05050155 CITY OF CUPER"11NO -•+ °"' "{°'"
BUILDING DIVISION PERMIT C�N�TRACTORINFORMACION::.
BUILDING ADDRESS: CUPERTINO ROOF, INC PERMIT N005050155
OWNER'S NAME: PERMUT ISSUE DATE
ONE: SANITARY10 CONTROL N0.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG - ELECr PLUMB MECH
0 0 0 0
_op LICENSED CONTRACTOR'S DECLARATION
jiwP I bobby affirm that I am licensed under provisions of Chapter 9(commencing Job DescriptionFI pk®R®�p1 p��
with Section?Bllll)C�f,1D.ivisionJofthe Bminea and Professions Code.and mYliccme is
=y infu110 can°"`L ELJ
-C Lk,a Co Y 7 TEAR-OFF SHAKES, INSTALL
D✓g z License Class
4;:c Date - Comruwr - n _ V
is
ARCHITECTS ocon ATIO 1�Z CDX FELT 40 YEAR ELK
5y xa< I understand my plans shall be used as public mentos o 1' 200[
=iU V 1
; ff Licensed Pmfcssionel
oGG
" S OWNER BUILDER m Ce Conti ON tea 11�n .4+A�
0 0 I reason.
.('firm that 1 rem exempt from the Contractor's Co License Law for the U 4L t�WD
O o followingguires a (SecOud 703 construct.
Business oM Professions Code:Any city or county
E:
m which requires a Permit m enostosis,ellen improve.Demolish,m repair any structure
prior in its issuance.also requires the applicant for such permit to Glc a signed statement
f?G mat he is licensed pursuant to the provisions of the Crimmins's License Law(Chapter 9 Sq. Ft. Floor Area Valua"o 00
ret=- (commencing with Section 7")of Division 3 of the B usiness and Profusions CMB)or 4�
i
that he is exempt msrefrom antl me baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant o a civil penalty of APN Number Occupancy Type
five not mom thanve hundred dollars(6500). P Y YP
Dl,m ownerorsW pmpeny,ormycmployces with wages v theirs°Iccompvwuon. 35923008 . 00
will do be work,and Ne swnum is misbranded ofoRcred Russia(Sec.]BU,Business
and Profemom Cade:The Contractoras Licarn law docs not apply to an owner or Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided mat such improvements am not inmrrdcG m offered forsak.If,
however she building or improvement is sold within one year of completion,the owner-
builder will haw da burden of proving that M did not Wild m improve for purpose of
.to.I.
❑1.a owner of the propony,am eaclusively contracting with licensed contactors to
com(mct du project(Sec.9Bld,Business and Professidm Code:)The Costumers Li-
come law does not apply t an owner of property who Wilds or improves(Wood,and
who contracts for such projects with a conuacmr(s)licensed pursuant o us Contutots
Licersom Law.
❑1 am exempt under Sec. .B&P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under penalty of perjury one of the following declarations:
I hsvc and will maintain a Certificate of Consent to self-insum for Worker's Compcm
737W
ion,as provided for by Section 37W of she labor Coda,for me performance of the
rk for which this permit is issued,
1 have and will maintain Worker's Compensation Insurance,m required by Section
ofthe labor Code,for me performance of me work for which this permit is issued.
y Works)�s�Comlpensa(i,ynhnafynncc carrier and Policy number mr:
rtier. II'- ��/`ser 7�-✓?Policy No.:-P.2-"/10 3 -C/
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tdi section need not W completed firm permit is for one hundred dollars(SIM)
or kee.)
1 certify dire in the performance of Ne work for which this permit is issued,I shall not
employ any poison in tiny manner are as in become subjuno the Workers Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cmtificau of Escmpion,you should
bwbma subject to the worker's Compenvsion provisions of to lair Cade,you muse
.,2, roMwith comply with such Provisions or this permit shall W doomed m°ked. .,
Z O
CONSTRUCTION LENDING AGENCY
IWroby aRrm met them its construction lending agency for the Performance of
use work for which bis permit 4 issued(Sec.3097,Ci,C.)
W�Q Landers Name
�Z Lender's Address
U Q 1 cenify that 1 bate read this application and sum that he move information is '
Iy FcommL I agree 0 comply wish all city and county ontintera<s and sum laws missing to
C)U building cdnstuction,and hereby authome¢prcunutivss of this city to enter upon be
x[17 above-mentioned property for inspection proposes.
gy (We)agree to save,indemnify and hep humbles;be City of Cupertino against
ti N Iiabilitiw,judgmena,costs and expenses which may in anyway accrue against said City
t„)z. consequncc of the graining orbit permit
^ APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOI�R REGULATIONS, cl' -Z-I_O
-,s-- 1) (�;7 Siloatrcm AOPliUm/Conuuacmf J DaRe-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haeardous material
as defined by she Cupertino Municipal Code.Chapter 9.13,and We Health and Safety
Code.Section zssulan All roofs shall be inspected prior to an roofing material beim
❑yes 2(.)? P P Y g g installed.
Will the applicant or future building occupam meegaipmedt prdevmes winch If a roof is installed without first obtaining an inspection,I agree to remove
emit ha--ordous air contaminants as Jefirmd by be Bay Area Air Quality Menagomcn( all new materials for inspection.
District?
❑Ycx �O No
I have read the bmarbmc materials require==under Chapter 6.95 of be Califor
rri��aHwlm&SafctyIt Scmimu255o5.255Jland z5534.1undcrstaM Wtifdm Wilding
de? curtcntly ow•mnanI,has it u my rapominh y to notify use occupant of be
myuimm swhjcgmux e(pr;nrtittaanabfacen;GeakoraNpanry. _ Signature of Applicant Date
l/!f)t ec—my 1- c
node ar�utbon''.d Sent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
ICupertino CA 95014
`0
e(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
zC) (P5 � iC1-") 0soS,0/ '
OWNER'S NAME: C -PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: f a-.e,2 �— 2 -1 U\
Signature Date l
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
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 Date
Community Development Department
Building Division
City of Cupertino
+' 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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.
i . 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 cari be performed.
`i 7. NOTE: if you'call for a plywood nail inspection and the job is not ready,
- •')" ;_ you will be charged a:re,inspection fee of$176.18:The re-inspection fee must
be paid before another inspection can be scheduled.
,. 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 poli y on re-roofing.
„ - Homeowner's Name:
Job Site Address:
Roofing Company Name:
Applicant's Signature:
Date:
Greg Casteel
Building Official
Revised 11/2/04 - -
admad nmPecvcled Paoer - -
CITY OF CUPERTINO
(I an
RE ROO F
ICUPEkTINO PERMIT APPLICATION FORM
APN # 359 Date:
- a3���
Building Address: I
Z" G (05 g C It? 6.), 1,J L
Owner's Name: Phone #:
V C, 6 c v
Contractor: Phone#: License#:
C 'tact: 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) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
- �<a2c h X U
Resi ent ❑ Commercial ❑,r :l:c
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: TofC nst ion: Occupancy group:
CJ1�c� L z �C
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