04110141 CITY OF'CUPERTINO y r ' w� " ,
" BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ''. _
...rigt..._" O. _
BUILDINGADDRESS: - DUBOIS ROOFING INC PERMITNb4110141 - '
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS PROPERTIES INC 99 D ARTE AVE 11 /22 /2004
ONE: - _. SANITARY NO. .CONTROLNO. .. —
510.) 793-9760
ARCHITECVENGINEER: BUILDING PERMIT INFO '-
BLDG ELECT PLUMB MECH
sox LICENSED CONTRACTOR'S DECLARATION Job Description
i�C w' I Mmby affirm chat I am littnxd under pmv'�.y'�s of Chapwt 9(commencing - -'---'
U ut'�mb70)U)af Divima3afd% Busimssand PrMesa'om Code.endmyliccnscis
uccnacClass "" 9 Lm.`,� 30 REROOF W/ASPHALT
,;:o Dam Cumnc -
�ryARCHITECTS DECLARATION
/ UUU
re I ac lana shm M ares m PObfie nor -
�au l
Licensed PmaI
fcssr
.� 3 OWNER-BUILDER m We Com oto
00 1 Mrthy affirm that 1 em exempt from d r Cmions, o :Any c Law for the -
20 following reason.Permit
]InIS.Businessand Prokssiom Code:Any city at county
K m whichitscartel...a Permit to rectums
W 1, plic improve,dcmmiN,or repair any nrvaurt 0
_Iy pdormiuiensedpalwmto me m,appliant for such Committal's o Man License
Lawdsummcm _
(commencing
heincing with Section
to me ofpsavisitins sion 3UcConlractufinirenuhw(CMpmr9 Sq.Ft. Floor Area alua[ion
ws-O Wathe s a remithherafrn7(a1d basis
rUl the
egainevaand
ption.Any Cook)
or - - - — --^---- — --
y�� Nn M u eumpl Omrtlmm and Ne bleu for dm Jl,ged eumplion.Any violation of
Section 7031.5 by a"applicant for a Permit subjects the applicant civil penally of 3 2,41109tinlibefi0 OCCUPAcy Type
not mart Nan five handled dollen($500).
❑.I,as owner of the propany,or my employes with wages as Well sok compensation,
will do We work and the structure is not intended or ffemd for Asia(See7061.Business - -
and Prefessi m,Codn a:The Contractors License Law donet apply to an Owner of - Required Inspections _ _
properly who Wada Orimproves memo,and whadoes vwhwork ldmselrormm igh his
Own employees,Provided mat such irepmvemcnts Ar not intended or offered rostra.If,
however,We building or improvcmem is mid within one year o(compledo.the Owner-
builder will have me burden of proving that he did not Wild or improve for purpose of
Aide.).
❑I,m owner of the yropeny.am esclnively contracting wile licensed ronuaaon to _
construct the pmjcct(Sec.7004,Business and Profcssirns Code:)The Contractors Li- ..
cnnse Law does not apply to an owner of pmpeny who Wilds ler improves theleon,and
who contracts for such projects with a eomosetor(s)licensed pursuant to me Conoacmr'S - -,
Lice^..law.
❑1 am exempt ander Sm. .B&P C for leis reason
Owner Data,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of We,following decimations:
I ham and will moirsam a Certifiam its Consent to self-intim far Wmkcr'eCmn,m-
sation,mprovided for by Secli,n J7W of the labor Code.far me performance of We
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as mutinied by Section
117 of me tab"rC da��..for me perlmrmantt of We work for which this permilu issued. - - - — -----
M Workers C Cmadon Insu n¢es d Policy number am:
C.
e�rry PoI"\No G7�32�-6
CERTIFICATE OF EK POONFROMWORKERS'
COMPENSATIOIWNSURANCE
(This section need not W complcmd iflic pennit is foram,hundred colors($10d)
ler less.)
