06010118ITY OF CUPERTINOBUILDING DIVISION PERMIT
ATRQNTRA TORJNFQRM4
F11111154
LDING ADDRESS:
KEVIN SULLIVAN ROOFING
PERM1TNO06010118
LA PALOMA DR
OWNER'S NAME:
_
PERMIT ISSUE DATE
TERENCE & MERCEDES MCCAFFR
Y1696 VALLEY OAKS DR.'
01/23/2006
)NE:
SANITARY NO. CONTROL NO.
(408)842-1057
ARCHITECTIENGINEER:
BVILOING PERMIT INFO
BLDG EIPCT PLUMB ME ff
p LICENSED CONTRACTOR'S DECLARATION
`
Job Description
1 fumby affirm that I an fuahned under provisions; or Chapter 9 (Commencing
with Section TOXIC)) of Division Sof the Bushes, ad Prefeado. Ga
infulfoneade e. d ,nd my IICCC Il
REROOF--T/O SHAKES, INSTALL SHINGLES
Z LlcenmClumM3
�
ARCHITECT. Ad AR
Iunderstan public
ffj
IAteLcensed
Professional
3 OWNER-BUILDERDECLARATION
g: 1 hereby .(Sere Nu exemptI am exempt from the resod.Contractat'iCou : Aoy. Law far the
O following moan (Section 7031.5. B, situ and Cale: My city os county
dcrons
sea • permit re ennstmeL alter, improve, demo or repair any nmcmm
which improve,
$8000
it u
prior WSA thalWItscensed 0.a antro ms pro inion of forsucthe CohpermrUafile ecomLncJ.MICHICTIL
its i
< harm,9
ulianwJpuntion7 hcpmvuisWofofTheBncwrilPumlAw(Chepmr9
Senion]0W)of Dividon3nf Business Profueians Cnm)ur
Sq. Ft. Floor Area
�'
by P..{ ,Valuation
?'A
(com The and
(commencing with
s -�' E't T
— that he b exempt therefrom ad the bub for the alleged exemption. Any violation of
f
"Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom ttsn nve hundred dollars (1500).
❑ 1. u Owner of Ne prepeny, or my employees with wages u Weir sole compenwton,
Required Inspections
will TO the work, and the aounure isnot Inmeded or Offered for sale (Sec. ]OM, Business
ad Profastlons Cam: The Consomme. Lt. law does at apply to an owner of
property who builds or improved thereon, and who does such work himsel f or through his
own employcu, provided that such improvements are at intended aroRemd finale. If.
howaer, the building or improvement is mid within one year of completion. the owner.
builder will ban the burden of proving that M did Out build or Improve for purpose of
ale.).
O 1. as owner of tse property, am exclusively contracting with licensed Contracwrs to
construct the pmjea (Sec. 7044, Business and Professions Cade:) The Conammes Li.
come Law docs not apply to an owner of property who builds or improm thereon. ad
who contracts for such projects with aenntrxar(s) licensed pursuant w the Contrmtoh
LKenm Law.
❑ I am exempt under Sec. ,B&P C far this recon
neo Date
WORKER'S COMPENSATION DECLARATION
1 hereby Aldan under penalty of perjury one of We fallowing declaratmts:
1 haw and will maimmin a Cenifl maf Consent he sel6inmmfor WorkceaCompcn-
tion. u provided for by Section 3]00 of the labor Cade. for the perfmmmce of the
work for which this Permit is inue0.
❑ 1 have ad will maintain Worker's Compensation Insurance, u inquired by Section,
3700 of NC labor Code, for the pe formas, of the work for which this permit is lured.
My Workee. Compensation Cartier ad Policy arrobserr am:
sIsms�ran�ee
Carrier. s�.�6" 5UPJA Polity Nn: �wg3.t=—O'O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis metre need not WCDMPlemd Ifft Permit is for one hundred dollar ($100)
or IG6)
I anify that in the performance of the work for which this Permit is issued, l shall not
employ any person in any manor as An become subject to the Workers' Comp rnsaton
Law. of Califamia. Dam
Applicant
NOTICE TO APPLICANT: If, after making this CcnlOcate of Exemption, you should
become subject to the Worker's Compcuation provisions of the Labor Code, you most
zforthwith Comply with such provisinu or this permit shall W Claimed revoked.
