04080197 CITY OF CUPERTINO kb
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BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: JNSJ, ROOFING INC PERMITNOO4080197
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY O. OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECt PLUMB MECH
0 t 0 0
.Opp LICENSED CONTRACIOR'S DECLARATION
¢m C I hereby affirm that 1 am ficessoulBu under provisions of Chapter (commencing Job Descriptio ��
n<i
withSectionIn.n7la(111)of Division lof the Business am ProfessionsCode, ylicen.is
in full forte and n.
�yz LieeneaC s Lie.a /� REROOF W/ PLY BUILT UP
is a DOW Cunlmlor
1 undo ns n my planssholl lie uaed ass publicreeordt
SEP V 2004
JyU
;Q Licensed Professional
OWNER-BUILDER DECLARATION II TI �D
af 1 hereby affirm that 1 am exempt from IM Contractor's License Law for IW
00 following mason.(Section 713 1.5,Business and Profuasiva Coda:Any city Of county
U
y m 9�. which mains a permit to Construct.alter,improve,demoluth,or mpair any slmewre
prior In its issuance,Aso requires the applicant for such permiuo rile a signed statement
that he is licensed purwanuo the provisions of the Commetur's Liccnse Law(Chapter 9 Sq.Ft. Floor Area Valuation
¢Is-O (commencing with Section Imo)of Division 3 of the B usinean and Prolbasinns Code)ur
y Nat W is exempt thcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any'applicant for a permit wbjC=the applkant to a civil penalty of 3 AIQ'Z11t era 0 Occupancy
not mom must ns,hundred dollars,(S50oy. P Y Type
I,u owner of the property,or my employees with wages as their able compensa0on,
will do the work,and the strunum is not intended or offersd for sale(Sec.7064,Business
and Pmrevions Code:The Conuavmrs Litems Law does not apply to an owner of Required Inspections
property who Wilds or improves Sarson.and who doessuch worthimselfor through his
awn employes,,provided Nat such improvements art not intended oroffemd Towle.If,
however.Ne building ar improvamant is sold within ane yeti of completion,the owner-
builder will have the burden of proving that he did not Wild or improve for pmpose of
sale.).
❑1,as owner of the property,am CxClusivcly contracting with licensed contractors to
construct the project(Sec.7(14.Business and Professions Cade:)The Contractor's Li.
Came law doer Out apply as an owner of property who Wilds or improvrs themon,and.
who contracts for such projects with a contnnor(s)licensed pursuant to the Contractors
License Law.
1 am excmpl under Sec. .B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
i hemby affirmunder pcnaily of perjury one of the following declarations:
1 have and will main.in a Certificate of Consent to self-insum for Worker's Compen-
sation,as provided for by Section 3700 or the Labor Code,for the performance of the
work far which this permit is issued.
❑1 have and will maintain Worker's Compensation Inwrana,as remitted by Section
3700 of Ne labor Code,for the performance of he work for which this permit is issued.
My Worker's C mpensa'on lnsu race its end Policy number am: Ya
Cartier: -�J�PoIiN No.;WOR lowERS, V�9 '
CERTIFICATEOM I N FROM WORKERS'
COMPEN ATIONINSURANCE
(This section need not k completed if tbe parmit is for one hundred unit=(SIM)
or less.)
1 certify that in the performance of to work for which this permit is issued.I shall not
employ any person in any manner an as to become subject to the Workers'Compcnsauon
Laws of California Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject m the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply wit such provisions or this permit shall x deemed revoked.
z
'T+� CONSTRUCTION LENDING AGENCY
I hereby afitm that Nem is a construction lending agemy,for the performance of
C4Ne walk for which this permit is issued(Sec.3097,CiN,C.)
U)Q Lcndcr's Name
IL Under's Addm.<
D Z
U Q I comfy Nat I have read this application and sate that the aWn infom.don is
FCarmel 1 agrte to comply with all city and county ordinances and atle laws rtlaling to
Q U building construction,and hereby audsorim representatives or this city in crier upon the
D.1 above mentioned property for inspection purposes.
(We)egmC to save,indemnify and accp harmless tha City or Cal rano against
h Hal,Ita,juit men..cos.andexpcaca which may in any way acme against said City
U Z in canseque a of the granting of Nis permit.
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC ULATIONS.
_ 3 Re-roofs
In App rc Co
HAZARDOUS MATERIALS DISCLOSURE Da Type Of Roof
Will tic applicant or factum Wilding occupant mom or handle haduadoue material r
defined by the Cupertino Municipal Cods,Chapter 9.12,and Ibe Health and Safety
cmc.ecttion 25532(ar K. All roofs shall be inspected prior to any roofing material being installed.
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
emit havardnus air con.minan.u defined by IW Bay Arta Air Quality Management
all new material r inspection.
District? [[[
❑Ycs AN-
'a
mail thch AMNlusmaterialsmquimmen.under Chaper6.95 ofthe Califor-
niaHealth&Safety Codc,Secwmi25505,25533 am25534.1undarnvrd thtifthe Wilding �7 k'
does
one
t currsntlY K enanl,Nat il6 my raponahility m notify de acupent of tbe / lJ
reyui¢nJTn.whi Wmd priortoissuance oraprior issuance ora Ccrtifice¢of�uPmq Slgn AppllCant DateSlgn Applicant Dale
y r All roof coverings to be Class "B"or better
Owner ser oomd agent Date
Community Development
f 10300 Torte Avenue
%- Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB `DDDCR�SS-. « If PERMIT #
OS w " C-V F 1 oyoTa
OWNER'S NAME: Zq PropArA, PHONE #
GENERAL CONTRACTOR N53 FAX #
I am not using any subcontractors: �'J 6
Signature Date
Please check applicable subcontrs and4complete 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
z3 v
Contractor Signature `mate
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v
—7
Community Development Department
ylgon
Building Division
r _%` City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
IUPEkTINO 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: f Y�Cnn __�C� L�
Roofing Company Name: �� 5 V�'0 IN C
A plicant's Signature: Date: 2 3 Oy
Greg teel
J Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO _jD �OgD Iq7
REROOF
CRY OF
CUPERTINO PERMIT APPLICATION FORM
APN# 2 2(0 — ( (�— CESS Date:
Building0r ss: 0— n
10
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Ow er's Nam : Phone#:
�sz N ZAPro .tYil C-S
Contract rPho: e#: License#:
milt 271, 6 /7/ 3 r/
Contact: hone#: Cupertino Business License#:
et-d — (at7
Type of Roof Covering:
Existing: Proposed:
J, Built-Up Roof Built-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#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Desc tion:
r o -"t5j6 t,.JJ
Residential ❑ Comm rcial
Fire Zone: Yes ❑ No ❑ Confirmed with-Planning,13 t. if
there are restrictions:,
Cost f Project: �� Type of, on t i n:,l Occu cy gro p:
Qty. if
A li able Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
y BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING