03080159 CITY OF CUPEWrINO s'q77777
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION '•.
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Bu1LDINCADOREss: DONE RIGHT INC PERMIT ND 03080159
a OW N
r1TPRPTTMn rTTV OF 3,127/2
(408) 377-8777 ER'S NAME: 1129 LONG FELLOW AVE PERMIT ISSUE DATE
]NE: SANITARY 0. CO OLNO.-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
= 0 t�
+exp LICENSED CONTRACTOR'S DECLARATION
wF I hereby affirm Thal l am licensed under provisions of Chapter 9(commencing Job Description
EZr3 with Scmion701k0af Division 3.170.Businsse,end
cmd Professions Codmy license is
a o, in full force and affect.
;q? IJcenm class Lie.. REROOF
�e DataSr CITY PROPERTY/NO PERMIT FEES
ARCIiITECT'I'S DECDECLARATION
f I understand my plans shall he used as public records ■CALE®
•v
'�
aot; Licensed Professional '
OWNER-BUILDER DECLARATION T as a rsLOOrJg
<Y 1 hereby affirm that I am exempt from the Contractoh License Law(or the OCT
p O following mann.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance.also roquiresthe applicant for such permit to rile,signed statement
. 2Zto that he is licensed pursuant o the provision of the Conuumr's License Law(Chapter 9 Sq.Ft. Floor Area BUILDINGupgT000
drier$ (commencing with Section 7000)of Division 3 of the Business and NoRwinm code)nr V 41L
3 that he Is exempt therefrom and the basis for the alleged exemption.Any vlolmion of
Section 7031.5 by any appllcem for a permit subjects the applicant to a civil penalty of
-- nm mom than fiva hundred dollen(6500). 3 3pgld74Cro o Occupancy TyPe_.
'--
❑ I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and thesnet..is not intended oroffc.d for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of q p
property who builds or improves thereon,and who deassuch work himselfor through his 305 - FRAME
own employ=,provided that such improvements are not intended or offered for sale.It. 307 - INSULATION -
however,the building or improvement is mid within one you of completion,the owner- --
builder will have the home.of proving that he did not Wild or improv for purpose of 601 - ROOF TEAR OFF '
sale J.
❑L as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(Sec.?oa4,Ruslncss and Pr.feasions Cme:)The Contraction's Li. 603 — ROOF BATTENS.
cense law dao not apply to an owner of property who Milds or improv dareon,and 604 - ROOF IN-PROGRESS
who contracts for such pmjecu with a contractor(&)licensed pursuant nah o the Co.m
License Law,
gam ex der Sm. ✓'—' ;B k P C for this reason
WORKER'S COMPENSATION DECLARATION
I herby a0inn under penal,,of perjury oro of the following d.elaralima:
1 have and will maintain a Certificate of Consent to self-imum for Workers Compere
- lion,as provided far by Session 3]00 of the Labor Cmma
Code.for the purfuranof the
work for which this Permit is issued.
❑I haw and will maintain Worker's Compensation Insurance,as mquitod by Section --
3700 of the labor Cora.for the performance of the work for which this permit is issued.
My Workers Com pensadon Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EKEM PITON FROM WORKERS'
COMPENSATION INSURANCE -
(Thbsenism need nutmcomplm.d iftht permit lshoont hundnddallan(SIBB '
or loss.)
I coni fy that in the performance of the work for which this permit is issued,1 shall not
employ any person in any namnr so as at Mcome subject n the Workeri Cnmponsatio r
Laws of California.Dal. - -
Applicant
NOTICE TO APPLICANT:Ir.after making this Cmircam of Exemption,you should
become object to tit.Worker's Compensation provisions of the Labor Code,you most
z forthwith comply with such provisions or this Permit shall be deemed r.veked.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that then its construction lending agency for the porror".i. .of
3i rhe work Cur which this permit B issued(See.3097.Civ.C.)
Alender's Name3.
,
3. z Lcndcr's Address
;J Q 1 comfy that I haw rad this application and also,that the above information is
E-' most I agree t0 comply with It city and county oreinarwes and state laws leading to
OU building construction.and hereby amhorim npresenutiws of this city to enter uPnn the
J+a
shrive,mentioned property for inspection purposes.
(We)Is=to save,imcmnify and keep harmless the City of Cupertino against
ti V1 Iiabilities.judgmcnu,costs and expenses which may in any way accrue again,said City '
..)z m onsequence of do gnnling.f this permit.
PLICANT�U�NADnER�STANDS AND—WIL'L COMPLY WITH ALL NO Issued by: Date '
Re-roofs
Signuule oMpplicaDataHAZARDO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occoccupantstore or handle Health and
' as dcrnm by to Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
code,Sectmn33s3x.r All roofs shall be inspected prior to an roofing material bei.
❑ta ❑Nu P P Y g being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h haaamnns air matmalnsnu as tkfincd by the Bay Arca Air Qumity Management all new materials for inspection.
nuicl?
CYca ON.
Ihaw&Safrl the w.Secumns255materials, 553requ3 it
1u derPmrd.95 if the Caldinr.
g '�1•(?�Sb' / V'!�V Y ~�
is HcalIhASmmyCmc,ambous 26305,3553)sum25534.ratand rChaptm Nmifthe Milling
d Jt vrt.n I hove o tenant,that it is my rcspunsihility to nimly the mcupm0 of rite
�n/r-�,vb ustbeegrJ rwissaoeenf.cenmcxmoracuP dy. Signature of Applicant Date
Owwroor amhodr�agent p All roof coverings to be Class "B"or better
Community Development Department
�/!� Building Division
G(jaQ�r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
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.
Homeowner's Name: �ClT OfM wW/I tid
Job Site Address: C-/2/An Q d
Roofing Company Name: one PLh 7
A plicant's Signature: c ��7/l� Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o / S-7
REROOF j g
CUAOL PEkTINO PERMIT APPLICATION FORM
APN# 3Y7 O 6 O I Date:
Building Address
me cl.ell,,t R�
Owner's Name: Phone#:
G er"r 77 - 32
Contractor: Phone#: License#:
o rte R19kri 7 7 77 V 7 6;?,
Contact: IPhone#: Cupertino Business License#:
Glenn LehKe.r— 1727
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)
Number of existing coverings ❑ 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 Policy: ❑
Job Description:
Residential Commercial ❑
Fire Zoe Yes ❑ ❑ Confirmed with Planning De t. if
there are any restrictions:
Cost f Project. Type of Co ti . Occupancy group:
lZ Ood
Qty. if
A a 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
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