04100006 CITY OF CUPERTINO
j BUILDING DIVISION PERMIT x CONTRACTORINFORMATIQN s. ,
BUILDINGADDR6.SS: DUBOIS ROOFING INC PERMITI9o04100006
20800 HOM STEAD RE) 4 20
OWNER'S NAME: PERMIT I SUE DATE
Ig hkPROMETHEUS PRO
41
ONE: - SANITARY 0. CONTROL NO.
(510) 793-9760
_ BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
stop LICENSED CONTRACTOR'S DECLARATION _ Job Description
FF 1 hereby af0rm Nu 1 em liemcd uade pmvi ons of Chapmr 9(commencing P
it`,S with Scctioa70xbof Diviskm3ordm Busi asaad rmonons Com.endmylicco¢is -
tom% inmumme .rc£Tt3'j. Lm.a rZ o REROOF -W/ASPHALT-- ._- --- - �✓ -
.�Z Licca ass
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Contractor
ARCHDECTS Tactor ION
Iundcrsun M used m public LOU
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Licensed Pn,fc bel
S OWNER-BUILDER DECLARATIONOn
_
qy I hereby a1TIM Nat I em exempt from the Corrector's License law for the /
o O following mason.(Section 103 L5.Business and Prfercons Code:Any lily Or county p\
K a ff which requires a permit m amitio 1,altec improve,demolish,or term,any euncture
toai prior to its issuance.alsu mquirmthcapplicans fensmh Notatin hlcasigncdsummcns
< thatheulicamedpurssiontotheprvisiomofdmConaaztorsLienseLaw(Chapmr9 Sq.Ft. Floor Area Valuation
YFG (commencing with SOetion7")Of Division 3 ofthe Businessand Professions Coae)or
'd that he u exempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 32 '�L crO0 Occupancy Type
not mart than five hundred dollars(5500).
❑I,as owner ofthe pmperty,army emplayecswith wagesas theirsom compensation,
will do the work,end Ne swctute is not intended ortifered for sale(Sec.7014,Business
and Pmressions Code:The Conunctor'f License Law does not apply to an owner of _ ... . _ Required Inspections -
man
enywhebuildsndedthavm0mreparevs who manot¢h wort onoffeedthrough
however.me cs,ping or i pr sue mobs emenuarenot es,MWmplecrtd the owfdhkxha.r --
huilder ill how the
or improvement is Out
he within one Weer of completion,me mem of - -— -
builder will have the burtlen of proving Nat M1e did not build or improve far purpow of _
sale.).
❑I,as Owner of Be pmpcny,am exclusively contracting with licensed contractors to
construct the project(Sec.704q Business and Palpitations Code:)The Conuacmr's Lt. _
me law does not apply m an owner of propeny who builds or improves memon,and -
-
whocontracufor such pmjecu with a conuacmr(s)licensed pursuan to Ne Connector's
License Law.
❑ 1 am exempt under See. .B k P C for this resmn
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under' .at,,of perjury ane of the following decharmi m:
I have and will maintain a Certificate of Consent o self.insure for Worker's Comim. -
737W
un,m provided for by Section 3700 of me labor Code,for the performane of the
ork for which this permit is issued.
1 have and will maintain Wmkcr's Compensation Insurance.as retained by Section
of Ne tabor Code.for Ne xi,dom urim of the work for which this permit is issued.
y Wa ker's5mor-e9soon in5unable callr and Policynumberaamel WTUuVOc �Pdmy No.:-L�L_7���
CERTIFICATE OF EXON FROM WORKERS'
COMPENSATION INSURANCE t -
(This section need not Wcomplemd if the permit is formal hundred dollars($101)
hal.)
I eeniry Nr in the performance of the work for which this permit u issued.I shall not
employ any person in any manner m as to hecome subject m the Workers'Compensation
Laws of California.Date _ - -
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption.you should
become millet to the Worker's Compensation provisions of the lahor Critic.you most
.JO forthwith comply with such Provisions or this Permit mail W deemed revoked.
