04050087 CITY OF CUPER'I'INO "
BUILDING DIVISION PERMIT CONTRACTOR`iNFORMATION
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BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NQ04050087
9631 LA MAP rT
OWNER'S NAME: PERMITISSUEDATE
JOSEPH
ONE: SANITARY NO. CONTROL NO.
�-08-�-�-?-- 9i68 -
ARCHITE707 864
CrIENGINEER: / BUILDING PERMIT I INFO
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LICENSEDCONTRdorderSoamord ATION!Chap 1 R�.MGJz ShICf Job Description
y u F 1 hereby,affirm that 1 am f due
Bu under and
Pisiom ofChapterCode, 9(commencing
n='uj whhllforcnnd efec Division]of me Ousittrss and Pmfcssinna Code,and my license is /
31a toy c. Livesomeand`rfroT. pq L1e , z - 31 REROOF — u)i OSfbf 3D FC LT } Spy(L COMP
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3 OWNER-BUILDER DECLARATION
<F hmy 0INm that I am cacmpt fru.do.Comncsots License Law for the II IAl 7 2004
0o it 11.igran.(Smuun 703 1.5,Business and Professions Code:Any city or county JU�C
K$ which mluiree a permit to construct,alma improve,demmixh,or repair any structure inoon
pd or at its ist also req vires the applicant for such permit to ri le a signed sutemcm
that he is licardad purmay,to the provisions of the ConnotchnS Lanance Law(Chapter 9 Sq. Ft. Floor Area tion '
yFm (commencing with Sermon 91100)of Division 3 of the Business and Professions Cindy)or It u\SSI
a that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 70]1.5 by arty is"licantfar apc.it subj¢u the applicant to a civil penalty of 364a2439uleet00 Occupancy Type
not more than Fire handmd dollars WWI. P Y YP
❑I'm Owner of to property,or my employeas with wage ss Noir snlc compensation,
will do me work and Ne structure is not intended or offered board.(Sec.7OW,Business
and Professions Code:The Contractor's License Law docs not apply to an owner Of Required Inspections
property who builds or improves mercon,andwho does such work himself or through his
own employees,provided that such improvements arc not intended or Offered for sole.If.
huweveq the building or improvement is sold within one year of completion.me owner, -.f/O
builder will haw The burden Of proving mat he did not Wild Or improve for pur /
pose of
sale.).
❑1,as owner of me property,am exclusively contracting with licensed catnmemra to
construct the pmjet(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law docs not apply to an Owner of property who builds or improves memo.and
Who controls for such projects wit a cantncmood licensed pursuant o the Contrano's
License taw.
Li lam acmpt under See. .B&PCfar misrcazan
Owner Date
WORKER'S COMPENSATION DECLARATION _I
I herperjury
by affm under penally of one of the following declarations: /c//V 4�-
I banned will maintain a Certificate of Consent ao self-insure for Worker's Compere
satidn,az provided for by Section 3700 of the Labor Code,for me isi fmmunce of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m required by Section
37W of me Labor Code,for thn performance of the work for which this permit is issued.
My Worker's Cam asation lnaurnee carrier and Policy number am: �p
Cartier.N.47' Free 1W Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Exits tom' t y-
(This section decd not recomputed if the permit is for One handrail dollar(SI W)
or e66)
1 certify that in the pcdarm macs of Ne work far which this permit Ls issued,I shell nut
employ any person in any manner W as m became subjmno the Workers'Compenmdon
Laws of California.Da¢
Apidmirm
NOTICE TO APPLICANT:If,after making this Cent feats of Exemption,you should
become subject to the Worker's Compensation provisions Of me labor Code,you must
0z forthwith comply w ith such provisions or this Permit shall le deemed mvokcd.
z O CONSTRUCTION LENDING AG ENCY
[-� l herebywhich thin
Nalthere ismad(Soconstruction l.Cly.agency for the Performance of
(k^ Le war's for which this permit Is issued(Sec.3(N7,Civ.Cd --
W p Lamb,'s Name
D. Lender's AJdrns
U C) I certify mat I have rad tis application and arts that lineation Information is I
B. f comet.1 agree to comply with all city and county oNinanas and sum laws misting to V
0U building contraction,and hereby authorise mperproatives of this city m anter upon the ../
r W above-mentioned property for inspection purposes.
(We)agate to nave,indemnify and keep harmless the City of CUPenino egainn
H N liabilities.judgmenu.eosu and expenses which may in any way nccmc against said City
in eonsequcn of the graining of th' pe t
'-' APPLIC UNDERSTAN S 0 LY WITH ALL NON.P IN Issued by: Date J ��
SOUR R.GULATIONS.
Re-roofs
Si a sof Applicardo"mtmctor ate
11AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser,futurc building weupanl atom or handle M1asallous mammal
as dcrimid by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)? All roofs shall be inspected prior to an roofing material beim
❑Ynat P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haxaNnus air contaminants as def ed by the Bay Arca Air Quality Managcmcm all new materials for inspection.
District?
❑YesNo
1 have read the hvaNnus materials rcquimmenls under Chapmr h.95 of the Califor-
doesOuta ctyCodc.Sccdsu¢255l1 2 3 J Silo,bocdyfficsta, Inin.the
Jtps not c nil h hilitymnodly tc ac pwt n me J /
to rich must . p' rn c f CNOcam of Ocaup cy. $I re ooa
f Applicant Dal
aubinilld.pan, J / a All roof coverings to be Class"B" or better
r
Community Development
0 Torre Avenue
Cupertino CA 014
Telephone(408) 777-3228
PTYF Fax(408)777-3333
UPEDTIN®
Building Department
JOB ADDRESS: ERMIT #
19 6031 N1 C oc4e"'-71—
-QWNER'S NAME: BstQl-1 y (--U/J PHONE #)t/CP
GENERAL CONTRACTOR:oe-,
9 coct /4poptv6FAX #—gyp F �–�z X30
I am not using any subcontractors:-- t?�� S–/a- o
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
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing OL COOLY or a 0 3 0c,'3
Septic Tank
Sheet Metal
Sheet Rock
AMW Tile
Owne Contractor Signature Date
I
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OP' Telephone: (408)777-3228
DT Fax: (408) 777-3333
CUPE1\1 ]NO
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: DCS LS lel t &�_Ulj
Job Site Address: / 9 6 3 / �—/} ASG G—
Roofing Company Name: tGOo
A plicant's Signature: Date: J� /a- J y
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO �� o
REROOF /
ICUPEF�TINO PERMIT APPLICATION FORM
APN#3 G a 6 O y 3 Date: / O
Building Address:
Owner's Name: Phone#:
,5cfl04 I/op -777-
Contractor: Phone#: License#:
0L_ , CmGINT yob) �a Co C 77- a l
Con t: P one #: Cupertino Business License#:
I Cis
s �� 7-F� oo a o 3b'
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
X, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ 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: l2(sh'1o✓cr l%X16IrtAIC SNP4-YGdOCKD
Viz 1:F 2511 kC C O S o r)
Residential A Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: fi
Cost of Project: Type of Construction: Occupancy group:
`ft / O
Qty.�" .
A 4cabl 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 i Business License BUILDING
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