05050011 F,c,
ITY OF CUPERTINO
BUILDING DIVISION PERMIT
.C®NTRAC"TO;RINFORMATION N £
ILDINGADDRESS: LOS GATOS ROOFING PERMIT NO 05050011
OWNER'S NAME: PERMITLSUEDATE
ONE: SANITARY OL NO.
ARCHI]ECUENGINEER: BUILDING PERMIT INFO
y�y�BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S wthums ATION
fChap JobDescr(`]�tlt RNA
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F I Mreby affirm that I em limned under provisions of Chapter 9(commencing a��s �aa�
`uf withSeNon]pMnaf Division 3or Oc Business and Profetium Code.uW my license is
in mu tone and a «L
��a Licsns.Cus Lic.g 7 a�EROOF W/COMP.
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Do Comrenor �[' C
ARCHTIE(.TS DECLARATION 2005
-s 1 understand my plans shall k rtmrds
used u public
DyU a/`��
G X Licensed hereby
affix U I I V/
3 OWNER-BUILDER DECLARATION
.� 0 I hrease affirm on I am cBusin from the Contractor's Cos LiAny c Law co Un
Rp 0O following mason.(S.it t ]11315,Business and ow,d.i oro Code:Any city as county
mu. whir i xyuisu aeRmit ree"resthe alMc improve,h Perlin or repair anystructure
yZy fti, iits ceawdc,alwnquina Uwapplicaofosuchpermf'SU .aalgncd.uawmcru
fro Nnmencin withSewanWallomvisiouofNcComm�essananxlaw(Chap¢r9 Sq.F[.Floor Area Valua[on -
y l-$ OhL(cohe s moon ith,reio a and of basses for the
the geed...and P,afcs y v Cram)or
tv .. Nato u 31.5 b any ap li and Un baso for the cls Om caemant he Any violation of
not on 7031.5 five
sary applicant for a permit objects Use aPPikann w a dart penalty of
not mom Nan Bae hundted collars(SSW). 31PFP211PbV*eC0 O Occupancy Type
❑1,u owom of the pmpucy.ar my cmploycu with wage u Heir wk eompenudon,
will do the work,end Nesuucture is not intended m offered forsak(Sec.7014,Business
and Professions Cade:The Contracerk Lksnx Law done net apply to an owner of Required Inspections
prapsny who builds or i m proves thermn.and who does sum b work himself or through his
own employ=.provided thatsuch improvements suranot intended at offend for We.If.
however.Ne building or improvement is sold within one year of completion,the owner
builds,will now Ure burden of proving that he did net Wild or improve for pu mse of
sal..).
El I,as owner of the property,am exclusively contracting with licensed conuacwrs in
construct the project(Sec.7054,Business and Professions Code)The Conuanors Li-
Comm law docs not apply in an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conuuwr(s)licensed pursuant in the Camrxetora
License Law.
p 1 am..emo undo,Sac. ,B k P C for this xuon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury one of the following declarations:
1 have and will murrain•Ccrtiocase of Consent in xlFinsum for Worsee,Compere
cation,u provided for by Section 37W of Ne Labor Cade,Int the performance of the
work for which Nis permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Secdon
J]W of me labor Code,for the perfoemantt of Un work for which this Permit is issued.
My WorkcesCrope d..[ mancec u and Polity nyWw�raR�4
Cartier. Policy No.: W
CERTIFI ATEOFEXEMPnONFROMWORKERS'
COMPENSATION INSURANCE
This section need not W completed if tbe Permit is funce a hundred dollars(SIM)
or lass)
1 ec,tify Out in the perf....of the work for which Nis permit is issued,I shall no
employ any person in any manner an at w kmme subject to the Work.n'Compcuauon
Laws of California.Dare
Applicant
NOTICE TO APPLICANT.If.after making Nu Ceniecsm of Exemption,you should
become subject he Ne Woher's Compensation provisions of Ne Labor Codc,you most
.JO foMwid,comply with such Provisions or Nis permit shall W dimmed revoked.
'Z h CONSTRUCTION LENDING AGENCY
[-i l hereby affirm Nat there its construction lending agency for the Performance of
Ci Ne work for which this permit is issued(See,3(19],Civ.C.)
(37 A Lender's Name
5 z Lender's Addreu
.
U Q 1 certify Nat 1 have mad Nis application sad Stix that the above information is
F coned 1 agree to comply with all city and county ordinances and sure laws misting in
OO building construction,and hereby authorize representatives of this city w cool upon om
W akvcros,judgm Property for inspection purNwhich May
6. (We)agree to saw,indemnify and keep harmless the City of Cupcnino against
Z
liabilities, costs and of Oil cwhich mey in any way emmc Against said City
V z in consequence of the Sooting of Nis permit.
^ APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON POI Issued by: Date
SOURCE$�FCfULATIO
Sibrund.of App an ono Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Use applicant or run=Wilding occupant store or handle henarchous material
as defined by Ila Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Cala,Section
Yes X-0Allroofs shall be inspected prior to any roofing material being installed.
❑
Will the,applicant or building occupant sax If a roof is installed without first obtainingan inspection,I agree to remove
it PP B e c.Ail.moldy h devices ch P
isukRardnus air cmumirunu u dcfimd by the Bay Arta Air Quality Managcmcnt all new materials for inspection. ,
❑Yes
so
thew mad thehuarNns materials requirements under ChePwrd.95 ride Califon
III He. Safety C.de,Smuons 15503,35533 and353J4.l understand thuifUe Wilding
dao rwt cur Uy hoc a Imanc Nat it is my ruponsibilitY w notify the axupant or the
mqm ntswhr mtrarbeme Signature of Applicant Date
L os
Owner or
auNomcd agent " Daw 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 Department
JOB ADDRESS:
'10) '35 e ar ' PERMIT #
OWNER'S NAME: rikalQ PHONE # -1/vg 9
GENERAL CONTRACT Q fo oo FAX # _ 7
I am not using any subcontractors:
Signature Da
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
o ac S1 a ate
I .
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P S kT'I A I�I O Fax: (408) 777-3333
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: Cra I !.I r4 a C
------..----...__—_Job.Site.Address: Lo L9 P/
Roofing Company Name: S
i
Applicant's Signature: L 11 . 1-6 Date: S/�'C
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO
REROOF �
CUPERTINO PERMIT APPLICATION FORM
APN# g&— ��_D yg 7Phone
25 03
Building Address:
d S o e
Owner's Name:
a �a cQo S D as3 y9
Contractor: / � Phon g License
� #:
OS CTu +bS 0670
Contact: U Ph o e Cupertino Business License#:
U 8 9 y8 /
Type of Moof Covering:
Existing: Proposed:
❑ Built-Up Roof Built-Up roof
❑ Asphalt Shingles ;ir
Asphalt Shingles
Wood Shakes C3Wood Shakes
❑ Wood Shingles ❑ Wood Shingles „
❑ .Other(Specify) /X Other(Specify) 7ly 1, 0:&g
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed >1d_ Provide Mfgr.Installation Specs. •
I Have Read, Understand and Will Co!Eply With Cu ertino's Tear Off Polic
Job Description:
Residential/Ek Cornmekial E3
Fire Zone:- Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: / _ Type o Cons tion: Occupancy group:
(o Panc Y i� P:
Qty. if
A licab e Fee ID Fee Description
BPERMFEE Fee Grou
Bld Pernut Fees BUILDING
BENERGY. _ _Ener.
_ .. . BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUII.DING