04080024 CITY OF CUPS IMNO h
BUILDING DIVISION PERMIT MCCNTRACTORINFORMAT
70N.'
BUILDING ADDRESS: PERMIT NO.
WEST COAST DEVELOPMENT 04080024
20222 RP_RGQ T)R
v OWNER'S NAME: PERMRLSSUEDATE
law PT—M—A—DEN
IARC[711��/�NGINEER:
SANITARY qt*OLNO,
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r I 0
.jroo LICENSEDCONTRACTOR
under
DECLARATION ypp rpt �['��tJob 111e$Qrl ton
�u F 1 Octeby affirm mail am licensed umJer provisions of Chapter 9(commencing 11�q/ywa �1rYC1kGp3n3MB00
¢a with Sc ih 7 )of Divuiom30f Ne ut�a d Prof.,,,.Codc.and mylicsnx is uB �7YYY rrr
�qi u«°tiro a; tc.%.� ZZ REROOF
n F-� Date Cunlracwr J
\/J ARCHITECPS RATION .�
wa tyr(d.cod my plans shall beused ublie re,nrds r s ' 200
]yU
SON Licensed Pmfcisinnal ®®® rI
g OWNER-BUILDER DECLARATION (f�a 8 ®�p� 11
1 hereby masio affirm that 1 am exempt from the Contnnoh License Law for the 'tLVy�( nu�V"
c If
o following mama section](171.5,Business and Profcsxinm Cndc:Any city m county
K m 8' which requires a permit to ennsomm,alter.improve,dcmoltsh,or repair any Comeau,
OC
¢i priorm its issuance,also muton the applicant for such Permit o Glc a signed statement -
pZa that be is licensed pursuant to the previsions of me Contractor's UccnxLaw(Charter 9 Sq. Ft. Floor Area Valuators
(commencing with Section 7")of Division 3 or the Business and Pro@ainns Code)or
i Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o acivil penalty of 3 2 'NeCO 0 Occupancy Type
not more than five hundred dollars(SSW).
I,m owner of the pri,eirty,or my employees with wages as their role compensation,
will do Bic wort and Ire structure is not intended or offered for sale(See.70s4.Business
and Professiors Code:The Comuanors License Law dors not apply to an owner of Required Inspections
property who builds or improves thereon,and who docssuch work himself or through his
own employnes,provided Nat such improvements art nos intended.,offered Bar..1,If.
however.the building or impmvement is sold within one year or completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of
sale.I
1,as owner of the properl am exclusively contracting with licensed contractors to
consoma the project(Sec 7054,Business and prefesumnt Code:)The Coma is L4
crouse law does not apply to an owner of property who builds or improves themom,and
who contracts for such projects with a compactor(s)licensed pursuant to Ne ConUaneh
LieCa o Law.
I am exempt under Sec. B h P C for this motion
Owner Data
WORKER'S COMPENSATION DECLARATION
a I herby affirm under penally of perjury one of the following declensions:
L37W
I bac and will maintain a Certificate of Consent m self-imum for Wmker'sCompere-
n,as provided for by Section 3700 or We Labor Code,far rhe performance of the
for which this permit is issued.
have and will mainuin Wmkcr's Comensation loomm nce,ss mounted by Section of the labor Code,for the peformance of the work for which this permit is issued.
Wmkcr' Cnmp�emauop.lnsman dPalieyoumberamer. 7 1:(�� j—yaa�[ nrtmrPolicY
CERTIFICATE OF EKEMPG MWOR ERS'
COMPENSATION INSURANCE
mus section need not W completed if the permit is for one hundred dollars IS I00)
less.)
1 ccnify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner an as to become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making lots Comficaue of Eacmlulon,you should
become aubjces to the Worker's Compcnsvion provisiona of the Labor Code,you..at
Z forthwith comply with such provisions or this permit hall he deemed aveed.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency lot the Performanceof
C the work for which this permit is issued(Sec.3097.Civ.C.)
W 0 Lendcr's Name
D z 1<ncer's Add.,
CJ Q I certify that 1 have read this application and sate that the above information is
W t: correct.1 agree to comply with all city and county ondran es and star laws relating to
DU building Construction.and hereby authors mpnsensatives or this city to enter upon lM
r
above-mentioned propersy for inspection purposes
F^ G (We)agree to save.indemnify and keep harmless the City of Cupertino agmmb
fq liabilities,judgments.costs and expenses which may in any way seems against said City
U z APPLICANTdUNDERnsequence of the rYANDS Ating of rNDrWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC ULATI S.
Re-roofs
go.
* rm
gnare of ApplicaHAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant res future building Occupant Store or handle hazardous matevl
u defined by the Cupenino Municipal Coon,Chapter 9.12,and the Health and Safety
Code,Section 255331x)? �� All roofs shall be inspected prior to any roofing material being installed.
❑Yes AWe
Will the applicant or fuwn building occupant tacit equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.nit hvardous air contaminants as defined by the Day Area Air Quality Management all new materials for inspection.
District?
t]Yes JJ�No
I have mad Nchvuardnss___mamriatirequimmcnts umkr Chapmr6.95 of the Cal
Wilifor-
ria Health&Safety Codc,Scctiom 25X15.25311 and25534.1 understood Jou if Jm ding t� •jJ l�
Joys not citron have a tenant.Nat itis my icaporunday a nudity met of me
myuircmcn soh nmust met prior wiguaaCcofacenarnteprOcnpaney. Signature of Applicant Date
Nn r
Ownerer aummi.d A,., x ate All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
i
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
"0932 1 f4Pv4ave 6 <�
OWNER'S NAME: s i NI V A YAvJ PHONE #
GENERAL CONTRACTOR ' E5 ons ���E�+ � 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
Tile
LF•a �
Owner/Contractor Signature Date
Community Development Department
r Building Division
City of Cupertino
10300 Torre Avenue
CIF Telephone: (408)777-3228
U P E kT I A O 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: - 5R1 ro I U A 5�- y A-A A-
Job Site Address: asy 32-
Roofing Company Name: L ( S�S t �o f}�T �CV Clfa Pr"tC—nl'T
Aplicant's Signature: Date:
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: O
Building Address: po �y3 2 Fax9 O v
Owner's Name: DD i1 sPhone#:
5�1 N 1'v r� �tJ
Contractor: Phone#: License#:
WC—ST (bN9T bCVEtpPr%4r-P,3Z 11D-t(v3
Contact Phone#: --1 a -u a� Cupertino Business License#:
TC--rc Li oar.
Type of Roof Covering:.
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles 1 1.1 R60
❑ Other(Specify) ❑ Other(Specify) T✓
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: ❑
Job Description: a S S 4e ego r t>SG tA A-Tc- t t-
^ o -1 C_ eo fn-. f avC2ywo� �
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed w' Planning De . if
h re are res ons: LJ
Cost of Project: Type of Construction: ccupan grow
J5 J-000 0 qeq- t Ga' 001 _
Qty '.
ApA51jqabAe Fee ID Fee Description Fee Group
BPERMFEE Bld.g Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
S