05030161 CITY OF CUPERTINO a'r >� '•'
BUILDING DIVISION PERMIT ,CON,TRACTOR�, NFORMATION 4
au
OW1LDING ADDRESS: PETERSEN-DEAN INC """%503016161
NER'S NAME: PERMIT ISSUE DATE
RI
ONE: SANITARY NO. CONTROL NO.
(";10) 494-99R2
."CHITECt/ENGINE
0 4 4-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONTRACTOR'SDECLARATION 0 0 D D
FF 1 hereby affirm that I am licemed under pmvisiom of Chapter 9(commencing Job Description
Z`uj wish Section 7M(p)of Division 3 often Busing and Profession.,Code.and my license is
<<=N infuOfoR;"de`
LicREROOF W/SINGLE PLY #5527
D,af?
ense Cl Lica
Dam CumDELLmcmr
ARCHITECPS A ATION
<< 1 ndcrsmnd my plans shall k used as public recordit
JyU
'30H Licensed Professional
OWNER-BUILDER DECLARATION
I better,affirm thm I am axampt from Na Conlacmrs License law for the
_'0 following mason.(Section IID 1.5,Business and Pmfasans bCode:Any city or county
Lad LL which requires,a permit la construct,construct,alter Impnow.demolish,or repair any structurestructure¢i prior in its issuance,also inquires to applicant for such permit in file a signed statement -
< Nal he is licensed pursuant to the provisions of the Comxm
rr's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
s:$ (commencing with Section 7")of Division 3 of the Business and Profesiorm Cock)or
to 3— that he is exempt Ikrefrom and the iasis for the alleged caempuon.Any violau m of
Section 7031.5 by any applicatn for a Permit subjects the applicant to a civil penalty of 3 24&1U &bet0 0 Occupancy Type
not mom Nan five hundred dolWs($500).
❑La sowner .athe propertyter is employee with wageaIketele a .Business
will dothawoh,Code:he era arm's tended Licenme, awdoeiffienad not apply an in owner
Required In ections
and Pro who Wild,.,
Code:The wsthe .. .d he law does not apply lf an owner is q CaX`T/-
ownertywha s.rr i i d than such impo anewho are
hmffered hmugh his
own employees,provided pr such improsemw t art not arofintended ropIcu¢e formile.If,
ow=r-
builder Nebuilding orden of pmanlithathwithinone,sat ofimPro tion,the owner- �..
builder will Mve Ne burden of proving that he did not Wild or improve for purpose of
ala.).
co I,asconstruct owner of Ne property,.B udus and prolactins with licensed conmamors to
mmLa d project(Sacapply
to an owner
of and professions Wi Cade)TheContractor'shemon.Lid
Genu law curs not apply m an own:of property who Wilds or improve Nanton,and
who contacts for such projects with a comanar(s)taunted punuam to the Contractor's
Lkcna Law.
❑I em exempt under Sec. .B&P C for his myon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of she following declarations:
J I haw and will maintain a Ccrufia¢of Contin to self-insum fm Worker's Compere
auan,as provided far by Section 3700 of Ne LaW!Code.for Ik performance of Ira
work(a,which Nis permit is issued.
❑I have and will maintain Wmkcr's Compensation laarance,at lactated by Section
37W of thc labor Code.for the performance of the work for which this permit is.,tied.
My Workee C. pema on Iaarma.enier end Policy num rare: S/
Carrier. �`/•s�Polity No.: _
CE FICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if Ik Permit is furore hundred end.(SIM)
or Ica,.)
1 mrmfv that In the performance of the work for which this permit is issued.I shall not
employ any person in any manner m as to become subject to the Worker Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject at Ne Worker's Compammd(n provisions of Ne Labor Code.you muss
O rarthwith comply with such prrt iuws M Nis Pmmtuhall W deemed revukcd.
Z " CONSTRUCTION LENDING AGENCY
[-+ � I hereby affirm that Nem is a coetmetinn lending agency for the performance of
C 7 the work(a,which Nis permit is issued(Sec.3091,Civ.C.)
WW A Lendcls Name
Z Lerder.Addres
U C) 1 ttr ify that 1 have read this application and rude that the above information u
Iy H correct.I agree to comply with all city and county aNinaneas and sum laws relating to
0 U building construction,and hereby auho m represinuusee of this city in emer upon she
r W above-memioned property for inspection purposes.
