04080142 CITY OF CUPERTINO -- '^
BUILDING DIVISION PERMIT CO NTRACTOKINk'ORMATION `•<;
BU II.DING ADDRESS: PERMIT NO.
CINDY ROOFING CO INC 04080142
OWNER'S NAME: PERMITISSUEDATE
ONE:
SANITARYN 0 OLNO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D O
ti00iJA
LICENSED CONTRACTOR'S DECLARATION Job Descriii
w❑ I hereby affirm that I am licensed under provisions or Ch.prer 9(Commencing
iW with Sccom.70 sq of Division Sof tW Budneaa ofessions Code,endmyliccnse is
rl
Li!. n anderrec < REROOF W COMP.
Asa? License Lk.N �— p ff__ /yam
e F Dale Cunlractor AU V (i al 2004
V ARCHITECTS 0TION
? � tun nil my Plmeahall be used u P=cord,
=A.
Oo� Licensed Professional BUIL®L N G
3 OWNER-BUILDER DECLARATION
f T hereby arm I am exempt frum the Contractors Liccnx Law for the
p O following mason.(Section 7031.5.Business and Professions Code:Any city or county
K m which mquihes a permit m construct,alter,improve.demolish,or mryvir any structure
FIy prior to its issuance.also nounct the applicant for such permit to fie a signed summmn
i<
that kulicensed pumusnucmrs
In roviaionsoftheOm aI.. aw(ChapmsY Sq. F[. Floor Area ValuaU n
ce
,FG (commencing with Section 10M)of Division 3 of the Busioear and Prefessiam Code)or
y $ that W is eaesopt tbcttfroa and the basis for the alleged exemption.Any violation of i�i
Section 1031.5 by arty applimnt for a permit subjects the applictnt a a Civil PMAIV of 3 BB1410t2tieC 0 0 Occupancy Type
not more than five hundred dollars(5500).
I,As owner of the property,or my employees with wages aa their sok compensation.
will do the wai and the structure is not intended or offered Ron].(Site Was.Busims, Required Inspections
and Profession,Code:The Confetti License law does ret apply to An owns of q P
property who builds or improves thereon,and who does such work himself or through his
own employm.provided Nat tech improvements arc not intended or o0ehed for sale.l-
however.Ne have
the
or improvement is sold within oto year of mprove for the owncry
builder will love the burden of paving that he did not build or improve for purpose Of
Cala.).
❑1,as owner of the property,am exclusively convecting with licensed convectors to
construct the project(Sec.70,14,Business and Profession,Code:)The CWUOAC ors Lf-
ccnM law does not pply to an owner of property who builds or improves thermn,and
who Contracts for such projects wife a eonesictor(s)licensed pursuant to the Coaracari
License Law.
❑1 Am Attempt under Sec. B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Mmby affirm under penalty of perjury one of dm following deelaratioos:
I haw and will maintain a Ce,ormte of Consent to self-insure for Workce,Coapcn-
7037W.fft
udn,as provided for by Section 31W of the Labor Code.for the performance Of the
rk for which on.permit is issued.
I base and will maintain Worker's Compensation insurance,As required by Section
laborCode.far the perfofmanee oftM eh this permit is issued.
yWoorker'sCompensation 1 mrriu andion n m:tpfpPolicy
Y CE IMC TE OF EXEMPT ON ROMW RKERS'
s�OMPENSATION INSURANCE
most section needt be completed ifthe,permit is forone hMdmddollam($100)
or kss)
I ectfify Nal in the performance of the work for which this permit is issued.I shall not
Ampl%any prawn in any manecrso as It become subject to the Workers'Compcn,etion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifteare of Eacmption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you muss
OfoMwith comply wish such provisions or this Infant shall be decreed masked.
Z'-" CONSTRUCTION LENDING AGENCY
E.t .N. I Wmby affirm that them iso croswction knding.1hey for fee ,to--Of
fY> Ne work for which Nis permit H issued(Sec.301 Civ.C.)
W A Linde's Name
IL Underi Add.,
U C) I certify not 1 have head this application and sate that thc above infmmatiun is
IL r c0omel.1 agree te comply with all city and county Chi and state laws totaling to
O('J building conwuction.and hereby mthorin representatives of this city tocnteru-uruse
n
above-mentioned property for inspection purposes.
4. (We)agree 10 save,indemnify and keep harmless the City of Cupertino against
In lubilitic.,judgments,costs And apaucs which may in any way Accmc.gei Rsaid City /
U z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date
50 RCER CATION i
Re-roofs
Si awrca A Ka aOaCor atr
H DOUS IAISDISCLOSURE Type of Roof
Will fee applicant or future Wilding occupant stem of handle havameus material
As defacd by ft Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
We.5ccdon 15532(.)? t All roofs shall be inspected prior to any roofing material being installed.
0 Ye
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haran ous air contaminants as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have mad on harasdous materials ic,immems under Chapin,6.95 of the noire,
nis Hmlut&Safety COM.Sections 25505,25533 and 25534.1 undemtsnd iMl if she Wilding
does not currently haw a tenant,Nat it IS my respon,ihincy in notify tM Occupant of the
mquimmc ,which at ntprio mramp
snanor.a _ nature Of plicant Tate
ecr nr anN a agent / Dahe _ All roof coverings to be Class "B or better
,b.} Community Development
CuTorre Avenue
peOrtino CA 95014
" Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADPERIT# D U ��
lo ('011aa v1p Z,7
OWNER'S PHO
GENERAL CONTRA O • FAX #-
I am not using any subcontractors:
Signature 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
Tile
I � �
ontrctor Signature Date
i
Community Development Department
_ Building Division
City of Cupertino
4 T
...,..: 10300 Torre Avenue
CITY OF' Telephone: (408)777-3228
CUPEkTINO Fax: (408) 7773333
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: OS'// li/P.yz �/�✓�
r
Roofing Company Name:'
A plicant's Signature: � Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO J/ o 0Z
REROOF T
�CUPETINO PERMIT APPLICATION FORM
APN# O Date:
Building Address: r
/GS// CPI�n lii�/r/ �v 2
Owner's Name: Phone #: yof
Contractor: Rdo�HS �j Phone License : /
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
`1 Asphalt Shingles X 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.
[ Have Read, Understand and Will Comply ith Cu ertino's Tear Off Policy:
Job Description: -e i�r ed C' 6:-x 1 S � Zc it s 4:1—
Residentilil ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Type of Construction: Occupancy group:
��5s
Qty. if
Applic e 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 BUILDING