Z w' CONSTRUCTION LENDING AGENCY
(-. I bemby affirm Nat there is a cumv mm lending apcmy far the perfurmame of
(S$ the work fur which Nis permit is issued(Sec.3097.Civ.C.) -
W Q Lander',Name
Ili Z Landcr's Address
U O 1 certify that I have read this application and state Nat the above information is
Dl F correct 1 agree to comply with all city and County ordinances and sure laws relating to
0 U building construction.and hereby authmim Mpresenutivev or this city to enter upon the
G alwvcmemiuned property for inspection purposes. ./s
f' (We)agree to save,indemnify and keep harmless the City Of Cupenino against
N
liabilities.judgments.costs and expenses which may in any way accmc against said City (J
or me
U Z APPLICANTeUNDERSTANDSthis
AND WILL COMPLY WITH ALL NON-POI Issued by: Date -
SOURCE RE S.
O/ Re-roofs
Sig of Applican rentor D.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or f)arc building mcupans state or handle harardous material
m defined by me Cupertino Municipal Cum.Chapter 9.13.and the Health and Safety
we.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym ❑
Will mea applicant or arm buildin encu r Oso c t m devices whict If a roof is installed without first obtaining an inspection,I agree to remove
pp g pan a Air Qn
mit ha'stlnux air contaminants ss defined by me Bay Area Air Quality Management all new materials for inspection.
DistrictDistrict?
❑Yes
I have mad me huvardousmaterialsreqummores under Chepmr6.95 Ofthe Califon
.is Hcal"Safety Cade,Seetimu 25505,25533 and25534.1 undernmW therrthe Wilding
Jam not eunnntly M1ovx a tenant mat it i,mY rciponsibilitY m unify the arupsnt of do
reyquircmebts wnm et priarmiataa7 of a cerdfieean+ey
�or eu.11 p ".Signature of Applicant �. Date
Owner oraamm vndagent D All roof coverings to be Class "B"or better
a
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS�: PERMI
/� /
Zo o /7D� ��7C iv D V C'7C7b(j b
OWNER'S NAME: 7�ro—,e. roP PHONE # - '5-7G- 5-300
GENERAL CONTRACTOR: IFAX # q s 5 Z
I am not using any subcontractors:
Signature ate
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
vim /
Owner/Contractor Signature ate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkJ1N0
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.
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.
p
Homeowner's Name: 1/o,,,e,7Ze-vJ �foPe iT Es,is
/7 ,� / / 2,0
Job Site Address: !/(/USO �-ea
Roofing Company Name: 1-) 3o,., 1p �- t 'J 7 ��
'a . A
pan 's Signature:' Date:
C
Greg t
Building Official
Revised 1/30/03
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CITY OF CUPERTINO
REROOF 6 ��o 6
_UPEkTINO PERMIT APPLICATION FORM
'RPAPN # 3 ZG a 01`
Date 7 d
Building Address:
20 O S ' 7�
Owner's Name: Phone #:
(c,✓t .ft, ev ' .vr81— /Wc x/50- S `l 53cx?
Contractor: ( Phone#: "p "1 / icense
-IJ��'J 1 G1"�t Ij .SIO 7q-3 1, ( 60 _ -' ' 6
Contact: Phone#: Cupertino Business License #:
�)Au l 5 Seo -1 VA - If 8 0C1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
°X' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings l ❑ Provide I.C.B.O. Report#
i To be Removed ❑ Provide Mfgr.Installation Specs.
i Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
ob Description:
—Ia4 O ;J 5�A053 ius,-a 6( /JeW 30 fev aS9ti,;C1 of
Residential ❑ Commercial " 1 Wit-Tri EX S'ANr� C �o� .
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res tons:
Co e of Constructs Occupancy gro 7
Qty. if
A 1' ab e 1 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