(We)agree to ave,indemnify and keep harmless she City of Cupertino against
F'N liabilities,judgmenor.costs and expenses which may in any way accnm against said City
U in consequence of the granting of this Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL N N-POINT Issued by: Date
SOURCE REGUL ONS. /
05 Re-roofs
Signature of App' anUC naactm Date
HA ARDOUS ERIALS DISCLOSURE Type of Roof
Will thee titer fmure building occupant store or handle hazardous mdonai
as reared by Ne Cupeni no Muni al Code.Chapter 9.13, ad It.Health and Safety
Core,Section 355J2(a)?
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applieam or fmurt building occupant use equipment or Jcvice whiter If a roof is installed without first obtaining an inspection,I agree to remove
mil hazardous air canuminanu as dcfired by to Bay Arca Air Quality Management all new materials for inspection.
District? ,WnL•/
❑yes
I have cowl tiro hvarrmsmamrialsmyuimmcntsundcr Chapter Q95 of NC Glifor- /� G•�
his Health&Safely Ca .Socurnt35505,25533am 5M,iuMcram irthe Wilding
does not currently have a moan,that it is my mapomibilily to noufy the pamt the
mgaimmenuwhich mumbo reprint ofa Cutiacam of anc�L_ S nature of Applica Date
A!) All roof coverings to be Class "B"or better
Owner or auto reed gens Date
Community Development Department
Building Division
;t City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U P E IST I N® Fax: (408)777-3333
.10Building 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.
4eJ--1!:To receive a final sign off from the City, the followi_n_g steps are
4 L....,.,.required:... s
1) Pre-inspection and/or tear off approval.
2)'In-progress irispectiori approval.
'3)--Fihal inspection appirodaP.
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,
'wrll'require the removal"of all'new material down'to the sheathing,
so a proper City,.inspection can be performed:,
7r:,i tm 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.
C. IMPORTANT: '
1. Flat roofs must have a minimum of 1/a" per foot slope and demonstrate
that there is no ponding.
2. l 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-
ro
ofin
g
.
31ters Name: =bT�- lei,
job Site Address: 'Ye I'ie/r Pew /
Roofing Company Name: P fel SPS �•Ea ` /
Applicants Signatur : Dater �S
Greg Casteel-"
Building Official
Revised 11/2/04
Printed on Recycled Paper
r Community Development
0 Torre Avenue
N ! ,-:/ CapaA
rtino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT # 6�D O J
ZoS 2ro rl-�5�1 '4/e
OWNER'S NAME: 11�r PHONE # .-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
SignatLtfre 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�A�wner/&ortlractor Signature Date
.. Community Development
10300 Torre Avenue
1' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
UPEkTINO `
Building Department
7 " JOB ADDRESS: A PERMIT # - 0J r
OWNER'S NAME: (4e i- PHONE # s/Q L9/Z c'
GENERAL CONTRACTOR:- r FAX # -p � f s5z6
I am not using any subcontractors: A0
Signa e Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
r. ,Cabinets &Millwork
Cement Finishing
Electrical �s
r
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
A
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal j
Sheet Rock
Tile r
�=Owner/ t nlractor Signature � ,A Date
CITY OF CUPERTINO-
aw REROOF
I�CUPECTINO PERMIT APPLICATION FORM
V APN
Building Address: ✓
2US�lS A,4e,5 .ad
Owner's Name:' t p Phone#:
t-rt _!t:Ja Prd 2 Y?Z
- Contractor: - _ _ - y� Phone#: License #:
Contact: Phone#: Cupertino Business License #:
_14K e /
Type of Roof Covering:
Exists g: -- - -- .: Proposed:
66. Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _ ❑ Asphalt Shingles -
❑ Wood Shakes ❑ Wood Shakes f L O /� p,
❑
"Wood Shin les ❑ Wood Shingles 10
❑"Other(Specify) - E( Other(Specify) 5
Number of existing coverings to Provide I.C.B.O.Report#
-,u . ❑..• To be Removed .. ❑ Provide Mfgr. Installation Specs.
I Have Read;Understand and,Will Com ly,With,Cu ertino's Tear Off Policy:
� Job Description-1. �cce W l ft �i bVkW
,
Residential 0' . 't r _ zns ( Commercial) t.r.:w, : � c �/�m�✓Ics �r"�
_
.-Fire Zone:, Yes '(] No_[�] ;_ " : Confirmed with Planning Det. if
� LJ
there are-any restrictions: `
` Cost of Project- Type o Cons ction: 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