04090008 ' CITY OF CUPERTINO ° '�]r�. �a�' �� •
BUILDING DIVISION - PERMIT - CONtTRA&T',0RiINF0 1Y�1�ATI ,,
flUILDINGADDRESS; R E ROOFING & CONSTRUCTION "W"04090008
OWNER'S NAME: PERMIT ISSUE DATE
K
ONE: SANITARY O. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.�ioo Lmthat I DCONTRd under
DECons of ATION
Job Descri o N/ Y�Cat O
I bmeby alfLIC that 1 am ONTRA under previsions of LTepter Y(commencing
'v ��yr
with Sutton]Olga ofD" fN Buius Profess, Cwe.antlmylicenseia
❑ypa in muto.And � -72 '7501 REROOF W/LIGHT WEIGHT TIL
jaZ License Class Lie.0
Date
A CH CTS DEC R 200/,
1 undemunJ my ....hell used. se cnr s 4
..O Licensed Professional
M.OWNER-BUILDER.mo
i fi DECLARATION BUIL®I�G
no i I .. .(Sm Nu 11. exempt from tie Cotimet Code:
:Anse law for the
y� following mune.(Section 7(31.5,Businessmol Rofcssiou Colo:Any city at county
k$LL which requires a permit to cnnNnscl,alter,Improve,demolish,or mpW r any aVUetum
.A i se Poor m its issuance,also requires the applicant forsuch permit to file a signed iutement
p��< thethc isliented punuantto the proviaionaof N (Cbmtm9 Sq.Ft. Floor Area Cmummara License LawValuation
£�C (cammenclagwith Section 70M)of Division Soflhe Busumound Profusions Code)m
o�L $ Nat he is exempt therefrom and the huLL for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjceLL the applicant to a civil penalty of 3 2�514V1t�er0 0 Occupancy f�,�
not mem an five hundred dollars(s500). . . _ P y ' Pe
I,u owner of Ibe pmpmy,m my employees wit wage u Noir mle cempenuden, '
willdo Ne woh and Ne swcum is not intended orofremd forsale(Sm.7W.Businus
and Pmreaaions Code:The Contractors Licenae Law dose not apply to an owner of Required Inspections
property who builds mimprovu thereon,and who dons sahwork himself or trough his
awn employee,provided mal such improvements am not intended moffered for sale.If.
however.Ne building or improvement is sold within one you of completion,Ne owner
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 I.as owner of to p.,n,am acluiwly mmracting with licensed enlrulom to
mown the project(Sec.7014,Business and Professions Cade:)The Contractor's Li-
cense law does not apply in an owner of Property who builds to improwa thereat.and,
who contracts for such pmjeca with a conuactor(s)licensed pursuant to the Conlnct9Ys
ummin Law.
❑I am aorpl under See. ,B k P C for this moon
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pemlty of perjury arc of the following destarnlaa:
1 have and will maintain a Certificate of enN Const selfAcuum for Woho's Compen-
utie ,an provided for by Section 3700 of the Labor Code,for the performance of the
w for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
3700 ofrho labor Code,For Ne performance of to work for which this permit is issued.
My Win mpa
uado wmurancecannermd P9lirynumberm, (^
Cartier. 'WI Policy No: U a tj
r CERTIFICATE OF EMPTION FROM WORKERS'
COMPEN ATION INSURANCE
(This section need not rte completed lithe permit is forone hundred dollars(SIM)
or less)
I certify Nm in the performance of the work for which this permit is issued,I mall not
employ any pmann In my manner an as N become subject to Ne Workem'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Ccdificae of Exemption,you should
become subject m Ne Worheb Compensation provisions of the Labor Cade,you must
.J z forthwith comply with such prevision or Nis permit shall be deemed revoked.
'Z CONSTRUCTION LENDING AGENCY
F4 Ihereb affirm that Nem is a construction lending agency for the perfamncor
a
the woh for which Nu pewit is issued(gee.3097,Cii,C.)
W� A Lenders Name
z Lenders Add..
V 0 1 certify that 1 haw red this application and sue thin the above information is
L1 F correct.I agme to comply with all city and county on imus and sum laws relating to
0 building construction,and hereby authorize reprosenutives of this city to enter upon to
4 above-mcntiened property for Inspection purposes.
(We)agree to save.indemnify and keep harmloss the City of Cupenino againat
ffi6r ,judgmenu.rosn andexpensn which may in any way accrue agelnst ssid City
fJ in censeq n yAc Lnu,ineof tspmmt.
