04040201 CITY OF CUPERTINO -�r::. «.wn�z>'r::- r�r I . & •A` --t
BUILDING DIVISION PERMIT x001 AE F WINFORMATION,
BUILDING ADDRESS: PERMIT NO04040201 4040201
OWNER'S NAME: PERMIT ISSUE DATE
THOMAS SCHAF
ONE: SANITARY NO. CONTROL NO.
ARCHIECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
noes LICENSED CONTRACTOR'S DECLARATION O O O O
=�C I hereby affirm Nm I am licensed under pmviskins of Chapter 9(commencing Job Description
i with Section]IXIU)of Division Softhc FsypGls afcuiom CoM,anderyliccsuc is
imm�m an Jam/ REROOF
S U'? Liccnu eC-^
T'SD CONTRACTOR: JIM FERKEL ROO�`�nvT C�Cy1��T•T
ARCHI'IECTSD=LA A Y Y�a"V�
as ndersunJ my Plans shall sc used c m rds
emU
;ot; Licensed Prumcninn.I MAY 10 2004
S OWNER-BUILDER DECLARATION
I Mrehy affirm that 1 am exempt firm the Conlsi License law for the
OO following moon.(Section](D1.5,Business and Pmformins Cole:Any city or county
u$� which requito a Permit toconstmcl,alter.improve,demolish,or repair any structure
BFiprior in its issuanee.alsu rtyuiru lhcapplicant forsueh permiuo rile a signed statement
y<
that he is licensed putmant to the provimms of the Constructors License law(ChaPler9 Sq.Ft. Floor Area U 000
QFC (commencing with Section 7")of Division 3 of the Business and Professions Cale)or
$ that M Is exempt therefrom and the hasu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(5500).
. ❑1.asewnerarmepmpery.amyemplare�wimwagaa.�tueirxemenmpena.dnn. 36925022 . 00
will do the work and the structure is not inermi or offered for sale(Sce.704,1,Business
and Professions Cade:The Contractor's License,Law does ant apply to an owner of Required Inspections
property who build,or improves thereon,and who does such work himself or through his
own employees.provided Nat such improvements are not intended oro@red formic.IL
however,the building or improvement is mid within ane year of completion,the owner.
builder will have Ilte burden of proving that k did not build or improve for puryom of
sake.).
0 1,as owner of the pmpeny,am exclusively contracting with licensed comments to
covtme,the project(Sec.70m.Business and Profusions Cade:)The Contractor's U.
cove law does not apply to an ownu of property who builds or improves thereon,and
who contracts for such projects with a comractor(s)licensed pursuant o the Contractors
Liccnu Law.
❑1 am exempt under Sec. .0 k P C far this moon
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby atiren under penalty of perjury one of the following declarations:
1 have and will maintain aCenifiwu orCovem m xelf-insure for WorkcraCompen-
EMCOMPERSATION
ided for by Section 3100 of the labor Code.for the performanea of the
h this permit is issued.
will maintain Workers Compensation Insurance,u required by Section
bor Code.for Ne performance of du work for which Nis permit u some.
ampensado➢.ytmrsnce artier and Policy number art
11
�Pnld.No.;
CERTIFICATE OF EXEM N—FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not M computed if the permit is forone hundred dollars(SIM)
or less.)
1 ccnify that in the performance of Ne work for which this Permit is issued,I shall not
employ any person in my manner an as is become subject to the Worlmn''Compeva0on
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Camficme of Exemption,you should
become subject to the Worker Compensation previsions of use,labor Code,you must
.J O Tom" ith comply with me,provisions or this permit""1 be domed revoked.
z CONSTRUCTION LENDING AGENCY
H Ihereby affirm that there is a conslmction lending agency for the Performance of
C the work for which this permit is issued(Sex.309],Civ.C.)
Lenders Name
=Z Lenders Address
C.1 p I ccnify that 1 have mad this application and sum that the above information is
Lt. correct.I agree to comply with all city and county odinancos and sale laws misting to
C)�U building covuuction.and hereby mthoixe repmunutives of this city m enter upon the,
ahove-menuonW property,for inspection purposes
gy (We)agree to on.indemnify and trap hismleu ftCity of Cupertino egainal
ry Iiebiliti ,judgmcoa,eests and espcmcswhich loan ways. itirstsaid City
V z APP, NTeUNDERSTANDSthis AND W t 0 V TH ALL NON-POINT Issued by: Date
50 C REGULATIONS.
C Re-roofs
rgnau f pplican✓Conu-to' dm
RDOUSMATERI DIS OSURE Type of Roof
Will the applicant or future Wilding uccu rehandle havardovs material
u defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
otic.Section 25532(a)?
r]Yu pyrll� All roofs shall be inspected prior to any roofing material being installed.
Will the applicmt or foto¢buiIdi ..pan,use equipment to dewma which If a roof is installed without first obtaining an inspection,I agree td remove
mit bixarJnus air cor umimmis as d cd sy the Bay Area Air Quality Management all ne materials for inspection.
District?
❑Yes
Ilia
mad the hvardous maenalsmgv' nems under Cluper G95 of the Califor.
ma Hcahh afmyende.5emov 254)5.35 3 d understand this if the building
drcs not c ntiy have a mnam Nat it i y sp ill m nndly the acupmt of the
rtgaire wmehmnslMmetpin an nifiew of Occa amy. l i na re of Applicant Dat
owner tar utbofiacdagem f Dam , All roof cove 'no be Class"B"or better
Li
x Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De fitment
JOB ADDRE S: PERMIT #
OWNER'S NAMK. / PHONE #� 3
GENERAL CONT CTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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 aC
Septic Tank
Sheet Metal
Sheet Rock
Tile
I
I � �
vp9r/Contractor Signa Date
Community Development Department
( Building Division
J U City of Cupertino
' 10300 Torre Avenue
ILCITY OF Telephone: (408)777-3228
PEkTINO 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: !S(f
Job Site Address:
Roofing Company Name:
Applicant's Signatur : — Date:--(J5/
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF C5 C> ° Z I
CUPEI_TINO PERMIT APPLICATION FORM
APN#
Building Add s:
G
Owner's Name: Phone#:
Contractpr: Phone #: ^� Licensees:
i G �
Contact: p Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles er—`Zsphalt Shingles
B--VVood 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: 0—
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restric ns:
Cost of Type of o t t' n: Occupancy gro
V74W -190
Qty 9-
App I'c l 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
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