05040133 CI•I•Y.OF CUPERTINOxz�w - > ''° `* "'• ^' "
BUILDING DIVISION PERMIT CONTRACTOR-INk'ORMATION
BUILDING ADDRESS: PERMIT N0.
KEVIN SULLIVAN ROOFING 05040133
455 KGLLY GAK 9R
OWNER'S NAME: PERMITISSUE DATE
NE: SANITARY OL NO.
BUILDINIT INFO
ARCIIITLCT/ENGINEER: G PERM
r ^ r i• BLDG ELECT PLUMB MECH
o'ao 0 0
tiwGF that
CONTRACTOR'S DECLARATION `Job Description„ ;�2)
1 O S I krcby affordal I am licensero
d under pvisions M Chapter 9(commencing
With Scedion 7Wp or Division J of me Business and Profound,Code,and my lice..is
Phu m fullfnrce end erfe<.
q?q License Clos Llc.a REROOF W/COMP. %OARCH
TS DECLARATION
r^a s++*—I✓�1 11
700 alis she I W use DECLARATION
1 undcrsunJ my plans shall k used.r public rccnr6n 1
3LL� Licensed Professional — r-
03 OWNER-BUILDER DECLARATION .-
iS I kmhy affirm m that I acacmpt from the Comraetor$License law for the
❑O rollo Chet reason.(Scedon 7071.5,Business and Professions Calc:Any city or county
e; which require a Permit in construct.still,improve,demolish,or repair any Mountain
Fi< prions its issuance,also requires On applicant for such Permit o file a signed moment
mat he is licensed pursuant in the provisions of the Codrecmr's Limne,Law(Chapter 9 Sq.Ft. Floor Area Valuate
(commencing with Section 7000)of Division J or the Business and Professions Code)at
R. Nat he 1.exempt tkrefrom and On basis;far OR a111ed exemption.Any vi.ho nm of
Section 7031.5 by any applicant roe A pemrh subjects the.,dwam m A civil penalty of 3.dAN.N.,smlxerOQ Occupancy Type
not...,ban five hundred Jolla..(5500). O L.tl L.l'St
❑1.uaeonof the propcuy,ar is intended
wtrhwages rMeirsole cnmpenuness
will dothe won'and Nc he cturreChronicler's
root intendede Law do fs meade ply 71144.Business
of Required Inspections
And Pofeui builds
Code:The Can crimes License Law docs tort him. to an owner of q P
property who builds lir improves merman,and who docs such work himself oor ffered
his
Own Or Wilding
that such Improvements arc not ear of c or mpleered for ole.1t.
Wilde,however.me building or improvement is sold within mu Wild of completion,OR owner.
Milder will ban the buNen of proving,het k did w,Wild or improve for purpode of
ulcd.
I,as owner of the propeny,am exclusively contracting with licensed contractors to
construct he project(Sec.7044,Business and Professions Code:)The Conh6lm'S Li
came Law does not apply m an owner of property who Wilds or improves dictate,and
who mntmcu for such projects with a mmracmr(a)licensed pursuant to tk Contractors
License law.
❑1 am exempt under Sec. .B&P C for this(coon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Faulty of perjury one of the fallowing declarations:
I have and will maintain a Cenific to of Consent to self-insure for Worker'sCompcn-
'iden,as Provided for by Section 07M of the Labor Cade,for OR performance of the
9rk for yM1 ch this permit o,issued.
®-rhvve and will maintain Worker's Compensation Insurance,As required by Section
3700 of the Labor Code.for the Performance of the work for which this permit is issued.
My Workers Compensation Insumncc ca"let and Policy number
am:
Carrier: :$ 4M 7 Polley No.: 'O�'�'�_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section mcd not k Completed If the Permit is faro.Wndaddnllars(SIM)
it,le.s.)
1 sanity that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner sat u to become subject to the Workeri Compensation
Lows of Califurnia.Date
Applicam
NOTICE TO APPLICANT:It,after making this CeniGcam of Exemption,you should
become$Object 10 the Worker's Compensation provisions of the Labor Code,you must
.JO forthwith comply with such Provisions lir this perm it star W dccmcd revoked.
z' CONSTRUCTION LENDING AGENCY
[-rte I hereby affirm mat mere its construction lending agency for the Performance of .
y the work for which this Permit Is issued(Sol.30 1 CO,C.)
41 Lender's Name
=z Under's Address
U C) 1 eenify Na 1 have read this application end sum that du above information is
U. F. correct I&gree to comply with all city and county ordinances and state laws Relating to
OU building construction,and hereby ao,horiae representatives of this city to enter upon be
Uabove-mentioned property for inspection preludes.
(We)agree to save,indemnify and keep harmless[be City or Cupertino against
TMA habildes.judgments,costs and expenses which may in any way Alcorn against said City
U ,n consequence of the granting of this Permit.
.. APPLICANT UNDERSTANDS AND��W,(LL COMPLY WITH ALL NON-POINT Issued by: Date
SOU0.CE RESytl1aATIONS.�
NJ-- Re-roofs
Signamm of ApplicMVCrmvarr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building=opw store or handle hansrdous material
M defined by tk CUpenlno Municipal Code,Chapter 9.12,and me Health and Safety
,asslicadc..eerie.x..72(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑don �Lb—
WIII mea liCant or future building Occupant useequipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
pF 6 pan
1,havardnus air conmminanu as JefmJ by me Bay Arae Air Quality Managcmem all new materials for inspection.
istrictt
❑Yes
(have road me haaarOnus mauriala.yviremcnu under Chapter 6,95 of me Califnr- v/�j]
ria Heal" Code,Sections 25505.25571 and 25574.1 undlostand thin if tk Wilding L 2•�ils/'�.,r
does no,currently have a lenam,Nn i,is my respmmibili,y to nod ly d[nmupant of the
.wimm L,w ds "°^"i..°'°°nr.cenacatearxmwy, Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authmixed age I Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #oS,-t 3,355 L_ !
OWNER'S NAME: PHONE # -7 fib-
GENERAL CONTRACTOR: , ueLeW�.( FAX # —6
I am not using any subcontractor .
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
Owner ontra r Signature Date
Community Development Department
Building Division
n> > City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
*UPEkTINO
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:
)' e-inspection and/or tear off approval.
2) I -progress inspection approval.
3) al inspection approval.
�. a) Spark arrester installation.
C 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 ins nd the job is not ready,
you will be charged a re-inspection fe of$176.18 he re-inspection fee must
be paid before another inspection can beeee 8uled.
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 wi`'th the above stated policy on re-roofing.
Homeowner's Name: ALkA�n� j CCk &jc.
lob Site Address: 21+55 bI OkY DV?- lCbt/��.J6
//�,��//
Roofing Company Name: K�f�l1N E� 14-►�D�-y
, sj"L�tl��1�� rICr
. SWIL'u�
"`
Applicant's Signature: s 1 ` _ ^` Date:` jam
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
-� CITY OF CUPERTINO
GCS- REROOF
Cf-TV-0
CUPEIZaTINO PERMIT APPLICATION FORM
APN # o Z_ o S Date:
?� Z
Building Address:
�S ko
Owner's Name: Phone #:
/
Contractor: Phone #:. License :
iN , 5Utz4 P 6E� ?,03474r_
Contact: ho Cupertino Business License#:
Tyo of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ uilt-Up roof
❑ Asphalt Shingles Lk� sphalt Shingles
O�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:
-76,v-
Residential
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: 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
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