05060085 CITY OF CUPERTINO r -n;[m n �"' ""� d•
BUILDING DIVISION PERMIT , CONTRACTOR•�INFOY2MATTON �'
BUILDING ADDRESS: SECURITY ROOFING AIR SYSTElfSRMITNO05060085
0445/447/449/451 MARY AVE
4
OWNER'S NAME: PERMIT ISSUE DATE
CASA DE ANZA HOA BLED. C 677 KINGS ROW 06/14/2005
ONE: SANITARY NO. CONTROL NO.
(408) 971-1777
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION O O O
FC 1 W reby affirm ta
i I am Laved under provisions of Chapter 9(commencing Job Description
iW with Sceti..7")of Di" 3ofmic Business and Profeuiuv Code.and my license is
a�' i^mn
License Class force Lie.4S REROOF W/ SHINGLES n,
t DamCnuamar 14
F J ARCHITECTS DECLARATION
w U I understand my plans call he used as public rommis
a
Licensed Pmfcsuonsl
3 OWNER-BUILDER DECLARATION �^ / =v
e 0 I hemhy.('firm Nat 1 1. exempt from the Conneclissome,Co License Law far the J ` Lh
E o o following moon.(Secuun LID L5,Business and Pofessiuns Code:Any city or rnunty ����
I
w which rcyuires a pcnnit to constm i,after.impmw,deouxish.or roPat,any..to. 831290
�2i prior to is issuarrcc.also mquims the applicant farmch pcnnitm rileasigaJ sutemem /,
FSG Nat he is licensed pursuant to the provisions her the Contrecturi Licenx Law(Chapter 9 Sq.Ft. Floor Area wry/� j/ \I Valuation
rot- (commencing with Section 7M)of Division 3 of the Business and Professions Code)of 1
i $ Nat he is exempt therefrom and Or basis for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty ofDr 0 `' �j'`tOccupancy Type
not more Nan rive hundred dollars($500).
❑1,amnerofthepmpeny,ormyempWycowiNw gumth kmlcc=Mnudon,
will da tW wok,and Ne awmum u notimmndcd or.ff mA forule(Sec.]OM,Businin
and Profgsions Cada:The Conuscior's License law does not apply in an owner of Required Inspections
propeny who Witdsorimprovea timmon.and who dassuchwmk himselfor drought his
own employoq,provided Nat such improvements are not intended oraRem l for sale.If.
however.the building or improvement is mid within ass year of completion.Ne Owner.
Wilder will ave use burden of proving tat he did not build or improve for purpose of
sale.).
❑1,as owner of the property am exclusively contracting with licensed c nsommrs to
construct to project(Sec.7014.Business and Professions Code:)The Contrumri Li.
cense law does not apply an an owner of progeny who Wilds or improves thereon,and
who contracts for such projects with a eanuutur(s)licensed pursuant an the Contractor's
License Law.
O l oro exempt under See. ,Bk P C far Nis mason
owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby anion under penalty of perjury arc of be following deelautions:
I haw and will maintain a Cuufcam of Covent in selfinsum for Wort sCompen-
uuon,as provided for by Section 37M of the Labor Cade,for the performance of Nc
_ ,it far which this Penni,is issued.
l have and will maintain Worker's Compensation Insurance,ax ashomd by Section
9([of Nc Labor Cade,for Ne Nfformauc of Ne woh lm which Nu pennu u issued.
My Wahers titian Insuma aniv and Policy number art:
Carrier: Polity No..
CE FIC OMPE SATION10NFROM WORKER '
COMPENSATION INSURANCE t
(This section need not be completed if the permit is formic hundred dollars DIM)
iso less)
I unify Nat in Nc performance of the work for which this permit Is issued.l shall not
employ any person in any manner an az at become subject to the Worlxn'Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Cenifigm of Exemption.you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�z roonwith comply with such Provisions Or this proni(ahal Jac Claimed rOvolecd,
zO CONSTRUCTION LENDING AGENCY
(-+v Iheroby affirm Nat there is a Contraction lending agency for the performance of
Lai the work for which this permit is issad(Sec.3097.Civ.C.)
0.Q Leader's Name
=)z Lenders Add.
U Q 1 certify Nat I have read this application and sum than the above information is
IL FCorton.I agree to comply with all city and county ordinances and sum laws relating to
(:)U building construction,and hcmby authodre repciamOnwS Of Nu city m enter upon the
LU ahovcmcjudge progeny fm 4xiam es purposes
(~ C (We)agree m save,indemnify and keep harmless Nc City of Cupertino against
lY7 Iiabilidq"CEREG
ecStart
andexpenses which may in any way ucme against said City
U z iugofI operron.
" S AND WILL C PLY WITH ALL NON-P Nr Issued by: Date
S rl( Re-roofsemadic of AppocanuComMitif Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant stem arhandlc harardous material
az defined by the Cupertino�Nci
pat Code.Chapter 9.11,and Ne Health and Safety 0Yes 25531(s)/ All roofs shall be inspected prior to any roofing material being installed.
❑Yq uwill Nc a (leant herbuilding Occupant trx a If a roof is installed without first obtainingan inspection,I agree to remove
np g p equipment or devices which
It hazardous air contaminants U derined by tho Bay Arca Air Quality Mienagcmem all new aterials for inspection.
I
triet]
❑Yea V
Ihavc mvl the he,Somi smamrials 5 andcntsundcr Chapter thatifNe Califon
Hgl1h& cry Ce hmarddws335ti5, 5 aoncons ndcrCcnundthatifmieWilding odic 0 he mnam Nat it is cspomibility to notify mica span of the
rcom h us me riormi cear.CCm'mtxuf CacuSignature of Applicant Date
neo W uthonvcd.gent a O 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
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
10-ITS- lc 1 S1 0So 60d>CF-S-
OWNER'S NAME: ()P— PHONE # L{
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: Q
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
Owner/Contractor Signature Date
jCommunity Development Department
Building Division
City of Cupertino
�w 10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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.
1J[
Homeowner's Name: � 1 4r2r, \'1000,
Job Site Address: — (� ILl _ OQ S� nnry\ - A-e—PVC,
Roofing Company Name: S l`WY1N
Applicant's Signature: Date: 'OlC
' Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
0
APN# -32,66L Date:
l7 �
Building Address: IL 4 , ,
lD�ls U,0__�
Owner's Name: 6S _Z� 6 �� Ph e#: fo O
Contractor: Phone#: License#: Q
Contact: U one#: Cupertino Business License#:
Type of Roof Covering:
Ex sting: Proposed:
Built-Up Roof ��s Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings (3 Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
J�Description: GGA �X\t O 1) QQQIct�_W�31 4 . S t 1 Q C
s�.,N 11g
Dec"
ComMercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
tl BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING