05060036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 9CONTR"ACTO' WI-NFORMATION.
BUILDING ADDRESS: WESTERN ROOFING COMPANY PERMIT ND05060036
C?15 FAIT QT
OWNER'S NAME: PERMIT ISSUEOATE
MAYT N TAN
NE: SANITARY O. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nee, 0 0 0 0
pp LICENSED CONTRACTOR'S DECLARATION
x C 1 hercby affirm that l am heoused under provisions of Chapter 9(Commencing Job Des;Iii ions
==w widiSection7faaEd fDivision 30fWCBusiousend Professions Code.md my license is (1� _ dl�
^=N in full forte and effect _ GN �j m 1m
7yg License Class Lick REROOF W�SHINGLES
^Fp Dam costrazmr m �, a�[
F�
ARCHITECTSDECLARATION ] 80^
s I undersand my plans shall W used as public¢cords
pyU
30t Licensed Professional i
Oat I am exempt 1 DECLARATION y `\� a
w I I hereby affirm OW I em exempt from Wn DECLARATION
rcrs License Law for IW [I jl Llfll)
p O following reason.(Section AD1.5,Business and Professions Code:Any city m county Y p �l
K Q 0! which requires a permit us construct,alter,impmvc.demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit m rile a signed statement
'
that W is licensed pusuam m We provistnsof We Conmcmr's U..law(Chapter 9 Sq. Fl. Floor Area Valuation
'i-C (Commencing with ScCUOO700ff of Division 3 of We Buslneir and Professions Cadc)or
i that he is exempt therefrom and the basis for We alleged exemption.My violation of �M�T,i-�,r,.,k,
Section]031.5 by any applicant for a permit subjects We applicant a civil penalty of 3 CTn VT0*Yeir0 0 Occupancy Type
not more than five hundred dollars(SYXy.
❑I,a owner of the pmpcny,rr my employcu with wage u Wcir sole compensation,
will do the work,and We swcture Isnot intended oroRemd for sale(Sec.7044,Business Required Inspections
and Professions Code:The Ccumbeme,Lt..Lw does Cut apply to an owner or q P
property who builds or improves Women,and who doessueh work himselforthrough his
own employcu.provided Nat such imprusmcns are not intended or.Rest[uratic.If,
howeveq We building or improvement is sold within one year of Completion,the owner-
builder will bas the burden of proving thin he did not build or improve for purpose of
salt.).
❑1,as owner of We property,am exclusively contracting with licensed contractors to
Comwet We project(Sec.20x4,Business and Professlpns Code:)The Contractors Li
cane taw does not apply to in owner or property who Wilds or improves Wemon.and.
who contracts for such projeea with a eontneter(s)licensed pursuant to the Contractors
Liana Law.
Fl 1 am exempt under Sec. .B&P C fw this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following declarations:
1 have and will maintain a Ccruf me of Consent to self-imum for Workers Compcm
tion,as provided for by Section 3900 of We Labor Code,for We performance or the
work for which this permit is issued.
1 ban and will maintain Worker's Compensation Insurance,as required by section
"Iof We labor Code,for We performance of the work for which this permit is issued.
My Workers CompensationInsurance carrier and Policy number arc:
Cartier. �f�'I f^-1—ItAAn Polity No.: "4 �E -
CERTI I�--�OF EXEMPTION FROM R ERS"
COMPENSATION INSURANCE
(This section need not W completed if the Permit is for one hundred dollars($100)
or less.)
I Carib,Nal in We perfom est.of the work for which this Permit is Issued.l shall nal
employ anypenon in any manner so as to become subject to the Workers Compensation
Law s Of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccroricam of Exemption,you should
become subject to We Worker's Compensation provisions or We Labor Codc,you must
.J O forthwith comply with such provisions or this permit shall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(-. I hereby affirm that Were is a construction lending ageocy for the Performance of
R 7 We work for which this permit is issued(Sec.3092.Civ.C.)
Lg] Q Undoes Name
z Lender's Address
U 0 1 cenify that 1 have mad this application and some Wm We above information is
IL F correct.1 agree to comply with all city and county ordinances and sate laws relating to
0O building Convection,and hereby AUWOds mpreunutives Clods city to enter upon the
7' U above-memoned property for irspcetan purposes.
E gL (WC)agree to Ave,Indemnify and keep homeless the City of CoaCrllno iganhfl
liabilitica.judgmcns,roils and expotaes which may in any way accrue against said City
of We
of
L)z APPhis Permit.
LICANfcUNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued by: Date C-6-J—
f�,'
SOU E EGU A 1 Ns.
(� O6'OC O Re-roofs
Signature of ApplicanUCon" r Date
HAZAR US MATERIALS DISCLOSURE Type of Roof
Will We applicant or f sort building occupant ssom or handle hmaAous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and We HcaIW and Safety
Gw1,Section 25532(ap All roofs shall be inspected prior to an roofing material beim
❑Yes ON. P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nil hazardous air comaminans as defined by We Bay Area Air Quality Management all new materials for inspection.
Jisvip?
❑Yes ON.
1 have head We baramousmawrials requirements under Chaplcr6.95of tw Califon- _
ria Health&Safety Cock,Sections 25515,25533 and 25534.1 uMcrand then the huilding �� da AC_6('
does not currently have a mnam,that it is my responsibility to nobly the«cuPant of We y b ( �.�\
moot ms ustWmet ptinrm iAuabecofa Ccniricxmof Occupmry. Signature of Applicant Date
�_ 91
All roof coverings to be Class"B"or better
Ownm or authorivct agent Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: /� PERMIT#
I
o oo76
O 'S NAME: - . -� PHONE# — 2
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
8ignAture 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
V- Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
41
Owner/Contractor Signature Date
0
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY Of Fax: (408)777-3333
UPEQ IN®
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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.
. 1
Homeowners Name: Ik�Y II&I 1 J '/A-N/
Job Site Address: �/(nII II C
Roofing Company Name: W P�!! PA 4.e� 1fly C
Applicant's Signature 1
''�._ Date: 06__0
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
Sam- REROOF' OS"v
CM OF CUPERTINO PERMIT APPLICATION FORM
APN#� 2 o / Date:
Building Address:
r' C)
Ow er's N Phone#:
NIA 1, I�J 1
Contractor: Phone #: License #:
Contact: Phone#: Cupertino Business License#:
til IU
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof El uilt-Up roof
❑ Asphalt Shingles B Asphalt Shingles
Er—Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
V/ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Er
Job Description: /
✓� L o S C /Y3 WOoI P t r
Residential E?' - Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group: O
D
1
Qty. if
Applicablp 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
��^ ?