05040025 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT0W1NFQRMATIQN
BUILDING ADDRESS: PERMIT N0.
05040025
OW NER'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY O. OL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
s
BLDG, r ELECT PLUMB MECH
0 0 0 0
aoo LICENSED CONT'RACTOR'S DECLARATION
1 Mreby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description. ..
with Scmian70K)Sof Div'ion 3ofdc Businev fssians COM ndmyliccaseis
"o in full forte Doti c e L
5 =
M.
I Lk.p {� REROOF W/SHINGLES
Da¢ can actor CONTRACTOR: KNOX ROOFING l
ARCHITECTS DECLARATION
42
I understand my plans shall be used.,.hit,seenrN
1� r lt ( r /\
30 0.
Licensed Professianaf
it I
ry OWNER-BUILDER DECLARATION RRR===///`
d q 1 hereby affirm Nm I am exempt from dse Conuacmr's License Law for the
p o fallowing mason.(Section 70115.Business and Professioas Code:Any city or county
K$� which requires a pcsmil to construct,alter,impmve,demolish.or repair any structure
a—'^ prior Or its issuance.alm requires she applicant forsuch pito Glcasigned statement
that he is licensed pursuant o the provisions of the Commremri License Law(Chapter 9 Sq. Ft. Floor Area ValViOT229
S
wF,G (commencing with Section 7000)of Division Jnf NC Businessand Professions Cock)or
y $ that he u exempt Mongrom and ft basis for Ne alleged exception.Any violation of
Section 7031.5 by any appliansfor.permit subjects the applicant In a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars($500).
❑Luowncr of the pmpcny,or my employees with wagesu Noir sole compensation, 35616012 . 00
will do the work,and Ne structure is not intended or offered for sale(Sec.7014.Business
and Prefnssions Code:The Common's License law does not apply to an owoer of Required Inspections
property who builds or impwvM;thereon,and who does such work himself or through his
awn employees,provided that such improsements art not intended at offered for sale.If.
hcweveq the building or improvement is mid within one year of completion.Ne owner-
builder will be.the burden of proving that he did not build or improve for purpose of
este.).
0 h as Owner of de property,am eaclusively contracting with licensed contractors to
consumer the project(Sec.70",Business and Professions Code:)The Cantrmtori Li-
ccnse Law dins not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a communist licensed pursuant to the CanamlOd
License law,
0 1 am exempt under Sec. .B k P C for this mazon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby grant under penalty of perjury one of the fallowing daleratimas
1 ham and will maintain a Cenifieam of Consent to sel6imure for Worker's Compen-
utian,as provided for by Seem.3700 of Ne Labor Calc.far Ne pcif Tri arta of the
work for which Nis permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of do labor Code,for to performance of the work for which this permit is issued.
My TWorkefdCompensation.Insurance artier and Policy
Cartier, aJI T'0VVl1I,1D Policy No.: "`+Llf�'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu see iter need not Ire comPlcsed if the permit a fmonc hundred dollars(SIM)
or loss.)
I certify that in de performance of the work for which this Permit is issued.I.Nall net
employ any permn in any manner m as to become Subject to Ne Workari Compensation
Laws of California.Dao
Applicant
NOTICE TO APPLICANT:If,after making this CcniOcase of Exemption,you should
become subject to she Worker's Compensation provisions of do Iabm Code,you mrw
.J O foMns with comply wit such MOVISIOor this Permit shall be domed o,m
aked.
'z M CONSTRUCTION LENDING AGENCY
�-+ I hereby affirm that dere is a construction lending agency for Ne performance of
C' the walk fur which this permit is issued(Sec.W.Co.C.)
G0 Lender's Name
r7 z Lender's Address
U Q 1 mnify that 1 have read this application and State Nil the Man information u
lL f-r correct.i agree to Comply with all city and county ordinances and sure laws relining to
pU building construction.and hereby authrim reprosentativer of this city to color upon the
r move mentioned property for' on purposes
gy
(We)agree msave,' dc fy and keep hasmlest City of upenino against
Fw TA liab"' ,judgmcnU
which may in against said Cisy
t.)Z APPUC cn UNDWI PLY WIT ALL NO POINT Issued by: Date
SOURC GUL
Re-roofs
Sign of Appl' onuactor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle harallous material
m defined by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[3 Y.
�'a
Will the applicant or futons building occupant uta equipment or devices which If a roof is installed without first obtainin an inspection,I agree to remove
it nict?heiardoue air contaminants az defined by the Bay Area Air Qualit anagcmp I
cnt all new mater; s for inson.
/
❑Yes �j}K
Ihave o,adth usn also,iiremenuun of NC Giiforr r
ria Hes ?c 25505 33and25 Sam dmiftirc Ivildin S
J olcuranlly anL Nat' Ihilitymroti' Occup of (�
almmcaut OR nmClprl rlSta Of Criulica Pa y ,JI atureo ices t 1 Date
ow ronudorir _/rfnib,lr All roof coverings to be lass"B"or better
Community Development Department
Building Division
o-• � �, City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkJINO
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.. .611f plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the iemo'val 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:LANA
Job Site Address: M910 L-I t M Q V LSTA IbZN6
Roofing Company Nam � (N,6
Applicant's Sign re: Date: -QF`
® •Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF p Z�
®CUPERTINO PERMIT APPLICATION FORM
a
1 rntAddre;s:
VISI OQa�6
Owner's Name: Phone#:
N 7 '
Contractor: - Phone#: License #:
a . X..
Contact: Phone#: Cupertino Business License#:
95 t —06e)34 I
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof- =- ❑ Built-Up roof
❑ Asphalt Shingles Er Asphalt Shingles
Wood Shakes - _ . ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
p'-To be Removed- - - ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: - --
Y Ql.
Residential Commercial ❑
Fire Zone: Yes ❑ - No ❑ Confirmed with Planning Dept. if .
- there are any restrictions: LJ
ost of Project:' - Type of Construction: Occupancy group:
_ OR S5 ?I�
--Qty. if
._ A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy - BUILDING
J BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
- BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING