04100192 CITY OF CUPERTINO - *-^
BUII:DING DIVISION PERMIT CU1i7�Ajl- . 17�izT�N'�`4MATIIN;' •
BU
]MING ADDRESS: PERMIT NO,
RE ROOFING & CONSTRUCTION INC 04100192
OWNER'S NAME: - _. ... ."` PERMITLSEUE DATE
. ..... ..
ONE: . . ... .-.. SANITARY - — _ OL NO:. ... ..._.
ARCHITECT/ENGINEER: BUIIDINGPERMIT INFO "
- - BLDG .ELECT PLUMB MECH
0 0 0 0
LOp LICENSED CONTRACTOR'S DECLARATION
y� FF 1 hcrcby affirm Nceat 1 am 1 sed under previsions of Chapin 9( O(commencing :, -- , _ rye eq I�ta�Y --
as withBeellon7MI)Of Divtat n3ofthe Busineaandpmfc.1 Code a dmyhcarec s ® ' '
EE in full fodef NC���oo066��
p'qz rce mLmenm5l Lin. "�"L�5' `t `)° REROOF W/ASPHALT COMP. - - -
p Dam C Con Q CJS F "� '
Y ARCHITECTS DECL DECLARAA TION �5
Y I understand my plans shell he rated as public cards - - -, TRC L -
6ddd
is Licensed Pnsfasaonel ppptt��4 ,. .
$ OWNER-BUILDER DECLARATION Y ^ 1 �■ aI��
d 0 I I .... affirm that I am exempt from the Contractor a :Any c Law for the - - B■■i/■■ D _
po which
re reason (Secant 711315,Business and Re.dermn Coda:Any arty smarmy ... .-
$ whichmymrcsnpermu requires;the
approve. mreparrany tWmam . .
thathei'licaesed pua6umutthe p.m.immfarauchpermit Licensele Law(Cned h amara _
££ Ihalhaencin withSrsuan4mheprovisimon3aftheBuutoraLicenscssonCode)or . . - Sq.FLFloor Area Valu don. '
N (cat he is
(commencing r Semiaen and)n e basison l of the eg einexempt on.Any vi Cs,Je)tar.
-"ty .. Net he u exampTNem(rom.and the baso for the alleged exemption.Any viola0oa of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of 3�ero 0 Occupancy Type
mol mare than Ow hundred dollars($500). - .. ,
❑I.usowneroflhepmpeny,mmyemplbyceswithwagesu NelrsomcompeneNon,
will do the work.and the armature unotintondeEmoffered rmsalc(Sao.7044,Business Required Inspections - -
y. '• and Profession Linen Law The Contemner LineLaw does not apply to an owner of 9 P '
property who buildsorimprava demote,and whadoes suchwork himselforrhrough hisOwn -, ^_,.,,r • ,�:-F - „r ,
havemPloyeus,provided pnai euch wmentirovements uld within
nne immndedmoffered for owwr, - —'
builder ,Nebuildingorimprovementissaid wdiinane year orcompletion,peaowner-
builder will have the burden of proving Net he did not Wild or Improve for puryam of
sale.).
❑1.as owner of the property.am exclusively contracting with licensed contraction to
construct the project(Sec.704,Business and Professions Code:)The Contractors Li. -
cense Law does not apply to an owner of property who Wilda or improved thereon,and
who contracts for such projects with a eanuacmr(s)licensed pursuant w the Contractors
License Gw.
l mm exempt under Sea B&P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury on of the following declarations:
I bare and will maintain aCertilica a of Consent to self.insum for Workers Compcn.
saten,a provided for by Section 3700 of the labor Code,for Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
3700 of the labor Code,far the performance of the wark for which this permit is issued.
- My Workers Compensation Insurance artier and Policy number am:
Core,:ATE IPVa.1O Policy No.: S�I'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - ..
(This mctian bend not Wcompleted if the permit is for arm hundred dollars($100)
or less.)
1 certify Nor in the perfmmenee of the work for which this permit is issued,l shall nut
employ any person in any mannersb as to become subject to the Workers'Compensation
Lama of Califomia.Dam
Applicant ... . . . . ___ _...
NOTICE TO APPLICANT.If, for making this Cenlficam of Exemption,you should "`-'- "' - _ ' _ - T- * - •, - -_^ _* - '
become Subject res the Workers Compensation previsions of the labor Code,you must
.70 forthwith comply with such provisions or this permit shall be deemed revoked.
'�'"" CONSTRUCTION LENDING AGENCY
HrN,. I hembyoRrm that Nen,is a construction lendingagency for on,performance of
LY
the work for which this Permit is issued(Sec.W.Civ.C.) -
W A Lenders Names - -
z Lendera AddmnS
U Q 1 certify Nat I have mad this application and sum that to above information is
coned.1 agree m comply with all city and county ordinances and state laws misting to
0U building coneuuction,and hereby authorim representatives of this city to enter upon the
W ahove-memianed pmperty for inspection purposes.
(We)agree to save,indemnify and keep harmless the City or CaPamom against /
i.r y liebilitin,judgmenls,casts and expenses which may in anywaymonm againsuaid City l 1
U z in cons OPmrsm of the grunting of this permit.
APPLICANT UNDERSTANDS AIJD.WIL6,COMPLY WITH ALL NON-POINT Issued by: �. Date -
SOId6ATf S J t nI 9
Re-roofs
Signature afApplicsVComm Dam ,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof _
Will tlm applicant or forum building eecupentstom or handle haardaus reenlist
as defined by thin Cape
Municipal Code,Chapter 9.12,and the Hcalth and Safety -
cade,seedon25532(a)a <N --All roofs shall be inspected prior to any roofing material being installed.
�Ycs 69No
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
emir ha'rardnus air contaminator n dcEned by the Bay Area Air Quality Management all new materials for inspection.
District?
'
C]Yes
pONu '
1 have mad the havafdaua materials requirements under Chapter 6.95 ofthe Califor
-
.iaHealth&Safely Cade,Sections 35505.25533 and 25534.1 undersand this,if the building
docs not currently have a reran that it is my rcspmedbility m nodry Ne occupant Of the
ma' wh a5tbc, enaeoraceninaamarOceapma. Signature of Applicant Date
/o
Owncr tar authorncd agent Dam All roof coverings to be Class "B"or better
Community Development
j r 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: IT #
1�4 rbcs le72
OWNER'S NAME: TPrfK l PHONE 2(a - 32C�
GENERAL CONTRACTOR: 12, L Rp i N - FAX # U - 6 2 6 - —f l 6 1
I am not using any subcontractors:
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owne ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
I NO Fax: (408)777-3333 UPEkT
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 statedpolicyon re-roofing.
Homeowner's Name:
Job Site Address: 2 y
Roofing Company Name:_
L� ( q Z1
A plicanYs Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO a L�l 0-Z!51 6 2
*0 REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: I I O r
Owner's Name:� �I C K Phone#:
[
r 109 _ 2 � � -13
Contractor: Phone#: License#`: 2-
Contact:
Phone
Contact: Phone#: b2_ — Cupertino Busine License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O 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 LC.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs. fq,4
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: '�QµuV'� j l fk'40 0* ex)M INS-FA-U, NOvJ Z `CD
'.3 u t* /ASTMAjkM - k (, eM 1}klM P.
Residential Commercial ❑ r
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projec I Type of Construction: Occupancy group:
Qty/if.
A i able 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
t4 �� .