04070045 • 'CITY OF CUPERTINOy'` � `�'v '"
BUILDING DIVISION PEEMUT 'r0 1
A&r.
BUILDING ADDRESS: - PERMITNO.
, DONE RIGHT INC 04070045
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY O. OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
OppLICENSED CONTRACT'OR'S DECLARATION lob Descriptio
1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing y4��®
with Se on 70(10 1,.D' xi Sof NC Busing an Prnfessioa Code,rendre cense is
imm�ro ,err 3�y REROOF W/ PLYWOOD & ELK
S Z Llcensq s LIc.0
Dem Contractor /
HMT S DECCd{��RATION U
Hey.
d nzehall W used as publrTJjlcoeds !yam ')OO
a ccU33 Licensed professional C/ ' e
a
C OWNER-BUILDER DECLARATION
I hereby affirm on 1 1. exempt s m Ne Cssion o e:Any c Lew for IW ®`Af�
i o o following rcazon.(Section 71U 1.5,Business and Profession Code:Any city or county
��YY
$ which requires a Permit us construct,elle,,improve,demolish,or repair any urocurt
y
poor its issuance.also requires line applicant for such Permit file asigncd statement
that he is licensed transient
o the pmvisionaof the Cimmucloru Lt...Law(Charter 9 Sq.Ft.Floor Area Valu hon
p O
of $ th(commencingtheI, xampt Sectionern and th basis
3 of al Buseged cssandexempt Professions Cnde)or
Nat he is exempt thertlrem and dre betu far Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanl In a civil penalty of 3 2VVUft8Cr0 0 Occupancy Type
not more than five hundred dollen($500).
❑1.an owner of the property,Or my employees with wages in their sole compensation,
will do the work.and The swcturt is not intended OroRertd forsale(Sec.70,14,Bitur eas
and Profession,
Code,The Contractor'sn no
License Law dot apply to an owner of Required Inspections
property who builds or i mpmves thereon,end who does suc h work him self or through his
own employees,provided thatsuch improvemenu are not intended orolfred forms.If.
however,the building at Improvement is mid within on year of completion.the owner.
builder will have the burden of proving that he did net build or improve for purpose of
sale.).
❑1.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
ccnse Law does not apply in im ow nor of property who Wilds or improves thereon,and
who contracts for such projects with a connotations)licensed pursuant to the Contractor's
License Law.
❑I am aempt under Sea .B ale P C far this mason
caner Dau
WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty of perjury one of the following declarations:
FI haveand will mainuin a CeNOcam ofConwnl to ml6lnsum for WorkersCompen-
,ation,as provided for by Section 3700 of the Labor Cade.for the peefoamance of the
work for which this permit is issued.
❑1 have and will maintain WOrkers Compensation Insurance,as required by Secdon
3700 of the Labor Cade for the performance of the work for which this permit is issued.
My Worker's is Mn Io rance oierand Policynuq logy
Cartier: �oliryy��..:
ERTIFI ATE OF IDUMPnOhf}ROM WORKERS'
'--\ COMPENSATION INSURANCE -
•I(This section need notbecomplowd Iran permit Is for one hundreddollars($10(1)
nr less.)
I certify that in the performance of the work for which this permit is hisnebt I shall not
employ anyperson in any manner an as in become subject o the Worker£Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in Ne Worker's Compensation previsions of the Labor Code,you must
.7Z for ith comply with such previsions or this Permit shall lie deemed invoked.
z-i O CONSTRUCTION LENDING AGENCY
[r I hereby affirm that there is a comtramion lending agency for the performance,of
a 7 the work for which this permit is issued(Sec.3091,Co.C.)
W Q Lenders Name
Z Lender's Address
U 0 1 coolly that I have reed Nis applornion and sum that the shove informed..is
ly F torten.l agree 10 comply with all city and county ommunces and sate laws relating to
O V building convection,and hereby authorise mpresenatives of this City to enter Open the
abovomentianed property for inspection purposes.
y (We,)agree to save,indemnify and keep harmless Ne City of Cupertino against
to Imbilida,judgments,emu and expenses which may in any way accrue against said City _h(62�
C)rMiC2(p.
e Of Dc ANDSfing of Ihis comit.
AND WILL COMPLY WITH A L N -POINT Issued by: Date AZO
NS.
Re-roofs
ppliant/Cmirector Date
HAZARDOUS MATERIA CLOSURE Type of Roof _
e applicant or future building Occupant store or handle harmdous material
the Cupertino Mumri al Cade.Chapter 9.14,and the Health and Safety
35534f i)7 All roofs shall be inspected prior to any roofing material being installed.
e applicant or future buildin6 oecupanl use eyvipmenl ar Jcvices whichIf a roof is installed without first obtaining an inspection,I agree to remove
us air cbnaminanu ss fined by the Bay Area Air Quality Management all new materials for Inspection.
Diatrin7
❑Yea No
I h&Safer the hazardous Suctime 25505,25533
505, rc 33=it 55 under dernan d.95Olthe Calding f�
iia Hcalthave ne Safety Coda,and ius materials oS33 aM25534.I under
.95 hat f the building y
dma not curtently h e te Nm is u my rcaponiC.m l,nnul'yu f the ��
reyuimmcn ptiorm issuance Ofa CcniOca¢of c j tU Of Applicant Date
Oo thoNr resent Dam All roof coverings to be Class "B"or better
Community Development
.'; 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDio.ADDPERMIT# p
3 5d Af
OWNER'S N e" PHQNE #
GENERAL CO CTOR: FAX#
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
Am Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing Ol'c
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/ o actor Signature Date
Community Development Department
Building Divisibn
T
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEkTINO
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: L���rA>�
Job Site Address:,' /D,350 16w
vv/'
Roofing Company Nam ° Q
A licant's Si ature: Date.
p gT1
C�l/�WDCXI
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO r
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# OO Date: O
Building Address:16 3 C/}
J CJ Bev/!/
Owner's Name: r /� Phone,;,. 05
Contractor: ` ` Pho u 6�7 License#•�7Y96Z
Contact: P g : 37V&7 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .8— Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Com 1 ith Cu ertino's Tear Off Policy: .0
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirme tth Planet a t. 'f
therepfe any reAtrictions.
Cost of Proje . 5a Type o n: Occ pancy
t7
QtY
A iabl 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
z � 233.
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