1 ceni(v mat in We hOlormanee of the work for which this Permit is issued,l shall not
employ any person in any mannerw As to become subject to the Workeri Compensation
laws of California.Da¢
Applicant
NOTICE TO APPLICANT:IL after making Nis Cenifcam of Exemption,you should
become subject b We Workers COmperW Ilan previsions Of me labor Code.YOU must
.JO forthwith comply with such Provisions of this permit sball W domed reversed.
Z' "• CONSTRUCTION LENDING AGENCY
1 hereby affirm that Were is a construction lending agency for We Performance of
the work fur which this permit is issued(Sec.3097,Civ.C.)
1 Lender's Name
7 z lenders Address
U O 1 ccnify mat 1 have read this application and sum that We above information is
0 H cording 1 agree m comply with all city and county ordinances or and sum laws r upon the fA
�(J move-gcrnmmcdon,andherebyauthr purposes.
(We)
this city wcnmr upon me I1II1/I
W about-mentioned to save for impcctien!keep h I/
(Wc)¢glee a.save.indemnifyredkeep may
way
of. ,.lost s against
inconseq judgmentsecosuand expenses which may in any way ettmc ogle^^midcity
UZ inconsequence of the graining of permit
APPL``CANT UNDE TANDS AND WILL COMPLY WITH ALL NON-P I Issued by: Date
OU CE RE NS. '• _
✓� Z Re-roofs
$' nawrc of ApPli,anVConvacmr / Da¢
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant w future Wilding eccup om store or handle mcardous material
As defined by We Cupertino Municipal Code.Chapter 9.12,and the Health and Safety '
coag.Sees.25532(1)7 - All roofs shall be inspected prior to any roofing material being installed.
0 Yes
Will the applicant future building wcuPam tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit haranoma air coauminanes m dclined by We Bay Arta Ail Quatily Management all new materials for inspection.
District'
❑Yes P110 'yJ
Ihave mad We ba7surbous requirtmcnChaPm6 fth,Califon
Hnith&SactyC,M,Scdom2305,2573and25534,tondudNfifth / /l
Wilding �/J �!/// � �•� � ® /—
t curmndy haat a tenant mat it rs my rnponsihilily m notil'yy me,eup t of me i
I nm,n muuMmelpdortuismanttofaCcnlacemof cup Signature of Applicant Date
2
Owncf or authomN egcm Oa All roof coverings to be Class"B"or better
' ..�.,. Community Development
10300 Tare Avenue
! � Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
BuildingD artment
JOB ADDRESS: / PERMIT #
OWNER'SV, •r,c=;r PHOI
GENERAL CONTRACTOR D-13.;, j„(- FAX #
I am not using any subcontracto s: tu6 l Z G
Signare ate
Please check applicable subcdn actors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINES 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
!! L m
Owner/Contractor Signature Date
i
Community Development Department
Building Division
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:
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 Y4 " 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: [oe✓S P(°P�T�ES I~'G
job Site Address: L g00 - 4a_&Lc_c"feca d- eb on rtl�d
Roofing Company Name: �y��`s �" F• f"e,
A plicant's Signature: ���� Date: /L.�4a 4
Greg teel
Building Official
Revised 1/30/03
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CITY OF CUPERTINO v � I
RE ROO F
a
CiF
UPERTINO PERMIT APPLICATION FORM
APN# 3 LZ o � vs Date:
Building Address: 2�
ZO 6 in S� S
Owner's Name: Phone#:
(U✓tr�.('�ev ' rure�— /WG k/S�- S `} b - S �cx
Contractor: Phone#: icense #:
Contact: Phone#: Cupertino Business License#:
f1/11�21� �u�jo 5 5lo -1 G`{ - 618Ocf
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
/)< Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Ajbj Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: f
ob Description:
Te,�,f oFF E-X15T rj c, 5"I(es ) PsTq-tti cw ?/j6 0s3 /N554'eC tiew 30 yeW 6&f ,icr oJF
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res tons:
Cosuap,,Vla ,X� e of Const rucri Occupancy gr 7
Qty. if
Applj,xabAG 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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