04070193 CITY OF CUPERTINO '^F '" "'`` m�' `•" '
BUILDING DIVISION PERMIT CONTRACTORINFORMATION•`;.
R UILDING ADDRESS: JNSJ ROOFING INC PERMIT NO 04070193
10880 F
OWNER'S NAME: PERMIT ISSUE DATE
CUPERTINO SAFE STORAGE 691 W SAN CARLOS RT
ONE: SANITARY NO. CONTROL NO.
4082796171
ARCHREC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
poo LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am limenvA under pulsions of Chapter 9(commencing Job Description ®�
with Section 7WR of Division 3 of the Business and Professions Code,and my license is
5qi LiaomC andcnect.G3 Uc g g0 REROOF
Z L z Date Contractor /1� �al,�
F� ARCHITECTS D ARA DN �'1 G as9 rs�f
w< 1 undersand my plans shall he used asp al 90'04
JodU w
G� Licensed Pmfossi...I /NPAp
OWNER-BUILDER DECLARATION aaa!l1000(w®®
<y 1 hereby affirm list 1 am cmor pt firm the Contraetors License law for the qtr
no following mazer.(Section 7011.5,Business and Pmfcssions Code:Any city or county � R._
which tequims a permit ,,conmuet,ala,,impmoc.demolish,or repair any mmcam Vri 9n
Zi prior in its issuance.also requires the applicant for such permit to rile a signed statement
< Bout he is licensed pursuant the provisions of the Comraetor's Ucensc law(Chapter 9 Sq.FL Floor Area Valuation
Fra�G (commencing with Section TOW)of Division 3 of the Business and Professions Coad)or
i Nat he is attempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a pennhaabjects ten applicant I. dud penally of 3afN0Qffi5er00 Occupancy Type
not mem mad r m hundred dollars(SSW).
will
Lothe work.the ppeny,mmycmntendedwim emdret retards
(See.
01,L Button,
will Pr the work.and the he Con is not intended Law ddrs do,a(See.7014,Business
and Professions Code:The Cstherma.License law doh not apply lf an owner is Required Inspections
man erlywho
yees,pdsorimpm sthacan,and
meats douauchwork ended omselror ed for saf his
own ymthecuip building
orithatsuchimps mid within one
intended poRmed for sale If.
however:the building or improvement is sold within one year ofimpromifor the owner.
of
builder will have the buMen of proving this he did not builtl or improve far purpose of
vie.).
❑1,as owner of the pro,eny,am exclusively completing with licensed comracrom to
compute Ne pmjem(See.7W.Business and Professions Code:)The Contractor's U.
cense law dao not apply to an owra,of progeny who builds ter improves memmn,and
who contracts for such pmjem with a conpaetor(s)licensed pursuant is the Contractors
Liccam Law.
lama mptunder Sec. .B&PCformisreason
Owner Dat
737MWORKERS COMPENSATION DECLARATION
1 hereby affirm under patty of perjury arse of the following declarations:
1 have and will maintain a Cenifieat of Consent m self-insum for Worker's Camper.
ion.as provided for by Section 37W of the labor Code,for the performance of the
rk for which mis permit is issued
1 have and will maintain Workers Compensation Insurance,m mounted by Section
of the labor Code.for me performance ofme work for which mis permit is issued.
y Worker's Compensation Ins inns caner and Policy mother atertier. Policy No.: I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if the permit is for one hundred dollars($100)
or less.)
I certify that in to performance of the work for which this permit u issued.l shall not
employ orogen n n mann to tic Subject to do Workers Compcmatims
Laws of Calif !Dao
Applies
N E TO APP ICA ,after making is CcniGcam of amended.you should
come subject m eWorker's Compcma- previsions of Ne labor CrM,you mum
.J O fo ins comply with such pmvii mis p..,mail he dccmcd remkcd.
Z CONSTRUCTION LENDING AGENCY
7- 1 hereby a M.mat mem iso mn timn heading agency for the performanceof
cd the work for which mis permit is issued(Sec.3W7,Civ.C.)
ILl Lender's Namc
6. tender's Address
7 2
U O 1 mnify that I have mad this application and Bute that the above information is
Uf F comet.1 agree to comply with all city and county ordinances and stat laws relating to
0 C.) building construction.and hereby amhorim mprceeonivu of this city,.eat,upon the
>.LSd ahovc-mcmimmil p,,,y for inspection purposes 1_27
F'0.
(We)agree in son.indemnify and keep harmless the mo
e City of Cupcnagainst
liabilities.judgments,costs and expenses which may in any way scenic against said City
of the flooding of
V z APPLLICANTeUNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS.
Re-roofs /
SignaturearnppM1nHAZAR Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will he applicant or future Muni building occupant r9.1 or handle Health a material
az dcfncd by me Cupertino Municipal Code.Chapter 9.12,and me Health and Satcry
aa,Sermon 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
C Yes
Will me applicant or future building=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnus air contaminants n defined by the Bay Area Air Quality Management all new materials for inspection.
Dinrict7
❑Yes gYN
1 have mad the bvallous materials requimmcnu under Chapter 6.95 of the Califon
ria
dom.rthc&SafctyCaovdea wnanL th2ou55if)t 5u.2m55y3m3ssnp=Ihilit.Yiwa dncrrsitalYndhme maicfuthp nbtOfdithne
tpdormlssuanceofaCcnircaaofOccupan'. ' natureofApplicant Date
1. t Vo
Owner e d a ant I Date I A11 r erings to be Class"B"or better
Community Development
10300 Torre Avenue
( Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�
#UPEkTINO
Building Department
JOB ADDRESS: (O 0 C 8(d �t PERMIT # 0y O 7 o I n
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: Z Q
Si ature Date
Please check applicable subcontractors an win 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
7 2 Q
Owner Contract r Signature Date
Community Development Department
p Building Division
City of Cupertino
!l 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
E �I�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�hsytated policy on re-roofing.
Homeowner's Name: �fi" nwk U�'
Job Site Address: �b $BD F►e..uo GF �ldsj.trYt`1
0
Roofing Company Name: Tu Q°O
A phcanYsSignature: Dater -'l-4 o�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 0 Es- Date:
7 ZF o
Building Address: r .t
If, a8o �� C�: l�cd . M
Owner's Name: Phone M.
'n�l.c SetiFc J rc� e-
Contractor: Phone#: License#:
bt 2-t7 -61T 1359Ro
Contact: J Phone#: Cupertino Business License#:
t
Type of Roof Covering:
Exist' Propos
9 Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nutgber of existing coverings ❑ Provide I.C.B.O.Report#
0 To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential ❑ Commerc al
Fire Zone: Yes ❑ NoConfirmed with-Planningept. if
i LJJ
there are any restrictions:
Cost of Projec : o, Type of Constr6 ii . Occupancy gr'u"p:
Qty/i�
Aplili °ablq. Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
r , BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING