The URL can be used to link to this page

05060047 CITY OF CUPERTINO � 3i BUILDING DIVISION PERMIT CONTRACTOR INFORMATION :i; f a,xnxe:<9 .s.v,_.F: w'"3. ..- �k_d"sx, •aF"xs°{ .axP-Jz � „< amLDwc ADDRESS; PERMIT NO PETERSEN—DEAN INC 05060047 O R' NA PL PERMIT ISSUE DATE ONE: SANITARY 0. CONTROL NO. ARCHITECflENGINEER: BUILDING PERMIT INFO II I BLDG ELECT PLUMB MECH ; k�..�� 0 0 0 °00 LICENSED CONfRACOR'S DECLARATION a' u � p 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description° Vu with Section]IXW)a'Division 3Ofine Busing and Pmfeadions Code.and in,license is in lull force and effect R "came Clazs, — Lic.x 7' REROOF W/ COMP. [� . ,z,r o Data Comraxim r — f L U( Ci ARCHr1ELTs DECLA A ION II II j,1 x•- �\�� m< I undersand my plans shall bo used as public¢cards V(fjf ;IUC u{i DiU U. Licensed Pmfcssinnal 3 OWNER-BUILDER m Ce Contractor's ON 00 1 Wrcso affirm Nal 1 1. exempt from Nr Conuns Co License Law for the O yO following reason.(Section](131.5.Business and Professions Code:Any city s county It which requires a penrite.also Irl construct,aalNy.c ins for su de le mitt or repair micracm Fla prisnnits kensedpalmreto the the forsuch wicensle asigned sulcmcnt mommencicgwith Section to the m(Divisionf theeBusinessnd Professions (Chapteroe)or Sq.Ft. Floor Area Valua[wn FFG (commencing with Section 1(110)ofDivisionJ of the Business and Pmfessisns Cmle)ur Or that he is ezempl therefrom and the basis far the alleged exemption.Any vialadan of - Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 IcfbglT�yerpp Occupancy Type not more Nen five hundred dollars(5500). ❑Lasowncr of the propenY•ar mY cmploYees with wages ulhev sole romprnsation, will do the work,and the structure u nol intended ar offered forsale tScc 79 .Busirvss and professions Code:The Cormaemes License Law does not apply In an Owner of Required Inspections property who builds or improves thereon,and whodaaauch work hirmu fm Iluough his own employ=,provided that such improvemenu are not intended or offered for We.If, however,the building or improvement is sold within one year of completion,the owner- builder will haw me burden of proving that he did net Wild or improve for purpose of sale.). E]1,as owner of the property,am exclusively contracting with licensed eontraclen 10 consaucl the project(See.](JCA,Business and Professions Code:)The Conuactor's Lt. came law does not apply in an owner of progeny who builds or improves thereon and who eontmets for such projects with a contractor(s)licensed pursuant to her Contractor's License Law. E3 1 am exempt under Sec. .B&P C for this reason OR'S owner Data WORKECOMPENSATION DECLARATION ffim 1 hereby arunder penalty of perjury ane of the following dxlantions: 1 have and will maintain a Certificate of Consenua elf-imum for WorkersCompcn- siumn,m provided for by Section 3]00 of me taWr Codc.for me performance of the work for which his permit is issued. ❑1 ban and will maintain Worker's Compensation limina,as required by Section 3100 of the Labor Code,for the performance of the work for which this permit is issued. My Worker'sCompensation Insurance carrier and Policy number art: Cafricr. /U1"1 C Polity No.: CE0.TIFICATE OF EXEMPTION FROM WO KV1, COMPENSATION INSURANCE (This section need not W completed if the fermi)is forma hundred dollars(SIM) or ass.) I certify Nat in the perannomee of me work for which this Permit is issued,1 shall net employ any permn in any mannerm as to become subject to be Workers Compensation Laws of c.liforom Dare Applicant NOTICE TO APPLICANT:If.after making his Cci ificate of Exemption.You should become suhjcet to me Worker's COmponeallpn provisions of the Labor Codc,you over .JZ forthwith comply with men provisions or this permit shall be deemed revoked. EM CONSTRUCTION LENDING AGENCY I hereby affirm that then is amnelmnien lending F Y g agency for the Performance of E the work fur which this permit is issued(Sec.3097,Civ.CJ WM A Lender's Name . Lender's Address U Q 1 cemly that 1 have read this application and state mel the upon information is ly H correct I agree to comply with all city and county ordinances and sunt laws misting an OV Wilding construction,and hereby authorim repmaenulivm of this city in enter upon me r Cal above mentioned property for inspccuon purposes. (,y (We)sinceIp save,indemnify and keep harmless the City of Cupertino against (4 liabilities,judgments,cases and e.,.which may in any way same against said City UZ in conaequentt of me graining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGUL ONS. ,: fY(GLW K0-7 OS Re-roofs � ( Signnurcof ApplicanVCom elor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ter future building Occupant lam or handle haOunlous material as defined by the Cupenino Municipal Code.Chapter 9.12,and Or HcalO and Safety tide,Se uon 15532(a)? YinNu All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building oes:upant use equipment or devices which If a roof is installed without first obtaining an inspection,Iagree to remove - cml hazardous air cameraman.as O fned by me Bay Arca Air Quality Management all new materials for inspection. District? ❑Yea IVNo I have read the No dotes materials requiremcnis tea&,Chapter 6,95 of the Califor- nuH.10&SafclyCadc.ScctiomMM.M53Jandn53A.inndcrsundmatiflM building Fif�.�2rX 6— OS does not currently have a tenant that it is my responsibility in noufy ter occupant of the �ie ,t,U nermatswhre must x� I prierto issuance of a Certificate of Occupancy Signature of Applicant Date "' 1 "tea 14, l'�'US All roof coverings to be Class"B"or better err of raimmi ed agent Dam £ Community Development ' . 10300 Torre Avenue I . Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building De artment JOB ADDRE S: PERMIT# 7S�lG Q S66 0o 7 OWNER'S NAME: PHONE GENERAL CONTRACTOR- o FAX# / D I am not using any subcontractors: �L&Ol o 11"'.k 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 eavi ) le✓CCt�p �0-77^ D-R�, Owner/Contractor Signature Date Community Development Department Building Division ( City of Cupertino 10Ito, 300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 UPEI�TINO 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: hU1s(f ak S I 4 �s P�Job Site Address: _ Roofing Company Name: lC✓SO//X/� ^ ��G '( ` fl� Applicant's Signature: 4eaAC YU NlCYC61ra{J Date: =4� Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper 1 CITY OF CUPERTINO 2�' REROOF CUPEI,TINO PERMIT APPLICATION FORM APN # Z Z7 / �— Date: Building Addre sj 1 Owner's Name: Phone #: Co tra tor: Phone #: License #: �, ✓sod .:' e TD � Contact: Phone#: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof AO':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: �� l�IO r ('� c�e is Residential A ommercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Z3 Type of Construction: Occupancy group: Qty. if Applicable 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