04080045 CI'CY OF CUI'ER'1'INO - �'y'
BUILDING DIVISION PERMIT GOW,, 't ACTOR INFQRMATION
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BUILDING ADDRESS: PERMITNO.
JNSJ ROOFING INC 04080045
OWNER'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY O. OL NO.
ARCHIRC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
,p� 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION Job Description j
i m G I hereby affil.Nat 1 am licensed under,provisions of Chapter 9(commencing
<c VV
U with Scaion7")of Division 3 ofdn:Business and Profcssium Code.and my license is
^ in full force and erregi.
License Clara ` p
�� LieX 5 60 REROOF frat.,
O Do. 6161 e V Contractor 7 ,�
��I ARCHIIEI DEC 1 200
< 1 understand my plans shall W used as po av
U Y®�® 200V
Jy
;aH Lkcnud Pmfcssionvl
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OWNER-BUILDER DEthe Cmu ION
1 humb,affirm thm I em cacmps from the eamaaclprs :Any C Law fur the
xo o fallowing moon.Permit t 7I31.5,Business and sae.deram Codc:Any city or county 'by
m which requires a penis ro construct,alter.improve.de Permit
1 m fix.
sig any ewm nt
'y—re paiarmiu issumcc,also mquirrs the applicant for such permiuo hlcasigrrtd statement
�Z< dmt he is licensed p...anu.Ncpmvisions of the Conuacmis License Law(chapter 9 Sq.FL Floor Area Valuat on
moi_ (commencing with Section 7")of Division 3 of the Business and Professions CMe)or
i that he us exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a penis subjccte the applicanuo a civil penalty of 3 2VTOt V0 0 Occupancy Type
not ream than five hundred dollars(SSW). r
Laznwner of the propcny,o my cmployces with wageraz their sole cpmpenxsian,
win do the work.and thesnucxrt is not intended or offered formic(See tone,BusinessRRequired Inspections
and Paofmlms Chou The Conoano's License law does nos apply man owner of e q -
property who buildsor improves thereon,and who doessuch work himself arthrough his
own cmployces,provided than such improsemcrtm arc not intended or offered for Sala IL
however.the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
1,as owner of Ne property,am exclusively coon,ing with licensed contractors to
construct the project(Sec.7144,Business and Professions Code:)The Contractors Li-
,anse law docs nl apply in an he,of propeny who Wilds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant W dse Contractor's
License law.
I sort exempt under Sec. .B h P C for Nis mason
ov,mr, Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm..or,penally of perjury one of the following declarations: .
I have and will maintain a Cenihcau of Cement to self-insure for NrmWorker'sCompen-
1M37M
ion,ax provided for by Section 37M of the labor Cade.for e perfoance of the
rk for which Nix permit is issued.
1 have and will maintain Wortrls Compensation insurance,az mounted by Section
of the Labor Code,for the performance of the work for which this permit is issued.
y Workers Compensation Insurance carrier and Policy number am:
Cattle,: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' ,
COMPENSATION INSURANCE
Qbuxction need nm W completed if tW permit is fprone hundrnd dollars($100)
.hss.)
1 certify That in the pcaformance of the work for which this Permit is issued.1 shall not .
employ any person ins man s ellcsubjceuo the Warkeri Compensation
Laws of California. c F
Applicant
NOTICE T LIC NT:IL ane aking thi Ceniricase or Exemption,you should
become sus t to the rkcr's Comps ��i uu ovisions of the Lahm Cotic,you mon
� rz foMwithcamp this Permit Wdccmcd revoked.
zO^ CONSTRUCTION LENDING AGENCY
l hereby affirm that Nem is a cormuuninn lending agcmy for du performance of
fY the work fur which thus penis is issued(Sec.3097,Civ.C.)
W Q lenders Name
z lenders Addmm
U Q 1 cenify that 1 have read this application and state non the xWvu information is
L. P correct.1 agree to comply with all city and county refinances and sate laws relating m
0 building construction.and hereby authome mocsenusmes of this City to enter uPnn Nr.
shove-(W Boned.nalityto saw forinstructionkeep s
(We)agree m cost,indemnify and kith harmless the City of Cupcnino against
F'r�q nitiuunce o o
nu
,costsrambing andthisamit. an
may in y wayaccmx
e againsaid City
in
co
U?
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of APPlicaDem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy T e,Cui enant or fume Wiling e.Chapter
stere or handle HcaNuusd Safer l
u defined by The,Cupertino Municipal Cade.Chapter 9.13.and the HcaIN and Safety
,MLCxdl ScNnn 25532(a)?Yes �F/ All roofs shall be inspected prior to any roofing material being installed.
❑
Will thea scant or futon,building occupant sex equipment or devie,s which If a roof is installed without first obtaining an inspection, 1 agree to remove
applicant 6 P a Ail n
it hazardous air conmminanm az dchncJ by the Bay
Arca Air Quality Management all new materials for inspection.
Diaria9
❑Yes �CW�
I have mad the hazardous materials re,nalo cau under Chapin 695 of the Calif., /;
no Hal Safety Code,Secuom 25505.35533 and 25534.1 understand the lithe Wilding - (�.JI
dors rot a tenon at it h my ous'n ihilay to notify the acupm,of the
1610
mqui now iazumeenfacemeateora try SignasereofApplcant Date
owner ser (zea,gen, 0 „� coverings to be Class "B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
0880 �- �o GE D\011- 'a I 01�0 BOO`kS
OWNER'S N D-q+a.a PHONE # 2?q�6
GENERAL CONTRACTOR: 3NSJ x. c , FAX #
I am not using any subcontractors: 9 6 O
Signature Date
Please check applicable subcontractor ollowing information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
i Linoleum / Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
AdW Tile
860
n /Contr ctor Si e Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF' A I Telephone: (408)777-3228
U P E IST I N 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: /M2 A P�S�- ,. <
Job Site Address: �6 Qg� Hca
Roofing Company Name: J fJ F40 t i
Applicant Signature: Date: 9 rs °
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 22(. — Q '6 5 5 - Date: 8 6 0
Building Address: 16 agD C `
�n
Owner's Name Phone#:
�S
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Jt�
Type of Roof Covering:
Existing: Proposed:
5--Built-Up Roof alt-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
t7--To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
C Bt't
Residential ❑ Commercial
Fire Zone: Yes ❑ No E1 Confirmed with Planning De t. if
there are any restrictions: LI
Cost of Project: so Type of Construction: Occupancy group:
Qty-
AppVcatAdFee 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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