05080243 CITY OF CUPEWrINO �"*^ + *' "" �' '" °»�
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: BECKS ROOFING PERMIT NO.05080243
E
•OWNER'S NAME: PERMIT ISSUE DATE
NEAL CASEY 6191
NE: SANITARY NO. CONTROL NO.
(408) 365-8979 r
ARCHITECT,rENGINEER: - � ! Q: i� yT BUILDING PERMIT INFO
v r J �", BLDG CB PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am ri¢ssed under Provisions of Chapter 9(commencing Job Description
<O with Section]IXIU)of Divisional Ne casino and Professions Cole endmyl'"meis
s in fe11 tome and cffc a
i'q? a«naw ams - Lit. REOOF-TSO SHINGLES�INaSTALL OSB7OC,`z'HINGLES
�c Dam camrECL h.y.
cJ` R Ithe used
DECLARA O t S
5y 1 undersand my Plans shall he used u public records LY s •y ,+Y
w F R_A
oats !f
o Licensed Pmfcssiunal
3 OWNER-BUILDER DECLARATION
ji I 1 hcrchy alarm that 1 am exempt from the Contractor's Licenu Law for the
00 following mason.(Section 7031.5.Business and Profe¢im s Code:Any city at county
K which me,omS a permit to ennswct.alter,improve,demolish,or repair any strvcmm $9000
u-ed poorm its issuance.also mquiru the applicant for such Permilto file a signed statement
that he is licensed pursuant m the provisions of the ComoCLor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
zea (commencing with Section 7WO)of Division 3 of the Business and Professions CoJe)or
y Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant o a civil penalty of r 0 0 v Occupancy Type
N
not mom an five hundred dollen($500). i'p �
❑I.u owner of the property,m s u my employees with wagetheir sole compensation, F3FlYil
will do the work,and the structure is not intended or offered for We(Sec.7(A4,Business v.+fi p' ,y a,
and Professions Code:The Canuacmr's License Law dors not apply m an owner of Required InspectionsA- 'FJ
/it-,
property who builds or improves themon,and who doessuch work himselfor through his sf•n i'./-'y
own employees,provided Nat such improvements art not intended oroRered for We.If,
however.the building at improvement is sold within am year of completion,the owner- T
builder) will have the burden of proving that Inc did not build or improve far puryose of j4. (�
ale.. % 7' ,y�Q
El 1,as owner of the propcny.am exclusively conlncting with licensed contractors m `��2vvv
comuuct the pmjecl(Sec.7064.Business and Professions Cade:)The Contracwr'S Li-
cense Taw docs not apply m in owner of property who builds or improves themes.and.
who comae@ for such impets with a eomae
fmin the l(S)licensed pursuant ro Commetof5 61
License Law.
1 am exem oder Scc. B&P C for this r mon
Cmm Da
WORKER S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declinations:
I have and will maintain a Certificate of Consent o self-insure fur Worker's Compen-
sation,Is provided for by Section 3700 of the labor Cade,for the performance of the
work for which this permit is issued.
t1 have and will maintain Worker's Co nNiation Insurance,m required by Section '
W of the labor Code,for to,perfarmarm of the work fim.Mch this permit is issued.
My Worker'}snrtfpemsa nee ca cr and Policy number a• 0
Cartier. `/_fYERTI Policy No.:GWOR
CERTIFICATE OF COMPENSATION
EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
mus section need not he completed If the permit is for one hundred dollars(SIM)
or less.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as In become subject 10 de Workers'Compensation
Laws of Califamia.Date
Applicant
NOTICE TO APPLICANT:V.after making this CertiOcaa of Exemption,you should ,
become suhject to the Worker's Compensation provisions of the tabor Code,you must
.,Z forthwith comply with such provisions or this Permit shall he deemed revoked.
Z O CONSTRUCTON LENDING AGENCY
'pw� Ihcrehy affirm Nat them is a convection lending apoc,for the performance of
S: the week for which this permit is issued(Sol.ID97.Civ.C.)
W A Lender's Name
Z Lender's Address
U
U0 1 comfy that I have mad this application and sera that the,above information is
W U mimeo 1 agree m comply with all city and county roatimcee and cute laws relating e
Q V abovengeoioned omantl hereby authonmmprtsenutivrs of this city mtrust upon the
r W shove-(We)agree
I. nay for inspection
mnify an keep s
(~ 6 (We)agree m ave,indemnify and kith harmless the City ofagainino against
Iq liabilities.judgmenu,costa and expenses agais which may in anyway accnnaid City
U Z in censequcnee of thc granting of this Permit. O
^ APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NONPOINT Issued by: Datesz
SOURCE RF,G1jLAjJON av
/� ply Re-roofs
Signature arisfplicactiConseactoor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicet tar fumed building occupant in.,.or handle haaallous material
as defined by the Cu x,nimo Municipal Code,Chapter 9.11,and the Health and Safety
Code.QY a -pp(a)? !No All roofs shall be inspected prior to any roofing material being installed.
Will the appliesm or ftuttuure building occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conundrums m dcfmcd by the Bay Arm Air Ouiliry Management all new materials for inspection.
n?
❑Yes u
I have mad the haeardousmaerialsrequirements under Chapter6.95 oldie Califor-
nu Hcalth&Safety Code Satiom75505,25533v 25534.1uokrsand thadirthc building
does notcunentiy havoc mnank Nat it ymsponsihility mnwtily tM osupant of the
mquircncnu wi hmq rUc ctprioru susnmofa CcruleamofQ cy.
9C }/ � ^/ 9R Signature of Applicant Dale
a�/ All roof coverings to be Class"B"or better
Owner of amhori'rctl agcm Da¢
- Community Development
10300 Torre Avenue
}� Cupertino CA 95014
I _
ti - Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
OWNE 'S NAME: PHONE # 75
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors t17.
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
O 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 ate
Community Development Department
P. p r Building Division
a' City of Cupertino
10300 Torre Avenue
CITY-
ITY ' Telephone: (408) 777-3228
CUPS�To Fax: (408) 777-3333AA
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.
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 policy on re-roofing.
Homeowners Name: rr/V j6A iL- C fps
Job Site Address:
Roofing Company Name: / �,cts pe �f k
Applicant's Signature: G Date:�3�V
® Greg Casteel
Building Official
Revised 71/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
SREROOF C)p � 216
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN # ��q 2- 1 C) I Date:
Building Address:
l 12GtJ
Owner's�N/�me: CA-s • Phone#: X255
Contractor:
/� GCS /I D Ja Phone #:—Lfd1 -0t� License #:
Contact: �o Phone#: 3 (01s--
` 1s— 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#
/1
4- To be Removed ❑ Provide Mfgr. Installation Specs.
1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: b 5 ? 50
Residential N9 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type ofonstruc ion: Occupancy group:
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