U jF/
UN DS AN�( c MPLY WITH ALL INON.P01 Issued by: Date
OURC�Eg ULA /7M
, O I i\
G` U
Re-roofs
at map"ApplicanUCanwc or/
Data
HAZARDOUS MATERIALS SC1.0$URE Type of Roof
Will appliem�uwre building ucupanuwm ar haTtleru'tl'ous meteoal
u defined by the Cupertino Muni m1 code.chapter 9.13,and the ncats�and Safely
Code.Quell 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yea No �—
Will the appli nl m rmum building..part use cquiptmm or dcvi/ ce which _TF roof is installed without first obtaining an inspection,I agree to remove
mil haaardom air cone trams as Jcfucd by the Bay Arca r Quality Management a -n materia Or T C 1
DturicO
❑Yes
Thaw veil the hnardnusmaeods rtyuimments under aperb.YS ofNc Califor- t
roHct S yC ,SmIJ 25533md25531.1unddnundtuifto building
not only 11 L wt it la mi n,tililr m rad oLeupanl or Ne
myui ich eIprorto isCortinee fan . atureofApplieant ate
owns mtorncdagent D„e All roof coverings to be Class "E”or better
Community Development
10300 Torre Avenue
y, Cupertino CA 95014
.'
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: I I (I „ a ��� PERMIT#01`tV
^ �I 9 c o OC
M —
OWNER'S NAE: L or� 15 t PHONE # �- 26 - 32u
GENERAL CONTRACTOR: v i N FAX # �-L ( - -1 l b
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 �f LL I/fiMS uC .
Septic Tank
Sheet Metal
Sheet Rock
Tile
ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OFS
�'�O 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: S
lob Site Address: �/ LA L a '
Roofing Company e 0
A plic is Si tore: '� Date: 16
• Greg C eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
t
k-, CITY RER ®®RTINO U
CUrtki INO PERMIT APPLICATION FORM
APN# :3 O I Date: 12
Building Address:
Owner's Name: 1^ r l Phone#:
Contractor: / Phone#: License#:
Contact: Phone#: Cupertino Business License#:
t , �� vz nen auk- 26 -�32� 2 0 5
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) G
Number of existing coverings Provide I.C.B.O.Report# U`l
❑ To be Removed //(❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
IV Job Description: Cf4 VC al W lj( LK 1 L dY- Vel o tm 5 f to K�zl L�j kA1,L
-,YU4- Fl T� � -�1ge -a-, Ll + �Ft Ll,
Residential Pq Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning DeLJpt. if
there are anrestrictions:
Cost of Project: W Type of Construction: Occupancy group:
31. 2 /V7
Qty. if
AppiieWe, Fee lD 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
*RESIDENTIAL T-N �, ROJE, -v
CITY OFT
4", ��Fl�i,
CUPEPTINO
4
Assessor's Parcel Number:
Name of owner. XEI�l
Proj.ectaddress. -2,111 5- t A Lil(g; 7714 V,8 , (lt,�P&Xr/4/0 014
Contact person. &/N 6,41,,4 44 Phone. &w) 39;3-6 -)-:7-S'
Fax.
Net square footage of lot.
Existine O PGur i
Square footage: First floor:
Second floor: V
Garage: 7/
TOTAL:
• Are there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the proj
On what floor(s) is work being done? MCIE
_Z51 4' ,2-10 .1 M C)B
jjW 140
Brief description of wow -5— A^✓s r,431
t.N-rk --CnelL , 4,041Cce- LO-Alf
Code editions: 2001 CBC (Y - N)2001 CFC (Y- N)2001 CMC (Y- N)
2001 CPC (Y - N)2001 NEC (Y - N)
Effective 11/1/02
Plan Review.Process Work Book Page-8-Revised 4/28/04
C
1
kz 1 _._ APPROVED '
W—
SIGNE
DANCE TH
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�r—t•? v CA
f
I P Thisbeof an d Usr vl
kepf on at all and III Is lallewhd r
to make y Changes alterations on sarne
without written perm Iron dre Building
_ C_ Department, City of Cu
51 �Lt� T'iv stamping of this and VwMcft
LgLL NOT be held pe mdt or 10
c.� al of the violatio of
Loy Q.1y Ordinance or S - a�
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ro
Of &I y
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