04110154 CITY OF CUPERTINO T�s,g* `� �' > �7yV '��f�a UZ "�" �"
`. BUILDINC'DIVISION - •• PERMIT �L\fL4v L1`IQ s .
' BUILDING ADDRESS: " _ - PE ""04110154
1'0405 MANN DR
OWNER'S NAME: - - - PERMITISSUEDATB
VINCE PREISING
ONE: - - - - "- SANITARY NO. �` CONTROL NO.
ARCHITECT/ENGINEER: - - - '" BUILDING PERMIT INFO
BLDG ___ELECT_.. PLUMB _MECH
p E o o
+100 LICENSED CONTRAADECLARATION -
I WSb,affirm that I am 11=need una .visions Chapter 9(commencing Job Description ..
with tips]Of11)nfDivmon Sof Ne Bu sine dPmfessiune Code,And my license is
'n ty r Bond caect. REROOF .
z�z Lice Ina uc.x. u`iis7 .. ......... .. _ .. ....___ ._
TSDElur CONTRACTOR: DADDARIO' ROOFING
�e
ARCHITECTS DECLARATION
y - I understand my plans shall he used ai L��lia�wtls '
3 C�a L'ccnud P cs anal
3 ' get I A.exempt fr DECLARATION
I 1 rehy=Rum Net 1 em exempt from the Conunctors License 4w for the .
i a allA,'ng mason,(Section 70315,Business and Professions Cade:Any city or county
u$9 which requires a permit to construct.alter,improve:demolish.or repair any structure - - - --- -
t-as�2 prior 0 its issuance,else requires the applicant for such permit to Ole a signed atatomenl -
<
that Wislimnudpursuant mthe previsions ofthe Contractor's License Law(Chapter 9 Sq.Ft. Floor Area _ ,. Valu�tigtp000.
tt� (commentlng with Section7000).(Division 3.fthe Busirmssand Pr,raaions Cole)or "^- --I -
Ev N$E Nm he is exempt Hcrcfrom and the basic for this alleged exemption.Any vloladon of
14
Section 7031.5 by any applicant for a permit subjects the applicant As a civil penally of APN Number 3 O CLL C e
Out mom than five hundred dollars($500). P y Type
❑;I:c hewer of and
property, re is employee with wages r dlei(Sec.compensation,
32645021 . 00
will do the wars.and the structure isnot intended oroRcred(analis(Sec.70aa,Business :,•• .. :. ,. n
and Professions Code:The Contractors n License law donot apply to an owner of .. .. Required Inspections
property who builds or improv thereon,ehdwho does such work hinuel f or through his
own employees,provided that such impmmmenll are not lnamded orolfered forsala If.
however,the building or improvement is sola within one year ofcompietion,the owner-
builder will have He burden of that he did not build or improve far purpose of
proving P
cieJ. .
❑1,as owner of the progeny.am exclusively contracting with licensed contractors to _ -
comwcl the project(Sec.Triad,Business and Professions Cade:)The Contractor's Li- -
cease law does not apply to an owner of property who builds or improv Hereon,and - -
who contracts for such pmjecMwith aconUaelor(s)licensed pursuant to He Convector'sLicense Law. - ._. __ _. ...�._..-...,_......
❑I am exempt under S.C. .B&PC for this moon '
Owner Dme
WORKER'S COMPENSATION DECLARATION ..
I hereby affirm under penally of perjury one of He following declarations:
I ham and will nommen a Cadiricare of Consent to self-insum for Worker'sCompen-
satian,its pmvided for by Section 3700 of the Labor Code,for ftperformance of the
work for which this permit is issued
O I have and will maintain Workers Compensation Insurer=,As required by Section
3700.(the labor Code,for the performance of the work for which this Permit is issued. _
My Worker's Comp salon lnsursns eamier and P/ylicy number am:
py No.:7lkLS'L�I %DO
\
CERTIFI NFROM WORKERS'
COMPENSATI INSURANCE
(This seen..ecd oat he complewd it the permil is forone bundrrd dollars($]W)
or kssJ
I=nify that in the performance of the work for which His permit u issued,I shall not
employ any person in my mannerso As to become subject to be Workcri Compensation - ..
