04110142 CITY OF CUPERTINO ' ' * . ' k's'w '€•.a�Sd"?":e,. *",.e�-+ewrote 'm `' F< _. -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION - _
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT N�4110142
0800 HOMESTEAD
OWNER'S NAME: PERMITIS UEDATE
PROMETHEUS PROPERTIES INC 99 DUARTE AVE 11/22/2004
ONE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION O O O O
z 1//I�Mrcby arum mat I an Hemmed under provisions or Chapter 9(commencing - Job Description - -
.,iw wiQSPftion7")or Div,pm3ofdre Buain���a Professions Code.and mylicene is
��R i.>Ilforceand effect. / oI REROOF W ASPHALT
D n g License Clazs Lie.N_!L•I O y /
n F p Da¢ �Cuntracbr
A CHIT ECr$DELLA TION
uLLunderstand my plans shall W used as publi6 rentor s
;Qt; Licensed Professional
5 OWNER-BUILDER DECLARATION
I hereby affirm mal 1 am exempt from the Contractors Leon.law for the
p o fallowing reason.(Section II51.5,Business and Professions Code:Any city or county 31,
yin which requires a permit in consumer,alit,improve,demolish.or repair any stmctum 1 600
Fieprior to its issuance.also inquires the applicant for such permit to file a signed statement _
Rod he is licensed pursuovthi the frovisiom of flue Comracmri Lienac Law(Coopter9 Sq.Ft.Floor Area aluation
zein (commencing with Section 7000)of Division 3 of me Business and Profusions Code)or - - -_ - -- _-- LL --
ai�$ that he u erem attempt thfroand the baso for the alleged exemption.Any violation of � Y _
Section 7031.5 by arty applicant for a Permit subjects the applicant to a civil penalty of e - Occupancy Type
not mom Ran firs hundred dollars(S500).
p 1,u owner of the property,or my employee with wages ss thefrmlc compensation,
will do fie work.and the structure is not intended or offered forsale(Sec.9066,Bedimad
and Professions Code:The contraemrs License Low doe not only in an owner or _ Required Inspections
pmpeny who buildsorimporms mereon,and whomea such work himself orthrough his
own employers,provided Rat such improvements art not intended oroRered forma_IL
hosvover,the building or imProvemcnt is sold within one year ofcompletion,the owner.
builder will have Re burden of proving that he did not Wild or improve for purpose of
sale.).
❑T.as owner of the property,am uclusively contracting with licensed contractors to
common the pmject(SCC.7W.Business and Professions Cade:)The Contractors Li.
cerise law does not apply to an owner or pmpeny who Wilds or improves daemon,and
who contracts for such projects with a communist licensed pursuant to the Comactori ._
License law,
E]1 am tempt under Sec. .B&P C far this reason
lc�7
wner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of Re following declarations:
1 have and will maintain a Cernficum of Consent m sel6imum for Work".Campcn-
tion,as provided for by Section TIDO of the labor Code,for the performance of the
ork for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,ss requimd by Section - —
(oo cube,Code.for me perfmmanee of the work for which this per mit is issued.
kers CnmN.u.on Inounnce(crier and Put*.,qumgb�er ase:
SThTZ,Fi/A9d� Policy.Np�/�7-3�1�
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
This section need not becompleed time Permit is foronc hundred dollars(SIM)
or loss.)
1 ccnify mat in Re perform rice of the work for which tis permit is issued.I shall not
employ any person in any manner m as in become subject to me Workers'Compensation
Laws of California.Dole
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject b the Worker's Compensation previsions of on,IaMr Cole,you must
.,O foMwith comply with such provisions or this Permit shall W deemed invoked.
Z "' CONSTRUCTION LENDING AGENCY
'[•+� I hereby alarm that then is a Consumction lending agemy for the parforians of
the work for which this p.it is issued(Sec.3097.Civ.C.)
U] Lenders Name
Q Z Lender;Address
U Q 1 certify that P have mad this application and sat¢that me anew information is
W F' building
I agree m comply with y city and county oNine i Of and state laws r upon t to
Q U mon-momponuctiogand hereby aumon p rposesenudacs of Nis City mcmcr upon me 1
N a about-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against I/
F' , Habibuea.judgmcnts.ensu and expenses which may W any way we=against mid City _
U Z in consequence of the granting of this Permit. ....
ti S ULICENE UNDERSTANDS AND WILL COMPLY WITH AL NON POINT Issued by: - .�-Date -
� y Re-roofs
On me of AppbcanVConuacmr —� pate
HAZARDOUS MATERIALS OLOSURE Type of Roof
Will the applicant m(alum building occupant Stam or handle hvallous material
as defined by Rc Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety
adc,Section 25532(a)� All roofs shall be inspected prior to any roofing material being installed.
❑Yes uQNa
Will Rc applicant or future building occupant tie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha.ummus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DwrictT
❑Ycs No
I have read the hm Nnusmamrials mquimmcns under Chapter 6.95 of thc Califon
Mria Health&Safety Coe.Section 25505.M533 and 25536.1 Understood over if the Wilding _
not currently Aare a tenant,mat it u my responsibility m non ly Or reeopant the
yai Co. 'stthe me(poor missaaneeoracertifiea¢oracupm Signature of Applicant Date
wner m authorimdagent All roof coverings to be Class"B"or better -
a¢ '
x Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB AIMSS. 9VAIT #
Z o c�� �j •7-,.,,d 6 Z/
OWNER'S N 1�o•�e�I�tLS �n L, r76-r, 1< c- P #
GENERAL ONTRACTOR:1 ) g, t1 CZE C, F
I am not using any subcontract 'rs:
Signatureate
Please check a 4ttr applicable subc 'ors 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
Owner/Contractor Signature /f Date
Community Development Department
Building Division
4 City of Cupertino
� ,.
10300 Tone 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 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.
Homeowner's Name:
Job Site Address:
Roofing Company Name: 60i< Q.ml r wr r c i
A plicant's Signature: ' Date: "/bL/�
Greg teel
Building Official
Revised 1/30/03 '
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CITY OF CUPERTINO
REROOF
_UPERTINO PERMIT APPLICATION FORM
# 3 z/ Cj a .� Date
N 2
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Building Address: t
Owner's Name: Phone #:
Contractor: Phone#: - icense #:
Contact: Phone#: Cupertino Business License #:
Sfo '1I`{ s180c(
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
XWood 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.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
IF ob Description:
Teox qFF EXIsT S�I�es j r�srq u e c� 7 i6 " os3 �uS �G( "etj a) eAl CtSA-1 oe
Residential ❑ Commercial _t o 0,164-TCi� 6-/I ;DN�s C got= .
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res Ions:
Co �^ —, e of Constructs Occupancy gro r 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