04120073 CITY OF CUPERTINO'
BUILDING DIVISION PERMIT CONTRACTQR�INF®RMATIQN
BUILDING ADDRESS: - PERMITN00 412 0 0 7 3
10160 MILLER AV V
OWNER'S NAME: PERMIT ISSUE DATE
RICK KYUTOKU
ONE: - SANITARY NO. CONTROL NO. '-
ARCHITECT'ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!!0, LICENSED CONTRACTOR'S DECLARATION
C w 1 rtby firm the(l am lianecd under pm lona ver Chapter 9(commencing - Job Description , L .•...
b iN Sccu J )of Division3^f Jm Buaine f si ns Code.andmyliceveis
tnfullfnrx erre./ LK. ^Q REROOF W/COMP. SHINGLES
Fq' `ieenn I-b,:thT_.ut6 PsCONTRACTOR: HIGHLAND ROOFING (RECEIP : #010000112
p Ddle Lie. ebr
1y ARC ITELTS DEC] TI
Ion J my plans shall o used as ublic
�yU
LLa Licensed Pmfcsuoeel
^ 3 mISon OWNER-BUILDER DECLARATION
d D O I hereby.('firm Net 1 1. .Bcmpt from N,Omme.fewonslCo a:truseAny c Law for ly -
he
o O fallowing teuen.(Section](131.5,Business
t, n and ga.demolish.'ons Code:Any city or county
y$ which itsinsae.also re cores the Wu,Improve. reenitvera Pair my structure - - -
=i< priorwitsissuance.also alto be the for mumuPeter's 0ln.Laedsuwmcnl -
ss
that heemingtwit Psection7 th)of Division
of thee Butinwri UanwlsionsCPtuY Sq.Ft.Floor Area Vah{a�t]-O�Irj 00
aFP (commencing with section 7")of Divi4on3 of the Businmand Professions Cstde)or `�'
That he is exempt therefrom and the buis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit Subjects the applicant to a civil penalty of APN Number 11 t ' r` Occupancy Type
net Some Nan fin hundred dollars(1500).
' � 'err. P y YP
❑1,u owner of the property,army employees with wages se IheGule compenamon, 37501002 .
a.,j• //�,
will do the work,and togrecture isna(nVmdedoraffered forage(Sax.7o<a,Biomass -Said Pmfusieu Code:The Convaaofs License dew does not apply in sn owner of - ire�dapInspections ._ _ _ ....____..•
propery who builds orimproves thereon.dnd whodoessuchwark J
Nm on himealforthough his �rj�l/� P/1La`bJ
own employees,provided such improementsnot intended ora(fered forsale.If, /�'
however.the building or improvement is Sold within We year of completion.Me --
builder IW bu
will have burden of proving Net he did not Wild or improve for purpose:of
sale.). 11•t
❑L u owner of Ne property,am uelusiv ly contrasting with licensing!contractors w .._ I/
conation the project(Sec.7066,Business and ProfeggWe Cedeq The Canoneer'sLi- -• _ „�.- - ,`�
,arae law does r o apply wan Sumer of property who Wilda m improves thereon.Said - - —
who contracts for Such projects with a contractor(s)licensed pursuant an the Contrenors �.
License Law.
❑Ion aempt under Sec. ,B&P C fm this region _ -
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affum under pCemy of perjury one of Ne following recensions:
I hart and will maintain a CcNftcaw of Conunl to self-house for Worker's Camper- - - - -
sation,as provided for by Section 37W of Ne Laor Code,for that pedormvus of the _
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Instuan¢,u required by Section - -.
3700 of the labor Code,for the performanee of do,work for which Nu permit if issued.
My Worker's Compensnion'nuvnce carrier and Policy man y,.
Ca r. �I ((
fa CERTIFICATEOFEX FflON MWORKERS'
COMPENSA ONYN RANCE
(Thu section need wt o,.repleted if the permit is Forane hundred dollars(SI00)
ver ssJ -
1'Crory that in the performance of the work for which this permil u issued.I shall not
employ any person in any mannerso as to become Subject to to Worker's Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making thb Cerifcate of Eaemption.you should
became subject w the Worker's Compensation previsions of one Labor Cndc,you must - "- -
.J0 forthwithcomply wilh Such Provisions or one Nomiuhall W dameA revoked.
