04090290CITY OF CUPERTINO - •; ...
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aCTOR I1\C TIV
-
BUILDING DIVISION PERMIT
s�0+\°1 VRl
BUILDING ADDRESS:
OLD COUNTRY ROOFING
PERMIT NO.
04090290
OWNER'S NAME:
PERMIT LSSUB DATE
ONE:
SANITARY VOL NO.
ARCHITECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
IIpt����
_ Job Descnpl� A I��
I hcfpby affirm Ihet I am lQtiedBe under pmvisions of Chopwr 9 (commencing
`®p
I ED
with )of Division3of NC Beninese; and Profccsi ss odc.aM my license is
� _ -_—
Lice. [I dor 3�
RERIIF W/LITWEIGHT TILE
_
Dtatense a%-2a2-n! Co.. n-
ATION
NOV �- 2004 -
��aa ARCHITECI'$DEGIa
>anucrstanJ my plans shall be used re pohlie pacnr�
--- -
BUILDING _
Licensed
OWNER-BUILDER DECLARATION
hereby ofir -
1 thereby .(Sere n I am eaemst (mm the Contncmis License law for the
following reason.ermtO 7011.3, Business and Pmfde oli Cole: Any city county
(Section
S
Which payuasura permit h, constme alma improve demolish, fir .,.it any srucmre
Sq. F[. Floor Area
Valu tI00
its issresed,alaantro a thovisiocant mioolociole n
lie<nmtsiws
aw(Chwment
tprior hm he oftlac ontracch
(commislicensedpunuam7") of Diviomof NC Conuacwra
Code)
(commencing with Section nand Division 3 of the Business and Professions Cade? of
Out he u essmpt ticrtfmm and Orc bash for vrt alkgrd exemption. Any violation of
the
3 SWV9 T qf`0 0
Occupancy Type
Section 7031.5 by my appliam for is permit subjttu the applicant to a civil penalty Of
not more than Rvc hundred dollars (S50).
❑ I. u owner of the properrY• or my employes with wage as Neh sok compemeOon,
Required Inspections '
q P
will do the work. and the swmure is not intended or offered for sale 7044, But.
and Pmfessimn Code: The Contractor's License Law docs not apply w an owner of
,.,.y who builds or improves thereon, and who doessuchwork himself or through his
own employees, provided that such impro emenu are not intended at offered for We. If,
_
however, Ne building or improvement is sold within one year of completion. Ne Owner-
Wilder will have the Auden of proving that he did not build or improve for parson, of
sale.).
I, u nwner of the property, am =elusively contracting with licensed comments; to
continuesthe pm)ect (Sec. 7054. Business and Pmfessimu Cade:) The COW acwr's V-
cense law does not apply to an owner of property who builds or improves thereon, and
-
whocontnetsfofsuchprojectswithaeonmemr(s) licensed pursanr m the Contractors
License law.
I am exempt under Sec. . B h P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury ..of Ne fallowing declarations:
-
IhaveandwillmaintainaCertifieateofConsenttomif-insum for Workers Compere
sation, as provided for by Section 37n of Ne tabor Codc, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as requited by Section
37W of the Labor Code, for the performance, of the work for which Nis permit is issued.
My Works/r'' Co(m�pensadoo. Imam. Cartierand Policy nryej
M.f �/u Inn] Policy No.: l/O
Cartier. /ta/AY/D
1' CERTIFICATE OF EXEMPTION FROM WORKERS'
.
V COMPENSATION INSURANCE
(This section need not be completed if Ne permit is for one hundred dollars (SIM)
fir less.)
1 Certify that in the pcnfnrmavcn of the .,it for which Nis permit is issued, I shall not
employ any person in any mans¢rso as to become subject in tM Worlmrs' Comp rommus
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making Nis Certifies¢ of Eacmption. You NwlJ-
Wcome subjcm w the Worker's Compcnsodan pmvisions of Ne Labor Coda, You must
forthwith comply with such pmvidom or this permit shall W deemed revoked.
'
cIONLENDING AGENCY
i
oatthe is a lending agency for the performance of
1 hereby Nn Nem is
s ed (Sec. 3
' the work for which Nis permit is issued (Sec. Jfyn, Civ. C.)
Lenders Name
I<nder's Address
1 certify that I have mad this application and taw that the above information is
correct 1 agree in comply with all city and county ordinances and sole laws palating to
and. authodx rep iva of Nis m enter upon the
building co) agree
above-mentioned Property (Or inspection purposes.