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.$Act making this Ccniftcale of Exemption,you should
became subject on He Workers Compensation provisions of the labor Code,you must
Oforthwith comply with such provisions or this permit shall be d=mea mocked.
z„t`! CONSTRUCTION LENDING AGENCY
► Ihcmb affirm that there is a construction lending acne for the
F+ Y . agency Performance of
C.�-t do work for which this permit is issued(sec.309'i,Civ.C.)
aii l7 Lender's Name
:7. z Lender's Address
t)Q I certify that 1 have mea His application and stem Hat the aboveretatlun is �S
rccorrect.I agree to comply with all city and county ordinances and sole lawsws retailingo,
0 0
V above-mentimmil iooana hereby action emprecmoly of His city to enter upon Nc
LS) ahovc(We) gram
to sa y for inspindemnify
an keep harmless
a
(We)agree to cons indemnifyandh=p hay in andm cryofCupertinoagainst City to liabilinconsequence of
gnats and expenvmit. may in any way eccmc egtlmtseia Cily
C)z A consequence of the granting of this Permit.
APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL NON-POINT ISSUed by: Date I
sOURCF,$EGULATfONS
,
f�6v Re-roofs
SrIF�ofA lm. tr Doc
`/ H ARDOUS MATERIAi CLOSURE Type of Roof
Will the applicant or future building occupant stare or handle hum dous material
as deMcd by Cu coin Municipal Code.Chapter 9.12,and the Health and Safely
C.',Section 25532(a)y.,_ -All roofs shall be inspected prior to any roofing material being installed,
❑Yes . __
Will the applicant or future building.ccupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hacrdoua air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disci
❑Yes''--Qltiu
I have mad the haeNous materials requirements under Chapter 6.95 of He Califor-
OdaHeslrh&Safety Cade,Soctints25505,25533 and 5530.1 understand Hal if He buil 'ng
does not eume.Ily have a more,that it i my losponsire a,w notify thc.ccupent of
mi,immeneswhich must be met 'ora suancc ofe Certificate of Occupancy. [ atui Of plica. Date
ow
an,
=sem Date -" All roof coverings to be Cass'T"or better
Community Development
j 1 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPEt�TINO
Building Department
JOB ADDRESS: PERMIT# i
LLAIA
OWNER'S NAME: F v PHONE # �, 6-4(
GENERAL CONTRACTOR: FAX# 5 3
I am not using any subcontractors:s-
gnature 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
umbra
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
oy
er on ac or ignature Date
Community Development Department
Building Division
amn n City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
16PEkTINO
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 area
required:
1) .Pre inspection and/or tear-off approval'a
2)'in-progress inspection approval. '
3)`Final inspection=approvah
a) Spark arrester installation.
t 4 5 If,plywood1is installed, a plywood11 ,nail inspection is required.
2 6 Any ioofmg wlirch rs apphed`without first obtauung an inspection;
. wilFrequire the removal of all new material&ow -tb the sheathing,
_so a proper City,inspectioncan be performed
7. : ;+ ; NOTE:,If you.call.for,a plywood naiLinspection,and.the lob is not ready,
you will be charged a re-inspection fee of$17618. The re-inspection fee must
�y, be'paid before another insdectioh can be'"scheduled.' "
IMPORTANT:
1. Flat roofs must have a.minimum of Y4" 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.
, s
Homeowner's Name:
Job Site Address: 1c3 O'S
+
Roofing Company Name: gA&YU 00-0 Ftp w
Applicant's Signature: Date:
Greg Casteel
Building Official
. Revised 11/2/04
'.Printed on Recycled Paper,,
_
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3 �6 a -2--
Building Address:
16 q5' Koaxy%
r
Owner's Name: Phone#:
"Y1 S ✓t ''^lam - 22 lbQ
Cont r tor: Phone #: 'License #:
r;D 83[ " _ l ok307
Contact: (- Ph e#: Cupertino Business License#:
' `VQ 110 tl In Ln
Type of Roof Covering:
Existing: Proposed:
❑ utlt-Up Roof - - ,. ,.. . ❑ Built-Up roof
` l�jsphalt Shingles 9K Asphalt Shingles
_ �l§§//Wood Shakes _ ❑ Wood Shakes
❑ Wood Shingles. ' ❑ Wood Shingles
U ..Other(Specify) - - - - _ ❑ Other(Specify) -
-�. Number of existing coverings S ❑ Provide I.C.B.O.Report#
❑ To be Removed - ❑ Provide Mfgr.Installation Specs.
I Have Read,-,Understand and.Will,Com 1 With,Cu ertino's Tear Off Policy: ❑
Job Description:.
i n d 1R C-
vc -Residential .,% Commercial C
_' Fire Zone:-, !:Yes'❑ . ,No ❑ Confirmed with PI 'ng Dep .
there are any res cions: LJ
_- Cost of Project: °-= Type of ConstMc7tiw. Occupancy gro p
�' Ou0 -ter
QtY
A i•ab 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
:
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