Z' CONSTRUCTION LENDING AGENCY
�—, I hereby affirm that there is a construction lending agency for Ne performance of
a the work for which this Permit is issued(Sec.31197,Civ.C.)
QLender's None
.7. z LCWCr'm Addm.a
U 0 1 citify Nat I have reed Nis application and stat,Net the move Infmmafun is
Corea I agree to comply with all city and county ordinances and mute laws misting m
oU building construction,and hereby authoria rep¢unialocat of this city to enter upon the
aovcmentioned property for inspection purposes.
n gy (We)agree to save,indemnify and keep harmless Ne City of Cupertino against /
h lubilid.,Judgno.mr.costs and expenses which mayin any way.C.against said City
U z in consequence of tic granting of Nis PermiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR ULAT NS.
Re-roofs
ignawm of Applic u Sur Data
n DOLS ATERIALS I c B Type of Roof
Willtheappbcaut forum Wilding ompanrnom or Mndk hvardaus material
food by the Cupertino Munich a)Code.Chapter 9.11,and to Health and Safety
We.Section M132(a)?
❑Yee No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining n inspection,I
Will the applicant or future building occupant tau equipment or Jevicos which g aagree to remove P
it havardnu air contaminants u fined by the Bay Arca Air Doubly Management all new materials for inspection.
Ji Witt?
❑Yes L-�
Ih.nresdNeh.SecuomM5O5.2553 iud2553,luLTm thaldf Ne Gldingit LItaSafetyCode.SceWns2.1 it b;myaaprodu0.1hean ndNetifthe WildonJoe.trot evrt whi deanatenant Natit ii a mce.IS a, e,, top y. of Ne.yui swhicM1 mussomet pdorwissuutco ora Crificae of(kcupuzY. Appl' vet DaencrveranNa <usg D,mAll of coverings to be Class"B"or better
w Community Development
0 Torre Avenue
t ! ` ✓' Cupertino CA 9 014
aTelephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT *
OWNER'S NAME: F-j Ge— PHONE #
GENERAL CONTRACTOR: A FAX #
I am not using any subcontractors:
ign a Date
Please check applicable subcontractors and co Tete 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
Ak[ Tile
e Ow /Co actor i afore ate
n r
Community Development Department
Building Division
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:.
'J,1) Pre-inspection and/or tear off approval.
-f 2) In-progress inspection approval.
f 3) Final inspection approval.
a) Spark arrester installation.
5. r If plywood is installed, a plywood nail inspection is required.
• 6. Any roofing which is applied withouEfirst obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be'performed.
7. j NOTE: If you call for a plywood nail inspection and.the job is not ready,
You will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another irispectioh can be,scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: RAC-+-- )G-Y U`D (e---C:)
Job Site Address: 10 ( lav M I LLl_�_, tUe- fiyw� 6.A-75_0 IV
Roofing Company Name: XII L-8`-1
Applicant's Signature: Date: I VLDL(
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF Z0 7-3
CUPE�TINO PERMIT APPLICATION FORM
APN # �;1r d vD Date:
Building Address:
01 M 1 t_c Ems- fir✓' CC&Pifiaql ,u o C,4—
Owner's Name: Phone#:
P..l "SCF$ . " SSI
Contractor: Q_H_tAND R�Phone#: k{-ogZCL5-890 License#:
C _ " 83
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof \ ❑ Built-Up roof
L3Asphalt Shingles Asphalt Shingles
Wood Shakes \ ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
er of existing coverings ❑ Provide I.C.B.O.Report#
o be Removed ❑ Provide Mfgr. Installation Specs.
u ,
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: D'
JobDes�wion: —rcA-k .vA-5t�;-Q. S' ),.-7"(7 !-5(g, P wuoaL t 0 /
o Wi
Residential Comm cial ,❑ . __. _ :-..•,.
Fire Zone: Yes ❑ No ❑. . Confirmed t Planning Dept. F
�t Fere any rest tions: O
Cost o ject: ( � e,Type of Construction: ancy grou r
Qty. F
A li a e Fee ID Fee Descri tion Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
13ENERGY Energy BUILDING
/ REISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
zYD/
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