05030113 CITY OF CUPERTINO .9r'
BUILDING DIVISION PERMITCONTRiACTOR INFORMATIQN
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BU ILDINC ADDRESS: CAL-WEST ROOFING CO. PERMIT 1/05030113
q n7”; rRIZENT1 1742 DR
OW NER'S NAME: PERMrr ISSUE DATE
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ONE: RORTAq SANITARY 0. C NTROL NO.
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CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
wLICENSED CONTRACTOR'S DECLARATION
I bereby affirm Nat I am lica sed under provisions of Chapter 9(commencing lob Description
h Scetion70(th of Division3 ofthe Business and Professions Code,and my license is
onrereandercee` REROOF W/SHINGLES
cnm Class —Zel Lie,peComnc r
qty / —I — ARCHITECTS DECLARATION
1 undersunJ my plans shall he used as public records
�aU
LL G Licensed Professional
w03
OWNER-BU
ILDER
mptfrm Ce Contractor's
00 1 hereby affirm that
1 am exempt from the Cssions o License Law for tM
p O fallowing mason Permit
t ]1oJ stn Business and Professions Code:Any city or county Ar g�A
5.'00
$ which aquina a permit m conswct,alter,improve,demolish,nr.,.it any structure A (fes-fr H
Fz< prior to as issuance,also¢quirm the applicant for such permit to rile a signed statement
Nat he B licensed pursuant to the provisions of she Contractor's Umose Law(Chapter 9 Sq.Ft.Floor Area l� p F 9ValuaUbn
¢~$ (commencing wish Saturn 7")of Division J or NC Business and Pmrasions Com)or O / /fDp � IO C
that k u mempt theafmm and sK basis for the alleged exemption.Any violation of l //A® 1
settle.]031.5 by any appliemt far a permit subjects the applicant to a mil penalty of 3 XPOUftAiiM 0ane- o� Occu Type
re
not mothan fixe hundred dollar(5500). �x P Y YP
O1,w owner ofthe prepcny,or my employees with wages m their sole compromon,
will do Ne work,and the swcture is not intended marketed fo...1.(Sec.]Oaa,Business V �'
and Professions Code:The Contractor's License law data not apply to an owner of Required Inspections
property he bui)ds.rimphat thereon,end who doaauchwork himself.,domain his
own emp)oyces,provided that such improaemencs are not intended oroRer d for ask.If,
however,the building or improvcmcnt is mid within one year of completion.the owner.
builder will have the Widen of proving that he did not Wild or improve for purpose of
sale.).
O h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70aa,Business and Professors Code:)The Contractor's Li.
cense law does not apply to an.wna of property who builds or improv Ncteon,and
who contracts for uch projects with a eonmttor(s)licensed pursuant in the Contractor's
License law.
O 1 am exempt under Sm. .B 6 P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby afrnm under penalty of perjury ate of the following declaraliom:
I have and will maintain aCenificau of Consent to self-insure for Worrier's Campen-
1371(a)
ion,as provided Tor by Section 37M of the Labor Code.for the performance of dte
rk for which Nis permit is issued.
1 ban and will maintain Workers Centralization Insurance,ss required by Sierra
of the labor Code,for the performance of the work for which Nis permit is issued.
y Workeri Compensation Insurance carrier and Policy number am:
rricr. y: 1&
�.w� Policy No.:�H�252 _
I,CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CDtu xaim need not be completed if the permit u foram hundred dollars(SI00)
nr less.)
1 certify that in the performance of the work for which this permit is issued,l shall not
employ any perxn in any meaner an as to become mbj=L 10 the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eumption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you most
.JO forthwith comply with such provisions or this Permit shall be deemed revoked.
Z"" CONSTRUCTION LENDING AGENCY
I hereby affirm that Nem is a construction lending agency for Ne performance of
fLa the work for which this permit is issued(Sec.3N7.Civ.C.)
Ow. Q Lender's Name
Z Lender's Address
0 Q 1 comfy Nat 1 harc mad Nis application and suis that the above chairmamn a
l2. E' coned 1 agree to comply with all city and county ordinances and sum laws relating to
� Uj alnivengconswnkn,atl hereby auNorimapasentatiacs of this city to cater ulmn de
0. above-(We) r progeny for indounify an amp
fl. eWel agme to save,indemnify and kith harmless w City or .,.lost
against
F Z inconsequ consequence
of thecesuand expcnsce which may in eay way accme against said City
C)zrmit-
APPLICANTCUNDERSTANDSthis
AND WILL COMPLY WITH ALL NON-POINT Issued by: DflIQ/4 CJ
SOURCE REGULA7NS.
•f C� 3I Dam Re-roofs
Signawa o Apphca Coneacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant to,future building occupant store or handle hmardous main.)
as defined by Me Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Sebon
ON.tion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or future building atopen(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardous air conumimnts as denned by the Bay Area Air Quality Management all new materials for inspection.
District?
OYes ON.
1 have mal the haardom maen.l.imi immcnu i ntbr Chaper 6.95 of the Califon .+-
nia Hca)th&SafetyCode.Sections 25505.25533 am125534.1 understand that lithe building
dna Trot curently harc a lemon,that it is my rapoembility to.61,the occupant of the
o usn hM poor ceraCerure.teerae.parey. Signature of Applicant Date
Own.,5,alum. —� i-�-teJ� I All roof 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 #
OWNER'S NAME: o r PHONE #
GENERAL CONTRACTOR: FAX # _
1
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
caner/Contractor Signature ate
Community Development Department
Building Division
sr City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
4U 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: z l r��c ���L fc�:. >
Roofing Company Name:
Cr
Applicant's Signatur Date:*cl
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
a(n�% RE ROOF
SICUPERTINO PERMIT APPLICATION FORM
APN# Date:
3 a7 o t�v
Building Address:
,;2 !
Owner's Name: Phone#:
Contractor: Phone#: License #:
66-1
Contact: Phone#: Cupertino Business License#:
_ z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
,0'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 Description:
So
Residential Commercial ❑
Fire Zone: Yes ❑ No-& Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: a . Type of Construction: Occupancy group:
r
Qty. if
Applicalc 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