04110140 •CITY OF CUPERTINO -
'HH"gNC DIVISION PERMIT �CONTRAGT,QR INFORMATIQN 4
_ BUILDING ADDRESS: DUBOIS ROOFING INC """b4110140 '
0800 H
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS PROPERTI2S INC 99 DUARTE
QP ONE: - SANITARY NO. CONTROL NO. - .. ..-
(510) 793-9760
ARCHITECDENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION
<�C I
loom y affirm that I am licensed under prov'�iois of Chapter Y(commencing Job Description
b
with iso OfU)ar0ivisian]aftM Bu4nee aM.ff�rofetiom Code.andmylicenmis
tans r. anger 8d Z 3oY REROOF W/ASPHALT
License less q IS
n F Dale /r 2 0• Contralto -
1 �AR HIiiLC DECLAcieco
y y e I unMman4my plans shall be uSed es public rc[n t
OSU
C.t; Licensed Pirfessionel >�
5
OWNER-BUILDER DECLARATION C
1 herehy aRutn tet 1 am exempt firm the Contractors License Law for tM
O O following maven.(Secuun 71n 1.5.Business and Professions Code:Any city or county `\
K m which requires a permit to construct,alar,improve.demolish.Or repair any structure `J
v—N priori its issuance.also mqPermit uires the applicant for such peit to rile a signed statement _
��< that he is licensed pursuenuo the provisions of the Conlracmr's Lune,Law(Chapter 9 Sq.Ft. Floor Area _ _Valuation
TFC (cMorm,mff with Section 7")of Division 3 of the Busincsaanit Professions Code)m -
i tat he is exempt tcmfrom and the basis for the alleged cmortumn.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty Of 3 2fQFQl�clO 0 Occupancy Type
not more bun five hundred dollars(SSML -
0 I,as mores of to pmpeny or my employees with wages as thetr We compensation, _
will do to wank,..it teswctme is not intended or offered for sale(See.7014,Busircu .- ,
and Processions Code:The Contactors License law dna not appy to an Owner or Required Inspections -
property who builds or improves terem.amd wh.d«such work himself.r trough his
own employees,provided tat such improvements are not intended oroRered for We.If.
.- however.to building or improvement is sold within one year ofcomplction,to owner, -..-_„--,,,--
builder will have ft burden of proving that he did not build or improve for propose of .
We I.
I,as my ter of to property,em exclusively cimmucting with licensed Contract..1. ..
consumer the project(Sec.7044,Business and Pmeasloes Code:)The Contractor's Li
Certain taw does not apply in an owner of propcny who builds or improves tcreon,and. .
who contracts for such propms with a coneractorts)licensed pursuant to the Cintncmh -
Line.law. -
❑ I am exempt under Sec. ,B&PC for this mason
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury One of to following declantiom:
O
0t I hero and will maintain a Ceniriae,of Comem to Self-insure for WorkesCompcn-
sation,az provided for by Section 3700 of to labor Code,for the performance of the
work for which tis permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the tabor Cod,for be perfmmanee.rte work for which tis permit is issued. -
My/Wor ex Compensation hounnce Cartier and Policy n tuber See:
C CameJr STR7 eJ✓rd Pohq y�o 67 3ZS -o
CERnFICATE OF FKEM PTIDN OM WORKERS'
COMPENSATIONJUsURANCE
(This section rood not to completed if the permit is for one hundred dollars(SIM)
,or less.)
1 Cenlfy tan in the perfom ancc of the work for which this permit is issued.I shall not
employ any person in any manner so U to bee.me subject 0 the Workers'Compemati.n
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cci ificae,of Exemption,you should
become subject to to Worker's Compcmation provisions of to Lather Codc,you main
.JO foMtcomply wiwith pti
such rovism.or s perout h.11 lac dccmN remlonL
Z'; CONSTRUCTION LENDING AGENCY
P,�. I hereby alarm But there is a Comwction lending agency for to performance of
to work fur which this permit is issued(Sec.YN7,Civ.C.)
L17 QLender's Name
0.z Lender's Address
U C) I mealy that I have read this application and soon tar to above information is
1L Fcormct I agree to comply with at city and county oNinancea and sure,laws mining t .
C)U building construction,and hereby autorm mpresentatiws of this city rte Cour upon be,
Amm-mcnkenc!propcny for noticed..purposes.
(We)agree t.case,indemnify and keep hvmless the City of Cupenino against
pI liabihoiebjiu^gments,toss and expenses which may in any way accrue against Said City
U in corse ccuf to granting of this permit.
AP ANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: - Dat
OURCEL.�TION9a
Re-roofs
Signature of App onuxtdVCt�d .rOSURE ate
HAZARDOUS MATERIA Type of Roof
Will the applicant or future building occupam store or handle hnarduus material
xaaa[az defined by to Cupenin.Municipal Code.Chapter 9.12,and to Health and Safety
ode,go[Iian 25532(x)7 - All roofs shall be inspected prior to any roofing material being installed.
[3y. Po - -
Will to appliaml or fr.mm building.,.pact ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove-.-
mit halaudaus air Contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District' �t
❑Ya P No
I have mad to handous materialsrequiremcnts undcrChape,rii.95 of the Califor-
ni Health Safety Code Secuum255115.25533 and 8534.1 undersumtd tatiftho building C
duevhaw a¢ no that it is my respomih0ity M notify the occupant of to
reym rtemlycru whit ant M met prior to issuance Of a Ccnifcat of upenny.
Signature of Applicant Date
Owner.r..t.rr [car to — All roof coverings to be Class"B"or better
Community Development
F 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRE PERMIT # 6
2-on-,00 ""c C,,124� 7-,--4:/
OWNER'S N -u -,G �oQti��s PHO #
GENERAL CONTRACTOR: b FAX
I am not using any subcontractor= ��
Signature /J Date
Please check applicable subcontractors and complete the following information?%
60 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/Contractor Signature --� Date
Community Development Department
Building Division
r p; 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.
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 LC.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: �/ l //Gtl1
Job Site Address: 2e)- aJ 11 " GT_e d aA (_VPPAT.wrl
Roofing Company Name:
A plicant' Date:
GregJ1e'
Building Official
Revised 1/30/03
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CITY OF CUPERTINO
C+ REROOF
UPEkTINO PERMIT APPLICATION FORINT
N# 31
6 Date of
Building Address: (� .L
20610
Owner's Name: Phone#:
f�✓t e.f�QV iUYF , - //UL �)50- S `llo S �jCX)
Contractor: Phone#: - ',icense #:
Contact: Phone#: Cupertino Business License #:
f Vl/12.1� Pio, Sfo _V A - 6(8 0q(
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
No Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
ob Description:
Teter o(F �X,ST 5�+l�es ,I�s,q u eco /b " os3 RNs%��C Ne�J 30 ew aSfti�CT oaF
Residential ❑ Commercial rt� 1N�tTcln EX'S'rrN� r GJC
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res tons: ❑
Co a^ e of Constructs Occupancy gr 7
Qty. if
A 1- ab e 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