04080116 r CITY OF CUPERTINO ""x
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN ;
eta e.DING ADDRESS: JNSJ ROOFING INC PERMIT NO b4080116
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY OL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lap LICENSED CONTRACTOR'S DECLARATION Rossi
til FC I bemby affirm that T an licensed under provisions of Chapter 9(commencing Job Descriptio
iW wiNSccdMO )of Division Sof Jlciumesasld Professium Code.andarylicencis
n<e in eCraJfp'c /LI
jg? Lkevwcas 1 = Li.ro_ 11 REROOF AUGfyy�
o Dale cumramr.
£4� d
ARCHREI DEC RATION 2oOvy
[an sunt my plans shall M uatl u public records
3C License fin.mmA 0®t®Bp
OWNER-BUILDER DECLARATION `"
.� 1 hemhy affrm Ilial I am coompt from dte Contractors License Law far the /tlr}1%
O f owing mason.(Section 7(5 1.5,Business and Professium Code:Any city or county
hich equims a permit ns cnrutrun,elmr,improv,demolish.or repair anY structure
m priorm its issuance,also mquims the applicant for such permit to rile a signed statement
< thatheislicensedpursuant10the pmvisiauolMeCintracim'sLimnsetaw(Chapter 9 Sq. Ft. Floor Area Valuation
�Fo (commencing wish section](W)of Division 3 of the Business and Professions Cook)or
y Nat he u exempt Memfmm and the baso for the allognd exemption.My violation of
Section 7031.5 by airy applicant far a permit subjects Ne applicant to a civil penalty of
not mom Nan five hundred dollan 3 ;ZIpP,�er 0 p Occupancy Type
(5500). -
❑1,m owner of the property in my employees with wages as Noir sole compensadon,
will do 0e work and Ne structure Is nal intended in offered for sok(Sec.7O".Busine.•
and Pmfestiom Code:The Contractors Liarese law arcs Out apply in an owner of Required Inspections
property who builds or improves thereon,and who doessuch work hunnelfor through his
own employcus,pmvidcd that such improvements nee not intended or offered foralc.If.
however.Ne building or improvement is sold within one year of completion.Ne owner.
builder will haw the burden of proving Nat he,did not build m impowe for purpose of
sel
1,as owner of Ne property,am exclusively contracting with licensed commutdrs to
Cons mer the project(Sere.9044,Business and P nfessioos Code:)The Comnemrs LL _
msec law ones..,apply man owner of property who builds ser impm.ft...anit.
who contracts for such pmjecss with a contractors)liceved pursuant to ft Contractors
Liecone law.
❑1 am exempt under Sec. .B&P C for his reazon
Owner Dae
WORKERS COMPENSATION DECLARATION
1 hereby union under penalty of perjury one of Ne fallowing declarations:
1 haw and will maintain a Certificate of Consent to self-insure for Worker's Compcm
737M
ion,as pmvidcd for by Section 37W of dW Labor Code.for the performance of the
rk for which this permit is issued.
1 Raw and will maintain Workers Compenadon Insurance,u required by Section
of Ne Labor Code.for Ne pcif mane.of the work for which this permit is issued.
yWorkch Com emotion sunny cartic/{'apyd Polity number neesein'. L N r rylscyNo.: III S7 T'I
// CERICA OF EXEMPr1Ofl FROM WORKERS'
COMPENSATION INSURANCE
Chia action nap not de eompleed ifthe Permit is for one hundred dollars($10i
no lesa)
1 cenlfy Nat in Ne performance of the work for which this permit a issued,1 shall not
employ any person in any manner so az to become subject m the Workers'Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:if,after making this Certificae or Eacription,you should
Remain miject m the Worker's Compensation provisions or the Labor Code,you must
.Jz forthwith comply with such provisions or this permit shall M doomed revoked.
z CONSTRUCTION LENDING AGENCY
[—� Ihereby aim Nal Nen is a Construction lending agency for Ne performance of
!Yi Ne work for which Nis permit is issued(Scc.3047,Ci,C.)
W A Lender's Name
g1.
z lender's Add.
U
U 1 certify Nat 1 low rod this application and sae Nal Me d above information u
(y building 1 ogee m comply with all city ono county nonan of his sum laws elating e
�U and prcprrscnulivu of this city to enter upon Nc
W ahnvt-mCnllrned pmpCrty for ImpCCll On porpoises.
w
(We)agree to saw,indemnify and teep harmless the City of Cuperino agairm
N Iiabilitiu,judg cru. Us d,.K...which may In any way se.igMr ,said City
U Z APPLICA n oNN RSTANDS AND WILL COMPLY WITH A NON OINT Issued by: Date
OURCE IONS.
(j Re-roofs
Sign 0f li JCocomemf in
HAZARDOUS MATERIALS DISCLOSURE Type of Roof h
Will Ne applicant or future building occupant store or handle eordous material
efned by de Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
ilk, Gy.us3z(a)' All roofs shall be inspected nor to an roofing material beim
❑Yea AN. P P Y g g installed.
Will the applicant or fume building Occupant use equipment
m devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new mater' Is for inspection.
istric,7
0Yes -,(No
I have real Ne handhorss materials requirements under Chapter-6,95 of NC Celifer /[•'] /O
ria Health&S ray ode,Sections 25505.25533 and 25534.1 understand Nei iflM Wilding Sate
7 I/
Jas not curt dy a a Woad.that it u my nomindbilily m ratify oats ant of the
mgmiemen wn h ustbcmetpnprmissuaneeoface eaor Pupa ign r Applicant
ow nrz tlagenl ICU
All roof coverings to be Class "B"or better
Community Development
i 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: t( t PERMIT ✓
/0880 eyoontA c yo8all�
OWNER'S NAME: ro vI PHONE # do
GENERAL CONTRACTOR: 3 g FAX #
I am not using any subcontractors-
Signature Date
Please check applicable subc act rs and complete the following information:
SUBCONTRA OR 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
Til
i d
er/Contractof Si ature I date/
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
SCITY OF Telephone: (408)777-3228
-UPEP,TINO 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.
•f 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 bf 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. V. '
2. An I.C.B.O.report is required to be on the job site at+the time on inspection
a
I understand and will comply with the above stated policy on re-roofing..
T
Homeowner's Name: I OO iQri C'OQe'fT��
Job Site Address: (tMG Fr�^�y C�. ��9. T,
Roofing Company Name: J N S.1 , F"a 1 T-c4C+
Aplicant's Signature: Date:
\il/YS1Jl�pC� •
Greg eel
Building Official
Revised 1/30/03 r 1 .
« " F
•' Printed on Reoydeo Paper
CITY OF CUPERTINO /
' REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 326— 10 — D S5 Date: 8 12 0
Building Address: O $SO �ft`o
Owner's Name: b Phone#:
-Pe1�n2 al V-0 rKesfi ro T;a
Contractor: Ph ne#: License#:
JIM a Vq-6/71 73g98Q
Contact: Phone#: t Cupertino Business License#:
Type of Roof Covering:
Existing: Propose
D�Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nunjbef'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 rtino's Tear Off Policy:
❑
,Job Description:
H t«tkwal C 4 ' lo.t I({ ' "of
Residential ❑ Commercial ET
FireZone: Yes ❑ No Confirmed with P g e if
there are any strictions: .'--'�
Cost of Project .--- - Type o on Occupan gioup:
U (. .`
Q t .
A hef 1 Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
' BENERGY Energy BUILDING
I BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK ` Plan Check Fee BUILDING
BUSLIC Business License BUILDING
l � r�. s �