03110064 CITY OF CUPERTINO +` -aa
BUILDING DIV
ISI/JN PI✓RMI'I' y CON�,TRACTOR INFORMATION s
BUILDING ADDRFSS: LOVELACE CONST. PERMITNc03110064
22141 HIBISCUS DR
OWNER'S NAME: 10144 CAMINO VISTA DR. PERMIT ISSUE DATE
Alk GRAHAM GEORGE W JR AND MARY C 11/13/2003
IF"E (408) 255-4923 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
IOZ LICENSED CONTRACTOR'S DECLARATION Job DesGrl1100
Fp� I lemby affirm that I am licensed under provisions Or Chapter 9(commencing - p
E with Section 700d)Of D' 'ion 3 ur me BusmC. nd Professions Cnde,and my license is
s inmBfr eandcffccr., ,// REROOF
t-E License / : / Lick
il-i Dam CumDraFc�mr ( LED
q I\de(smnd my plans shad be useaa�puhuc ream)
eoG LicensedPadessimnl FES 1 2 2004
S OWNER-BOILDER DECLARATION
T1 hereby affirm that I am exempt from me Comraaois License Law for the
O o following reason,(Sccdun 703 1.5,Business and Professions Code:Any city or county
S$ which mquires a permit in construct,alter,improve,demolish,or repair any structure U $4000
y-�< M.,m its issuatree.also"tares the applicant for such resit to file a signed statement
that he is licensed pursuant to the pmvmions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
FkFC (commencing with Section Well)ofDiosion3Ofthe Business and Professions Cede)or 32602025 . 00
i mexempt m
al he is cref me end the me basis for alleged cxcmptinn.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mom than fin hundred dollars(SSW),
❑1,u caner of the plate,Or my employees with wages as theirsark,compensation.
will do the work,and me structure is not intended or offered for sale(See.1094,Business
and Profession Cmc:The Comsactori License Law does not apply to an owner of Required Inspections
pronely who builds or improves mercon.and whodoessuch work himsel(or through his
Own employees,pvided that such improvements art not intended or offered for sale.If.
however,the building or improvement is Sold within One year Of completion,the owner
builder will ban the burden of proving that he did not build or improve for purpose of
mlc.I.
I,as owner of the property.am exclusively Contracting wish licensed contractual 10
consumer the project(Sec.1044,Business and Professions Col The Contracwri Li-
me Law docs not apply to an owner of pmporty who(wilds or improves themon,and,
who contracts for such pmjecm with a cormacmr(s)licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. ,B&P C for Nis mazon
OwnerDat
WORKER'S COMPENSATION DECLARATION
1 itemby affirm undo penally of perjury arc of the following dedaalions:
I have and will maintain a Certificate of Consent to sell-insure for Worker's Compcm
737].,B)
ion,az provided for by Section 3100 of she labor Code,for the per ro comet,of the
rk for which mire paired is issued.
1 ban and will maintain Worker's COmpensmion Insurance,as required by Section
of me labor Cmc,for me performance of me work For which this permit is issued.
WorkerssCompensaation11nnauumncc Tn'e d Policy number ammrrier, M//rLI/�rJ//t/ M1SV No.:
CERTIFICATT�EMPrIONFROMWORKERS'
COMPENSATION INSURANCE
(This section need nm McompleteJilthe permit isfnronehundredd011aran](0)
or less.)
1 certify mat in the performance of the work for which this permit is issued,)shall or
employ any person in any manner so az m become subject td the Workers'Compcnsaimi
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,.(mr making this Cenifeue of Eaeen ption,you should
became subject to the Worker's Compensation provisions of the Labor Code,you must
=O forthwith comply with such provisions or this permd Sort bC dcemcd revoked.
Z y CONSTRUCTION LENDING AGENCY
I hemhy affirm that there is a construction Iendi all,agency for the performan ,of
7 me work fur which this permit is issued(Sec.309?.Civ.C.)
U]n~- lender's Name
y Lcnder:Addteas
JQ 1 certify that I have read this application and sum that be above information is
D.F emitted.1 agree to comply with all city and county umininces and sum laws relating m
pU building contraction,and herebyauthorie mpresentatiscs of this city to enter upon he
ahovcmenudgm nip costs
for a peNon puBwses
(We).&me to save,indemnify and keep harmless tie City o(Cupmm.against
Fraj1 Nobilities judgments. uand expenses which they in any way eccrve regains sold City
Uz Acnnsequenee eBraming of this permit.
'—' APPLIC U ERST SAND LL OMPLY WITH ALL NON-POINT Issued by: Date
SOU LATIO 1y�
t'� Re-roofs
Signatuk of ApplicanUc. a o Dam
H R S MATERIALS DISCLOSURE Type of Roof
Will shuppli mor future building Occupantsmm Orhamlc hazardous material
az dented by the Canadian Monte Code.Chapter 9.11,and the Health and Safety
Code,Section 15531(x)? All roofs shall be inspected prior to any roofing material being installed.
Yes
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
B h...amnus air aontaminanre az darn by the Bay Arca Air Quality Management all new ma rials for inspection.
ionic?
❑Yes
I have dshc hmardnus materials require nu untkr Chapmr695oFlhe Califor-
nix Heal tyces,"cuuns 85115,255) 15574 undcrstanddtaif the building / / V/
Or
t' Cally havea n4 Nat iii m n IY to nndly me acupanl pF me
req i au which mus mdpri t an(t mficatepruaup _ i nature ofAppl' at Date
0 ,amhorueda t Date! II roof coverings to be Class"B" or better
Community Development Department
Building Division
ic ajrrzta2lolll
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkTINO
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.
S. 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: �Z� LlL�r`;cu Z v
Roofing Company Name: Cl Q
A plicant s Signature: Date: //
Greg teel y
•
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
CITY OF CUPERTINO G 3 o O C4 c�
REROOF
CITY OF
CUPEI�TiNO PERMIT APPLICATION FORM
APN# �� d Date:
Building Address:
Owne Ia e: 7 �7 Phone#c
Contr ctor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
neiv, W-E/O PN c�E
Type of oo Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ wilt-Up roof
❑ /asphalt Shingles 9--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:
25*L
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D if
06 q91 there are any restricti
Costo o �- Type of on: Occupancy group: q
61
Qty
A p pK 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 BUILDING
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