Of
indemnify and keep harmless Om City o(Capcnino against
(We) agree to rode haters
s.save,
g Iiabilitics.JudBmcno.cests add expenses which may in anY waYamuc againsLtid City
F in consequence of Ne granting of this permit
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINf
Issued by: Date
SOURCE R TIONS.
g'36-oel
pian�f. tAh
Re-roofs
Type of Roof
Signal of IianvConwcwr Date
HAZARDOUS MATERIALS DISCLOSU RE
Will tM applicant or future building Occupant store or handle hasardous material
as defined by the Cupertino Municipal Code. Chapter 9. 12. and Ne Health and Safety
Cole. Section 15531(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes CIF'
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devim which
it havardous air cnnuminanu as defined by the Bay Area Air QualitY Management
all new materials for inspection.
Davin? ..!
❑Yes 11 No
1 have reel the hvudnus materials requirements under Chapter 6.95 of Ne Califon
V
9—�Q—QIP
fits Health k Safety Cade, Sections 25505.15533 am125534. 1 unJenord den if the Wilding
I� ',sec /l
Q�n�
Docs not�c rtendy bout a wnon4 Nat it h my resports hility to notify Ne, eccuprit of Nc
%�y�t' �"— - 77
Date
reep"O' whichmut"W� etpdarwiss w alcetifiatearaapsn .
Sig sea re of Applicant
Oris 4 / E7A ill ,J 930-aL�
All roof coverings to be Class "B" or better
owner0 autho..sel. em Da¢
•
•
01V,I LL C
Please check applicable subcontractors and complete the following information:
vac
r Contractor Signature
�-30 -!V
J� Date
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
6cDJ 13
Septic Tank
Sheet Metal
Sheet Rock
Tile
r Contractor Signature
�-30 -!V
J� Date
ax
cm OF
UPEkTiNO
Building Department
Subject: Re -roofing policy for the City of Cupertino
Cepar:ment
Bulld:ng Di% Lsion
Cit: of Cupertino
10300 Torre Avenue
Telephone: (408) -32123
Fax: (408) r7-3333
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standard
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: (�_1.1(A NL, /AcSU
Job Site Address: 1 O C/ 8 0 rn /" lz),q L_ rl V,
Roofing Company Name: O L,�P C O(,4AJ k -EO o F 1 A)6
A plicant'sSignature:Date:2' _P- 'Def
L� Greg eel
—� Building Official
Revised 1/30/03
Printed on PeCyCled Pepe•
ci-rN. OF CUPERTINO
REROOF v 4 v 7D 2
UPEkTINO PERMIT APPLICATION FORM
Date:
! Buudin,2 A u'ress: /
10 q (po It-n%'L 2r L /7 ULA
O%k ner's Name:
BPER.MFEE Bldg Permit Fees
BUILDING
Pho''g9e #:
C-1-1 ISI AJC /-F 5M
BUILDING
`t o � 075,5- (ago I
Contractor:
Phone »:
BSEISMICOM Seismic Commercial
License #:
off-: CCO(JAlTl2V i2ool%In>c
L/08
X300
1
Contact:
Phone =:
Cupertino Business License;::
T�'SS
Lf o'�-
00
• a v • �' g
Type of Roof Covering:
Existing:
Proposed:
7 Built -Up Roof
❑
Built -Up roof
7 Asphalt Shing!cs
Z)
Asphalt Shingles
oc I Shakes
❑
Wood Shades !
7 \good Shingles
❑
W'ood Shingles
7 Other (Specify)
TS,
Other (Specify)M OAI/esK- L16)t (Jv76ir-F T/'r
Number of existing coverings
Provide I.C.B.O. Report # o
7 To be Rcmoved
❑
Provide Mfg. Installation Specs. i
I
dibHave Read, Understand and Will Compl% With Cupertino's Tear Off Policy:
bDescription: r{C�rnvVc5'
or l 1/-33 rd -r -t_ to ScS
1 dO a .fMog) t &7 � L1 6JJ-r-W&'16-fT
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anv restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
-U> 1 9.000 ✓-z(s/�?oor- 5F1<_ IIF, -3
Qty tf
An licahle Fee ID
Fee Description
Fee Group
BPER.MFEE Bldg Permit Fees
BUILDING
BENERGY Energy
BUILDING
BSEISMICRE Seismic Fee Res
BUILDING
BSEISMICOM Seismic Commercial
BUILDING
BPLANCHK Plan Check Fee
BUSLIC Business License
BUILDLNG
BUILDLVG
I