04030147 CITY OF CUPERTINO `+�`� '"`'"
'
PERMIT RINF0RMA1I'0
N t,BUILDING DIVISIO
BuNTRA
1LDING ADDRESS, WESTERN ROOFING COMPANY PERMITNO04030147
•OWNER'S NAME: PERMITISSUEDATE
ONE: SANITARY O. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am lisnnud under provisions of Chapter 9(commencing Job Description
with Section 7IXknof Division Sof Mn Business and Professions Cnde.end licireas
"ow infuufomeandeffe,' (jZS`S TEAR OFF ROOF, INSTALL LIGHTWEIGHT MONIERDURALI
jqZ Littnu Cl Lick
,.arm
TILE
s A HITECTS DECLARATION
n 1 understand my plans shall list used as public¢cords
OyU
3r o G Licensed Professional
33 OWNER-BUILDER DECLARATION
1 hereby afford that I am caemp,from the Comramors License Law fur the
_pe following meson,(Section 7031.5,Busincesand Professions Code:Any city or cnumy
,�, which mquims a permit ,,d.muun,almr,improve,dcmalixh.Or open,any uacare
prior to its issuance.also acquires the applicant for such permit a file a signed statement
FiCthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuat'220
al- (commencing with Section 71100)of Division 3 of the Business and Profession.Corr)or 4%
that he is exempt tnemfrom and Ne basis for the alleged exemption.Any violation of
Sited..7031.5 by any applicant far a permit subjects the applicant to a civil Prosily of APN Number Occupancy Type
not mom Man five hundreddollars($500). P Y YP
❑1.as owner of the progeny,or my employees with wage,as their rare compensation. 35931019 . 00
will do Ne work and the mo ctum is not Intended titillated Rustle(See.7044,Business
and Professions Code:The Courtrai License Law does not apply or an doowner of - Required Inspections
propenywho Wilds.,improves there.o.r d who dues such walk himself or through his
Own employees,provided that such improvements are not arofintended foe sale.If,- LE D
however,employees
the building or that such
improvements
is sold within one year of completion,oroeyed me Owner-
builder will have the burden of provl OR that he did not Wild or improve for purpose of
sale.).
1,as owner of the proper,am exclusively contracting with licensed contractors to APR 0 2 2004
concoct the pmjut(Sec.70 4,Business and Prefcumns Code;)The Contractor's Li.
cense law does not apply to as owner of proper who Wilds or improves themon,and
.It. exempt¢soar sen. .B&P c Tor trimmers for such projects with a sdmcmcmr(s)licensed pursuant m Ne Coal..o't
License Law. oM�l�D0 O
❑lam moa moxas
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following declarations:
I have and will maintains Cenificem of Consent to self-inure for Worker's Cum Pem
amass n,u provided for by Section 3700 of the labor Code,far the peffamanre of the
work for which this permit is issued.
❑I base and will maintain Workers Compensation Insurance,as required by Section
Morris Labor Code.far Ne perfmmanee of the work for.loch his Permit is Issued.
My Workers Com`nsation macron¢carrier and Polity torrid,am:
Gander. 1,A 1 g-F A "n Policy No.:b —0000 I- 8
CERTIFICATE OF UEMPIDON FROM WORKERS'
COMPENSATION INSURANCE
[Ibis section need not be completed if Me permit is for one hundred dollars(3100)
n Ices.)
I cenlfy Not in the performance of the work for which this permit is issued.I shall not
employ any person in any manner Of as to became subject to the Workers'Campcnalinn
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Cli ifcau of Exemption,you should
bitome subject 1O the Worker's Compcnsmion provision of the lahor Cnde,you must
.,2, fonnwith comply with such provisions or this permit shall be deemed invoked.
'ZO CONSTRUCTION LENDING AGENCY
[-r I hereby affirm Nat Nene is a construction lending agency for the Performance of
(Yi the work for which this permit is issued(Sec.3097,Ci,C.)
Iy] Lenders Name
Lender's Add.,
J Q 1 reality Net p have toad this application and sues thus Inc above infatuation is
0 bandit I agar ct comply with all city and county ordinances of and sum laws miming e
�U buildingconstruction, heabymNmi purposes. of this city to enter upon the
y W anav6meatitlaed property Rot inrpeClinn pulpnYS.
(-'C. (We)agree 1a save,indemnify and keep handless rhe City of Cupenino ageinsr
to liabiliues,judgments.cats and expenses which may in any way&came against mid City
C.)Z in canuquenee Of the graining of Nis permit.
^ APPLICANTrrVVNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE IE. IJATIONS.
�U o3 -/6-0qRe-roofs
Signature anve tmel r Dale '
HA Z RD S MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupam stare or handle havardous mamdal
as defined by Ne Cupertino Munidpal Cade,Chapur 9.11,and Ne Health and Safety
,gjjWMd,.Section 15531(07 All roofs shall be inspected prior to an roofing material being
❑Ya ®7+a P P Y g g installed.
Will the applicain or futon building=open(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nit havardnus air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes L�Wo
I have mad the hmaNaus materials m1uimmen6 under Cl Igor(.95 of the Califar
nix Ilcelth&Safely Calc,Sections 75505.15533 and 25534.1 undersand that if the building
docs not fatly have ssnan4 Nat it is my responsibility us nodiy oc oecupam or thc
myuim uwhich must W metpdur m isauance.fa cemfieste of Occupancy. Signature of Applicant Date
�C'� A_-G3 03_16-6
ed gem Daa All roof coverings to be Class "B" or better
Owner ser authnrir
Community Development
10300 Torre Avenue
e' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPE111N®
Building Departr
pent
JOB ADDRESS-. V PERMIT# 0
) 14 kEN o A- T v
OWNER'S N I l C PHONE #
GENERAL CONTRACTOR: — ' FAX #
I am not using any subcontractors:
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
,18 Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing 2 �,
Septic Tank
Sheet Metal
Sheet Rock
Tile ll
Qw;i /Con actor "ignature Date
Community Development Department
Building Division
19 Jam, City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
UPEkTIN®
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.
i
Homeowner's Name: x-47& , E
Job Site Address: ��- � rr l�-�"1)-W 00 b /V IE �2 (I11(�
Roofing Company Name: 00J
P
Aplicant's Signature: Date:
Greg leal
Building Official
Revised 1/30/03
Printed an Recycled Paper
Jy03oiq-)
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# �j'5 ! "! , 0 Date:
Building Address:
1 1 0 V f Irl"
Owner's Nam _ � Phone
L
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
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) CJ Other(Specify) u rT l tCt 7 t
Number of existing coverings n Q VY Provide I.C.B.O.Report#
P,'-To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description: j Pip-jz_off L C16f P200f j,l1A,l I L,�LIJEj'(rff7 XkOK60�b4 e f
Ph--
Residential Commercial ❑
Fire Zone: Yes ❑ No L' Confirmed with Planning De t. if
there are any restrictions:
Cost of Project: . Type of Construction: Occupancy group:
tR�7
Qty. if
Applicable 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