04080046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �,iCONTRACTOR INFORMATION
BUILDINGADDRESS: JNSJ ROOFING INC PERMITND04080046
OWNER'S NAME: _ PERMIT ISSUE DATE
ONE: SANITARY 0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=00 LICENSED CONTRACTOR'S DECLARATION
C
C I hereby affirm Nat 1 am liccnad under provisions of Chapter 9(commencing Job Descriptio r ay
U with 5enion]IM1U)or Division Sof Ne Businns and Professions Code.end my licence is ��ssaf3�sj�g�
in atev
to, mu oroeanderce� ` f e REROOF
Liceve CI 3 l. Lie.a ]I l l
ppCa Do
Ca On
� —t nnCHl'IECr Cu \ION f'IU 9p
i understand my plans shall Wu daspublic records , JQ 2oQA
�,w,u ® ■p YF
30Q1 Lkcnsed Professional /8
a'03 OWNER-BUILDER DECLARATION r1
iI 1 hereby affirm that 1 am exempt rmm Ne Contractors License Law for On IV'G
00 fallowing reason.(Station 7031.5,Business and Pretensions Code:Any city or county
K m which requires a Permit to Construct,alma improve,demolish,or repair any strundre
re"^ prior to is issuance,also requires the applicant for such permil to file a signed statement
=R< that he is licensed pursuantto Ne,provisions or the Contractor's L{mnx Law(Chapter 9 Sq.Ft. Floor Area Valuatl0n
'at-0 (commencing with Section Till ro
o(Division 3 or the Business and Prasimu Code)or
X. Nal he is exempt Iherefrum and the bole for Ne alleged exemption.Any violation of �i��.x.
Section 9031.5 by any applicant for a permit subjcce applicant D NGtIII o a civil penalty of 3 aLft 0 - Occupancy Type
not more Idea five hundred dollars(5500). a thr ,
D 1,u owner of the propery,m my employees with wages as their able compensation,
will do the work.and the structure b not intended or onacd fbrsale(Sec.7044,Business Required Inspections
and Professions Code:no Contractors License Law docs not apply to an owner of q p
property who builds or improves 1Lcmon.and who dres such work himselfor through his
own employees,provided thatsuch improvements arc not intended or offered for sale.IL
however,the building or improvement is sold within ane year ofeompletion.the owmr-
builder wilt have the burden of proving that he did not Wild or improve for purpose of
sale.).
D I,as owner of Be property,am exclusively contracting with licensed cbncommrs to ,
oMOXI the project(Sec.70a4.Business and Professions Code:)The Contractor's Li
mase law does not apply b err owner of iomperty who Wilds or impmves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
I am exam pt under Sec. ,B&PC for this recon
Dome, Data
WORKER'S COMPENSATION DECLARATION
1 hereby of ran under penally of perjury,one of Oc following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
ion,as pmvided for by Section 37M of the Lator Code,for the performeacc of the
737M
rk for which Nis permit is issued.
1 ban and will maintain Wuher's Compensation insurance,u required by Section
of the Labor Code,for the performance of the work for which this permit is issued.
y Worker's Compensation Insurance carrier and Pal icy number ate:
rtier, Policy No.:
CERTIFICATE OF E%EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is foronc hundred dollars IS III)
m Ices.)
1 artlfy Nm in the performanac or the work for which this pe.I,is issued.1 shalt our
ompleyany persb c 'a
mIW
coe subject,. Workcri CompertaLmn
iforni
Laws of Cot hn
Applicant
NOTIC PL ANT:Ill.after ma ampoule err Bacmptl.,you should
bttom subject to the Wor pcesauon provision b(thc Labor Gnd[,you mum
z. foMwi such provisions or Nis permiuhall be deemed invoked.
ZO CONSTRUCTION LENDING AGENCY
�-.� I hereby afflm that there is a construction lending agency for Ne performance of
a5: the work for which this permit is issued(Sec.3097,Co.C.)
aQ Landers Name
C 2 4nder's Address
U O 1 certify that 1 have read this application and suit that the above information is
" r conical.1 agree to comply with all city and county ordinances and scam laws relating to
OU building construction,and hereby authorise mpreuntativea of this city to enter upon the
U abovcmentiuned property for impaction purposes.
(,a (We)agree to son,indemnify and keep harmless the City o(Cupenino against
y liabilities.judgmcnu,cosu and expenses which may in any way&come against said City
U inconsequence,of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SOURCE REGULATIONS.
Re-roofs
signamrc of ApplicaOeste
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant n (Muni building occupant rstore9.1 or and b ha�uus material
u defined by the Cupertino Municipal Coda Chapter 9.12.and the Health and Safety
Code.&adon 25532(.)7. - All roofs shall be inspected prior to any roofing material being installed.
Dyes
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
it hvsdnes air contaminants u h d by the Bay Area Air Quality Managcmcm all new materials for inspection.
Davi 7
u
❑Yes N
I have read the haaardnus materials requirements under Chapter 6.95 of OC Czlifor
ria Health Safety C�e,jcImms 255(15.35533 and 25534.1 undersand that if the Wilding
does rot cu eve aunapt boat nlamyv on Oility to nodfy ft..'rot of or
mimwhich mcar
kmatPoor
tonsterem. eemfialeotoam 6CY. Sign is of \pphcant Date
0
wncr tar auoritraine Class "B"or better
'rcd agent
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
�6 6 80 �a�.co .61d 6 0� D 800 y'(�
OWNER'S NAME: 'De A% P Sic S PHONE #
GENERAL CONTRACTOR: vS J �, �, FAX #
I am not using any subcontractors: $ G o
Si a e 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
660
Owner/Con actor Signa e Date
Community Development Department
Building Division
actffiwl
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
SUPEkTINO 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:
Job Site Address: (0 $$Q
Roofing Company Name: S� �� ' �C
A plicant's Signature: — Date: 8 6 6y
I
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
OF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: ,
l0 8 80 �, C-0 $�d .
Owner's Name: Phone #;
I)P- ro �i° C k,"
Contractor: , one#: License#:
JYN� ?44:1r Z�q-6111 732 80
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existin Proposed:
Milt-Up Roof uilt-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nbor of existing coverings 13 Provide I.C.B.O.Report#
C9�Tbe Removed ❑ Provide Mfgr.Installation Specs.
® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
sl KA-1) 4rkl 0,51 rt-of
Residential ❑ Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Q$ G
Qty.
A co bl 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 BU]LDING
c-0-13f. 63