-
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec, 3097, Co. C.)
'
QLendcr'e Name
,
z Leader'. Add.
p 1 Certify that 1 have mad this application ad nam that the above Information is
fx correct. l agree in comply with all city And county ordinances and stem laws mlating in
U building construction, ad hereby authorize representatives of this city m enter upon We
W above-mentioned property for inspection purposes.
(We) agree to save. indemnify ad keep harmless the City of Cupertino againat
ferry liabilities. judgments, costs ad expenses which may In any way accrue against Said City
Z incmiremuenceofThe gramugofthis perrah.
�.h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
'
Issued by: Date /--;;z-7-,o r
SOU ULATIOy$a '
Re-roofs
Type of Roof
�c/yam 1431066 A6
Signnum ofA,pm;AUCCmrAcm, I Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding =upset Rom arbandle hazardous material
As defined by the Cupertino Municipal Code, Chapter 9.12. and the Health ad Safety
odc, Section 25532(a)? ^,IJ
Eyes Qv_
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
It heyardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
iWiCl7 —/
DYos 9,11.
I have mW tin haaardousmamrlals requirements unser Chapter&95 orthe Califor.
/
nbllcalth&SafetyCodc, Sedans 25505,25533 ad! 25534.1underwand thuirthe hading
Jos not currently how a mount, that it is my responsibility to notify the eccupmt or the
gu
rcymrenot 'hM^•t poor to issaa«ar,Certificate orpa/my,
Signature of Applicant Date
1/ 4-
-
All roof coverings to be Class "B" or better
Owner or authorized agent
CITY OF
�UPEI�TINO
U
t
Community Development
10300 Tota Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Buildin De artment
JOB ADDRESS:RMIT #
S IPECP cio(T%
OWNER'S NAME: PHONE # a -GD
GENERAL CONTRACTOR: IZZA ✓ FAX #
I am not using any subcontractors: �/� ;1 Z O
Signature Date
Plcnen rhnrlr annlirnhla enhrnnfrnrfnre and rmmnlPfa fhP fnllowing information:
Z
Owne 'Contractoi ignature Date
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
Z
Owne 'Contractoi ignature Date
�CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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
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: -0-262 ;,&Y
Job Site Address:
Roofing Company Name: 5-WOVArl 9W&1&- C /1 Orzf t�V)
Applicant's Signature: _ ^-` -j 23 6
It Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
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.
Homeowner's Name: -0-262 ;,&Y
Job Site Address:
Roofing Company Name: 5-WOVArl 9W&1&- C /1 Orzf t�V)
Applicant's Signature: _ ^-` -j 23 6
It Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
r
L—
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # 3s /
�G ! 6 a �`1
Bldg Permit Fees
Date:
G
W66
Building Address: I / '
"T
Energy
BUILDING
,
Owner's Name:
BUILDING
Phone #:
Seismic Commercial
�,,-e.t
?�S' -zz�611(
Contractor: S�/1 J�
h #: e -v
License #: r
contact:
Phone #: -
Cupertino Business License #:
Type of Roof Covering: .
Existing:
Proposed:
❑ Built -Up Roof
❑ B t -Up roof
❑ Asphalt Shingles
Asphalt Shingles
0/Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Num of existing coverings
❑ Other (Specify)
❑ 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:
Jobs ptioon:
C J
gD�escr
/� L
iCJ �I��YF 5 `s s- �iiI US//-�'.3 ��V. 4- ,ASPIsgMn fNVGd
Residential Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cos of Project: Type of Construction: Occupancy
group:
Qty. if
Annlicable
Fee ID
Fee Descrit)tion
Fee Grout)
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
[i