04070101 • CITY OF CUP js, ��CONTRACTOR�INIFORNTATION
BUILDING DIVISION PERMIT .,:
BUILDING ADDRESS: INTEGRITY ROOFING PERMIT N004070101
1002
OWNER'S NAME: PERMIT ISSUE DATE
RANK MOYANO lgi'17 CASA DE PONSELLE
ONE: SANITARY NO. CONTROL NO.
40.8 225-9263
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=oo LICENSED CONTRACTOR'S DECLARATION
=U C I hereby affirm that I am licensed under p9vamns or Chapter 9(rnmmcncing Job Description
c with Sccuop')00B)of Division 3 of NC Busiresspfp rufessiom Conn.and my license is
Lfull icense
dcrccd. ✓ /AsS� REROOF W/PRESIDEN. .TL SHINGLES
` ? )kunst 31 Lk.N (Jl�
n i-a Dale Conlranor — "IF,n
ARCHITECTS D ON
un nu^d my plans shall he used u public ads
JyU
u. Licensed Professional
S OWNER-BUILDER DECLARATION
iI hereby oRrm Nal I em exempt from dm Comnnors License law for[beo O following mason.(Section 91131.5,Business and Pmfasima Code:Any city m county
It a o which requiresPermit to Can.,,elle,improv,nnmnlish,or repair any structure
u"^ prior its issuance.also rcquma the applicant for such permit to f Ica signed imminent
mat he is licensed powarml.to the previsions of the Contractor's Uccnw Law(Chapter 9 Sq. FL Floor Area Valuation
QFC (commencing with Section 70IX0 of Division of the Business and Prefosions Code)or
i dot he is exempt therefrom and the buts for me alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3 5'2l)N3-[b$tber0 0 - Occupancy Type
not more Nan fm hundred dollar(SSW), o ,
I,as asvmmr of the property,or my cmploycu with wage urease sole compcnuuon,
will do the work and she structure is not intended a offered foraale(Sec.7014,Burow
and Professions Conn:The Committees License Law does Out apply to an owner of Required Inspections
propcny who buildsorimprovu thereon,and who dos sucltwork himself or Borough his
Own cer,the uiprovidedmauuchimps mid within one
seededmpQered ferarthea nee.
builds .Ne buildingorimprovement ishatheiidnoneyear of completion,the owner.
of
builder will have the Darden of proving that he did not build or improv for puryou of '
sale.).
❑1.as owner of the pec.704 am exclusivelynesand
convening Cid licensed .
construct meta non pplyna4,Businessand Profusions Code:)Thews theemr'snd
eche Law does not apply a an owner of limper(who builds or improver mesion,and.
who contracts for such pmpcu with a convanor(s)licenud pursuant to the Convenor's q
License law. !/
❑lman cacmpl ander Sec. ,B&PCfor this mown
Owner Data _
WORKER'S COMPENSATION DECLARATION
11cj!ye/rca1Tum under Penalty of perjury one of the following declare inns:
dbywill maintain a Cenificam of Consent to self-insure for Wmtrts ComNn.
uuon,as provided far by Section 3700 of the labor Code,far the performance of the
work for which this permit is issued.
have and will maintain Watrfs Compntsatio InsunnT,u required by Section
J
of labor Code for me performance of me wprk fyf whicM1 this permit is issued.
Ys Compensation Iartier P.(k�numMrc
Ylr a :
napnT aand Cato/gTAT✓' Policy No.:
CERTI CATS OF EXEMMON MOM WORKER
COMPENSATION INSURANCE
(This section need not hceompused if tk permit is faronc hundred dollars(SIM)
a lets)
1 certify,that in the perrommnce of the work for which Nis permit is invited.I shall out
employ any person in any manner an as in become subject to the Workers'Compcuation
Laws of California.Data
App wham
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
became subject in me Worker's Compenuuon provisions of me Labor Code,you must
Z forthwith comply with such provisions or this permitshall be deemed rtwked.
z O CONsTRucn ON LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency for the performance of
Ito.,it fur which But permit is issued(Sec.3091,Civ,C.)
A Lender's Name
DIL
Lendees Address
U C) 1 ecstify But 1 have read this application nmd mule that me above information is
F"
comm.1 agree to comply with all city and county ordinances and sou laws relating to
pU building construction,and hereby aumoriveuprescnlmives of this city to tour upon We
r Idl above-mentioned proper(for expenses pugwcs
(We)agree to save,indemnify and keep harraess me City of Cupertino against
UZ ince ianqueneofthe grandents,Cosa and expenses which may in say way aTmc against said City
U z inco^sCANT ofmcgnm Nof O'this permit.
APPLICANT NDERSTANDS AND WILL CO PL ITH ALL NON-POINT Issued by: Date
CBRE LA S.
Re-roofs
gnat r of Apppp•��y' Convaaor Dete
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W' did applicant or future building Occupant store or handle hazardous mammal
u dcr, by me Calicos Municipal Coda.Chapter 9.12.and the Health and Safety s
Code, 0ye'COa 35332(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu Nu
If a roof is installed without first obtaining an inspection,I agree to remove
Will me applicant or furore building Occupant roto cyuipmcm or dcvi=which g
mit hazardous air Conumi^lpu as defined by me Bay Area Air Quality Management all new materials for inspection.
District?
❑Yu No
Ihavcread meltsaardnumaur5.255uiremcntsunnnr Chap ffi5of i,Calding /^
rias.1 &Safety Cod e,Sttuovhatit 25577 enJ 35534.1 indersmnd,oe p building
Jars not cunen0y have a unanL that it u m ihility m nosily the axupnnt of Be
nequirawn.whiO must Dlvmet ficruiofa cnifcamof Occup cy. Sig Of I et DytC
O%=.agcm Dau
All roof coverings to be Class"B"or better
Community Development
aw
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #e 0
r
OWNER'S NAME: PHONE # Sr 2 9 3
GENERAL CONTRACTOR FAX # /
I am not using any subcontractors: 7
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
J
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
7//2/ay
n Contractor Signature Date
Community Development Department
Building Division
or
t City of Cupertino
0
10300 Torre Avenue
{ Telephone: (408)777-3228
CITY OF
4UPEkTINO Fax: (408)777-3333
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: F2 A M TV-)ov Z n 4
Job Site Address: QRZ Kt nnnk�r-Nr-c? C �Idr C
Roofing Company Name: I
ApGr
icant' Date: 7//?-/o/,-/(egteal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
CL am_- REROOF o °'7 ( cCITY l
CUPEF�TINO PERMIT APPLICATION FORM
APN # Date:
150 '7l19 C3
Building Address:
Owner's Name: Phone#:
T'R,AT,1K 99(0 - 156
Contractor: Phone#: License#:
-1V TC o - 5 US `l oO 55 ` 1
Contact: Phone#: 39S
Cupertino Business License#:
1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles $ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
i? Other(Specify) CAS S"&E ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
a To be Removed ❑ Provide Mfgr. Installation Specs.
SI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with PI ng Dept. if
there are anictio s: LJ
Cost of Project: Type of Construct' Occupan group:
oc� 1 r s r
Qty f.
A licabl 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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