a contractor(s)licensed pursuanuo the Convacwr's
Licence law.
19 l am aemp,under Sec. ,B&PC for this ration
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oz of Be following declarations:
I have and will maintain a Certificate of Covent Ir self-insure for WorkeraCampen-
sation,.s provided for by Section 3700 of Ne IaWr Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as requited by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compevmion Insurance carrier and Policy numb,are:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,This Section need rat W completed if use permit is fm one hundred dollars(510(y)
or Bart.)
1 cenify Out in Be Performance of the work for which this permit u issued,1 shall not
caw of .11 to F rq bl5omc subject to lM Workers'Compensation
Lawsyof Cal' m �"/
lxme aTO P ANT:If.is artur making this provisions
n s of of Exemption.you should
We me su a m me Workei s Compensation proviaiom a(the talar Code,you most
.J O foMwith comply with such provisions or mu Permit Shall W deemed¢voted.
Z'N CONSTRUCTION LENDING AGENCY s
[-. I hereby affirm mar there is a conswcrin t lending agency for the perrormance of
a the work far which this permit is issued(Sec.3097,Civ.C.)
W Q Under',Name
6. Landers Address
D
U C) I cenify Nat 1 Nate mad Nis application and torte mat the above information is
W F correct.I agree to comply wire all city and county ordman es and sum laws relating or
0U Wilding cenametLion.and hereby autharix¢pfcotomivea of this city to enter upon Nc
r W aWve-mentioned property ror ivpecuon purposes.
(We)agree w taut,indemnify and kap harmless the City or Cupertino against
F' y liabilities,judgments.costs and expmtses which may in any way seers,against said City
U aZ in consequnrce of the gmmi ng of this Permit,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E EGULATION �,L A�l&0
21110 ay Re-roofs
na mof ApplicanUC racer ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant store or handle havNous material
as defined by But,Cupertino Municipal W l Code,C7upter 9.13.and me Health and Safety
alc.Section 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs
1 If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
mil he
air contaminants as dermad by the Bay Area Air Quality Management all new materials for inspection.
District'
❑Yes 21Nu
I have read me hvardnusma¢rials regsimmantsundeeCNpte16.95 of Ne Califor- \ _
maHealth&SafetyCode.Sections 25505.25533 and 25531.l undersand matifte Wilding ✓ 2 �d 0P/
does out currently have a tenant that it u my ruponsihility w notify She occupant of the -7
rcquimmc h,Ita mclpdorwissuaneor.cealiencofOcap rya r
tureofApplicant Date
r autharizW agent ale
All roof coverings to be Class "B"or better
1 Community Development Department
" Building Division
City of Cupertino
10300 Torre Avenue
" CITY OF Telephone: (408) 777-3228
t
Fax: (408) 777-3333
U P E k I N O
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:
Job Site Address:
Roofing Company Named �.) W J �c' 0 0 a--L
Apeellicant's Signa e: Date: ?-/ -6-/
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
0
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# r7 Date:
Building Address/73
n✓` -S TC t r ii7ZivC C 5"0 /
Owner's Name: Phone#.-
Contractor:
;Contractor: Phone#: License#:
* 1_1) CC 43 orl_15 0S - 4/J - 30sa 7669/z
Contact: ` Phone #: Cupertino Business License#:
otv S7evCn/San/ 9 — 4 3/ -3092
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
J. Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) p Other(Specify) tact 65$ 006 Y3a16 Fe�f
Number of existing coverings ❑ Provide I.C.B.O.Report#
A To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: tg
Job Description:
eX£ rsrr flgeP Pdor -Wee> " 059 nklU . 3016 reH V 30 a!T N.' fps
Residential ® Commercial
Fire Zone: Yes 0----No-F,� Confirmed with Planning Dept:-
there are anyre tric 'ons:
Cost of Pr 'ect:�700a ea ) Type of Construction: Occupancy oup:
/ ,4�or
Qt !if
A livable 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
6V
�a �' 2O
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEI,TINO
Buildin De artment
JOB ADDRESS: PERMIT #�
p - T
OWNER'S NAME: )}6D Hill 1 K PHONE #
GENERAL CONTRACTOR: d tZaa F�:A( FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin 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 NEz IUM- 6a ZIC 2
Septic Tank
Sheet Metal
Sheet Rock
Tile
2 8�
�` Owner/Contractor Signature ate
10/28/03