04110143 ! CIBUILDINGurvEsONU
NPERMIT 51 ONTRACT�ORbINFORMAT O'
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITN"041101-43" - -
0800 HOMESTEAD
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS PROPERTIES INC 99 DUARTE AVE 2004
ONE: SANITARY NO. CONTROL NO. •
(510) 793-9760
ARCHITEMENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_oo LICENSED CONRACTOR'S DECLARATION
z�F Ahcmby affirm that I am licensed under Provisions of Chapter 9(commencing "Job Description -
< whhSecfan 7")ofDivision 3oftm Business arhd Prometioar Code.and my license is
�t1y Lie.Ofodecend
c ccG / fZb o REROOF W/ASPHALT
5 v�z License Class 3 9 Lic.X_-qe-z(_ � _ .
�'O Date Convenor —'
-�by ARCNRECTS DECLAMATION ,
I untlaua tans shall k used u public decades.
O3 y6 ��
o t, Licensed Pmfcsa I Z
' Oat I am exempt
from
DEMe Comf ION
.�<P 1 hcmM1y alfirm that I am exempt from Ne COnmaors License Law for the
O O following mason.(Second 7031.5.Business and Pmfevvions Cum:Any city or county
K m(< which requires a permit to consumer,alter,Improve,demolish.or repair any structure 117
'Fly pd.,wits non....start noun.un,applicant for each Permit to Ole a signcdsosumem
< that he is licensed pursuant othe pmvisiomnfMeConmcwriLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
tt�m (commencing with Section 90th)of Division 3 of tic Business and Professions Code)or ._-�--
y $ Nat is,is exempt tmdefrom and Ne basis for Ik alleged exemption.Any violation of -
Section 703 1.5 by any applicant for a permit subjects the applicant o a civil penalty ofa Occupancy Type
not mom Nan five hundred dollars(SSW).
❑1,as owner of the property,or my employees with wages as Weir sole compensation, _
will do the work.and We Hill is notimended or offered forsam See.70b,,nosiness '
and Professions Code:The Conuazmrs Live Law does nor apply in an owner of - Required Inspections - .. .h .
progeny who beilds m improv Marmn,and who does such wmk himself.,through his
Man employers,provided Wet such improvements we notimended oraffered forsale.If,
however,the Wilding or improvement is sold within one year of completion,the owrmo _ _ - •-. - -— ,_•-
builder will have the burden of proving dou k did not build or improve for purpose of
sale.).
❑I,as owner of the property,em exclusively contracting with licensed contractors to
construct the pmjca(Sec.7(j6x.Business and Prefussions Cuba:)Tic Conoacwr's Li.
cense law does not apply to an owner of property who builds or improves tomon,and
who contracts for such pmjem with a comocwr(s)liwoed pursuant o We Contractor's _ - -
License law.
❑1 an eardr t under Sec. B&P C for this mason
103"'."M
ner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of We following decimations:
I have and will maintain a Certificate of Common to self-imus for WorkersCompcn-
i.n,as provided for by Secoon 3700 of me labor Code,fm We pcumnorm me of the
rk for which this psonit Is Issued.
1 have and will maintain Workeh Compensation Insurance,as required by Section of We Labor Code,for the performance or the work for which this permit is issued.y Wor 's Compennsation Insurannce carrier and Policy number am:
mPolicy,N..:/ CERTIFICATE OF EXEM PION FROM WORKERS'
COMPENSATJ01{INSURANCE
('(Thu section need not W completed if lk proud,is for one hundred dollars(1100)
or less.)
1 cerofy that in the acrformancc of We work for which this Permit is ismctl,l shall not
employ any person in any manner an a in become subject to the Worker'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifrcau of Exemption,you should
become subject to We Worker's Compensation pram aim¢of We robe,Code,you muse
.,O forthwith comply with such prmitims o,this permit shall cdeemed revoked.
Z CONSTRUCTION LENDING AGENCY
I Wreby uffrte that them is a construction lending agency fnrthe Performance of
fY
thRuss e work for which pent,u issued(Sec.3097.Civ.C.)
19 ders leaName
z leader',Address
O Q 1 cenffy Wet I have read this application and state that We above infomostiu t is
It, E-' caned 1 agree to comply with all city and county or iwhtts and lose laws nclating in
0U Wilding construction,and hereby auWorlm representatives of this city at enter upon We
r W ahove-mentioned pmKrty for inspection purposes.
(We)agree no save,indemnify and keep hamniess the City of Cupertino against
f' h
liabilities,judgments,costs and expenses which may in any way home against said City _-
U Z in consequence of the granting of this permit.
APPLICANT UNDERST S AND WILL COMPLY WITH yyyCCCLLL NO -POINT Issued by: Date
SOURCE EGUL —'- �j/ _
_ ��/— Re-roofs
:Shgna mofApPlhcaHAZARDOUSMATERIALSDISCL09 RE Dau Type of Roof
Will the applicant or future building uccupanurom or hand c hwarmas material
a defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
ode.sectianus3x(an - All roofs shall be inspected prior to any roofing material being installed.
j oyes � -
Will We applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
-mit hanardnus air cmAndoo n defined by We Bay Area Ai,Quality Management all new materials for inspection.
District? �
❑Yes Nu
Ihe.mW We nusmaterialsmyvirtmcnss under Chap¢r695aflk Glifor- -�
ria Heslth&SafctyC .S .25505,25533.d25534.1undm di.iff Wilding
dors not cuncntly have a wnans Nat it u my responsibilitym nouf to nt Occupaof thc
dequiremeuw WmnprioQcu
rwissuance.f.cumica g�cr. jS ignature of Applicant ,fie
0wn lnranthorVvnd •�� / Data - All roof coverings to be Class"B" or better. __
x - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
B.uilding Department
JOB ADDRE • PERMIT # I
Zo moo �/�'^ e STea�P �J/ � le ,7. .0
OWNER'S NAW,- ri'o • t7l—c r PHO
GENERAL CONTRACTOR: >j!3, s FAX #
I am not using any subcontract6i; �l 2
Signature � Date
Please check applicable subcontractors and complete the followinginformati�
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
OwDa
onner/Ctractor Signature Date
Community Development Department
Building Division
• z � �; 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 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: Pf ��Q�S� QC��� tfC-SIF
/N�
Job Site Address: 20terr_ C% Q en 1i r`�O
Roofing Company Name: a� �'°ts 1�oY ' N5-4
A plicanYs Signature: Date:re
Ltf
Greg teel
Building Official
Revised 1/30/03
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CITY OF CUPERTINO '/ 2
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REROOF o 0
UPERTINO PERMIT APPLICATION FORM
FAA-PN# z Date:
Building Address: 2�j7
2v on1 �Ql�) /Nc 11I S� Ct CL ' S J
Owner's Name: Phone#:
flue. bSv- S `Ib ' S �cx
Contractor: ( Phone#: `,icense #: l/
-{J\X5 1 i,1�trJc ,S 10
Contact: Phone #: Cupertino Business License #:
S Dc1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >( Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
1 To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:
Tear o FF EXIST� 5�+I�es „�srst-u. e.ct� 7 /6 ' 053 /Nsra�c, Nec.� 3r� ew aSf�AC1" ooF
Residential ❑ Commercial To VVA-TcA� E)/ST)pj c boF
Fire Zone: Yes ❑ No ❑ Confirmed with Planni 1 Mt. if
there are any res . ,ons:
Co ��ti� e of Constructs Occupancy gr 7
200
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
j6 � 3