04080055CITY OF CUPERTINO
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CONT, CT0WJNFP"'""'' 0th: F.
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
TAURRTTA IDR
MONKS ROOFING
PERMITNo04080055
OWNER'S NAME:
PERMIT IHSUH DATE
ONE:
SANITARY O. C NTROL NO.
ARCHITECfIENGINEER:
_
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
fl
LJ
I hereby affirm Nat 1 am licensed under provisions of Chaptur 9 (commerming
with Seen r7ors of Div' ion]of the Businesses rofe 'u od en ylicense is
in full fa d fey-,
Licen�l;e,a
a
REROOF AUV ZY 2004
Da Cumrsnor
ARCHITECTS OEC A ON
lundcrsundm�y Yens shellMused as public rccmJs
BUILDING
G
Licensed Professional
OWNER-BUILDERDECLARATION
I hmaso .Diem Nm 1 am excmpt frim the Convectors License Law for the
exempt
mason. (Section ]II3L5. Business and Professions Calc: Any city s county
which toconsume.the older, improve, anyewctum
which
for Su,h ptorhtonrmash
as issaapmmit
prior to itsissuance,also theapplicantfor suchpmmit to file
Sq. Ft. Floor Area
Valuation
suainquires ssignedsmtcmcm
that he is pursuant 7000) inr9
the Contractor'snd
of Divionnf
(commecingwiit
Proflaons Co
(commencing with Section7000)and of Division J of the Business and Professions Com) of
Net he u exempt thcmfrom end Nc baso for Ne alleged exemption. Any vinlati0n of
325GDD15t"gr00
Occupancy e
P y �p
Section 7031.5 by any applicant for a permit subjects the applalrt to a civil penalty of
not mom Nan five hundred dollars ($500).
1, u owner of Ne pmpery, m my employees with wages m their sole compensation,
Required Inspections
will do the work, and the serctur, is not intended or offered for sale(Sec. 7044, Business
and Professions Code: The Contractors License Law does net apply to an owner of
q p
property who builds or improves thrcon,and who doessuch work himselfor through his
awn employees, provided that such improvements are not intended Oro@rml for sale. If.
however, the building or improvement is sold within one year of completion, lie owner -
builder will have Ne burden of proving Our be did not build or improve for purpose of
sale.).
0 I, as Owner of the property, am exclusively contracting with licensed contractors b
,
consume the project (Sec. 7044, Business and Professions Code:) The Contractor's Lt.
came law docs not apply to an owner of property who builds or improve Neuron, and ,
who contracts for such projects with a co dractorEft licensed pursuant M the Conuactors
Licence law.
❑ I sin exempt under Sec. . B h P C for this ..an
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby ashen under penalty of perjury one df the fallowing decimations:
1 have and will maintain a Cerilwaate of Consent or self -insure for Workers Cooper.
,
ion, as provided for by Section 3]00 of the labor Code, for Ne Performance of the
rk for which Ni. pctmit Is Issued.
14aaw,0
I have and will maintain Worker's Compensation insurance, as required by Section
t10 mf Ne labor Code, far the per(o�mance o(Ne work for which this permit is issued.
y Wo yer{C/t��npeaJon �ce/g]'i",nicr rand Policy number art:
Ce me,`J i" I a -C- Paltry No.�atf k�S
CERTIFICATE OF EXEMPTION QOM WOR ERK S'
COMPENSATION INSURANCE
(rets section need not W completed if the permit is foronc hundred dollars ($100)
or less.)
1 cerdify that in Ne performance of We work for which this Permit is issued. I shall not
employ any person in any marnersn as to become subject to the Workers Compensation
Lewes of California. Data
Applicant
NOTICE TO APPLICANT: If, after making Nis Cenificatc of Exemption, you should
become subject to Ne Worker's Compensation provisions of the Iahnr Code, you must
forthwith comply with such provision or this permitahall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a conwctinn lending agency for the performance of
Ne work for which this permit Is issued (Sec. 309], Civ. C.)
Lendcr's Name
Lenders Address
1 certify that I have read this application and state that We above information is
-'
carer, I agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby mutation representatives of this city to enter upon Ne
abov)-mentioned property for Inspection proposes.
to save, indemnify and keep harmless the City of Cupertino against
lients.costa end expenses which may in anyway accmc against said city
n
ithegrantidg of Nis permADERSTAt�D
A L COMPLY WITH ALL N -PO
J-
Issued by: Datei
ATI�py/
Re -roofs
Type of Roof
V
W4, azure0 pplicanJCont wor ate
HAZARDOUS MATERI LS DISCLOSURE
Will the applicant or future building occk a tatore or handle harsamus material
az defined by the Cupertino Municipal Code. M ter 9.12, and the Health and Safety
COlc, Sc❑iumn 25532(.)7 -
All roofs shall be inspected prior to any roofing material being installed,
yea,�/ o
Will Nc applfe,n(/or�mtir}c building occupant tau cyuipmcnt or Jcvicrs which
If a roof is i Iled without first obtaining an inspection, I agree to remove
it hazardous air contaminants as noticed by the Bay Area Air Quality Management
all new eri Is for ins
iwir'7
❑Yes �No
�ctioI.
Ihave aJ Ne harard0us matcrialsinyvimmcnu under Chapter6.95olthcCalifor-
�
.iaHelN afcty Codc, SccGan 255115, 255J]enJ255J4.lundcrsmntl Nmi(thc building
Docs not remly have a ten t, Nm' m responsihility to notify Ne a<upant of the
r`
/ V
d)quim ¢whichmu.tbe t r an)em. eanireamrrOc)rpat .
ignature of Applicant Date
All roof coverings to be Class "B" or better
ow rmanmmixedagcn, Dat
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CI OF Fax (408) 777-3333
�UPEkTINO
Building Department
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
JOB ADDRESS:
OFA 1-Gv�f� 2„ p
PERMIT #�
U O� dO 55
BUSINESS LICENSE #
OWNER'S NAME:
PHONE # 3 Y
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
I -01i r /i,
5 U
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
yV UYJ�C� %Z
Septic Tank
Sheet Metal
Sheet Rock
Tile
I -01i r /i,
5 U
Date
n:
�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
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: ^ 1K�1 �� L t' ik
Job Site Address: LA 1Z Q-7113 DE,
Roofing Company Name: CS l,r\ r/
A plicant's Signature: Date: a % D
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
G
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOFS`-
PERMIT APPLICATION FORM ` v
APN # /
(' /
/
BUILDING
Date:
Building Address:
BUILDING
BSEISMICRE
d2 P 2
BUILDING
O er's Name:�I,
Seismic Commercial
BUILDING
Phone #: /—
Plan Check Fee
BUILDING
BUSLIC
a
ContractiF:
KS vol', n
Phone #:
License #:
cc" I
Phone #:9/ 2 —q-2
7 7
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed: 3
❑ Built -Up Roof
❑
Built -Up roof
❑ Asphalt Shingles
zK
Asphalt Shingles
AC Wood Shakes
❑
Wood Shakes
❑ Wood Shingles
❑
Wood Shingles
❑ Other (Specify)
❑
Other (Specify)
Number of existing coverings
❑
Provide I.C.B.O. Report #
c�W To be Removed
❑
Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descriptio,
),e-c,fL�F 6
Sii �t k� 1 s 1
o 1
,.)
o ►�,
Residential(
Commercial ❑
Fire Zone: Y No
Confirmed with Pl tng Dep if
there are anr ictions: E
Cost of Pro'ect:
ype of Construc '
Occupancy
U
Qty�+f
AtAicable
Fee m
Fee 1)Pcrrintinn
FPP (rnnn
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
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