05050129BUILDING DIVISION PERMIT
BUILDING ADDRESS: I RIGHT ROOFING I PERMIT NO 05050129
:U•'J.I�:IFYJI`ulall
PERMITISSUEDATE
NO.
ARCHITECT/ENGINEER:
I hereby affirm that 1 am limned under provisions of Chapter 9 (commencing
wish Section 9000) of Division 3 of tin Business and Professions Code, and my license is
in full fart and effect +,1� 83�
Lken�_Lic. D- RXThO
Ddx Contractor
ARCNITECs$ DELLA
1 aneeratard my puna an.n W used As park rtenrdr
Licensed Pmress m al
OWNER -BUILDER DECLARATION
1 hereby from Nat I Am exempt fru. the Coninsewea License Law for the
following reason. (Section IID 1.5, Business and Pmfeawon Code: Any city or county
which requires a permit in construct, alte, improve, demolish, or repair any structure,
Poor us its issuance, Alan requires be applicant for such permit to file a signed statement
that Imis liemucd pursuant to the provisions of me cormaewr's umax law (Chapter 9
(commencing with section )000) of Division 3 of the Business and Professions Code) or
that M is exempt shcmfwm and Be toms for the alleged cremption. Any violation of
Section 9031.5 by any applicant for a permit subjects she applicant in a civil penalty of
not mart Nan Eve hundred dolurs ($500).
❑ 1, u owner of the pmpeny, m my employcu wish wages u their sole compewdon,
willdo she wary and the structure is not himnded oraRered formle(sec. 9014. Businw
and Profession Code: The Conmoub's License Law dins not apply As in owner of
property who builds orimproves mcmmn. and whodmasmh work himself or through his
own employees, provided Natsuch improvements are not intended or offered for sok. If.
however, me building or improvement is sold within am year of completion, me owner -
builder will have she burden of proving that M did am build or improv, for purpose of
Job Description
REROOF W/ SHINGLES FI LE U
Area
_b- A6- 2005
Required Inspections
Date
❑res �Na All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant future building occupant man If a roof is installed without first obtaining an inspection, I agree to remove
rr 6 p Area
equipment which g
It hazardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
isuiet?
O Yes Cblu
1 have read the hezardhmamamrials mqui.mmm under Cl,A,W6.95ofshe Califor-
his Halm&SafetyCoo,Sece.25515, 25533 and 35530.1 undersand mat ifshe Wilding 2
docs not curenely how a mmmL that it is my nop ouinlity u nobly the aeumm ggqfff the l.J
rtuirt
ymenu wry't to me w iuuana of v Cenifmam a> sv. /
L a anz 2j Signature of p an Date
of
Dwner cera or taxon yb.m All roof coverings to be Class "B" or better
I, u owor of ten propcny, am eaclusively contracting with licensed conuacmrs to
cowmct Ne pmjcn (sec. 7004, Business and Professions Code:) The Canuxwr's Li
morelaw dors not apply to an owner of pmiteny who builds or improves thereon. and
whocontacu for me' projects with a contractors) licensed pursuant w the Cormactoes
Lkmm Law.
C3I Am exempt under Sea. ,B&P C for this notion
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby Affirm under porosity of perjury ore of she following declarations:
I have and will maintain s Cenifseam fConsent to self-insum for Work,riCompen-
astion, u provided for by Section 3]00 of then Labor Cade, for me performance of rim
work for which this permit is issued.
1 have and will maintain Workefs Compensation Insurance, u required by Section
9 of she labor Code, for the performance of the work for which this permit is issued.
My Workefs Compensation Insurance artier and Policynumber art:
Carrier: Sr�l"/fAgll Pull, No. �fL�yTL'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need nor W completed tide permit is future hundred dollars (SIM)
or leu.)
1 anify Nat in she performance of the work for which this Permit is issued, I shall not
employ any person in any manor an As In become subject m IN WorkerSComp ndamen
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. If. after making Nis Cenifimm of Fi,orio on, you should
become subject to the Worker's Compensation provision of the Labor Chum. you most
faMwish comply with inch or this Nall be domed
0 O
Zti'y
Provisions Permit remked.
CONSTRUCTION LENDING AGENCY
F
I hereby AIErm mat mem is A cmuuuction lending agme, for me perfmmaoc of
FL
the, work for which oris parnir u Wood (Sm. 3099, Civ. C.)
�W Q
L ande,'s Name
Undera Addreu
= Z
U 0
1 unify that I have mad this application and sum that the above information u
It,
p
coram 1 agree to comply with all city and county onlinaners and slate laws relating to
Wilding construction. and hereby authorize repassmasoves ofthis city to enter upon me
a Ww-mmuoncd property for inspecuon poryoses.
F 1
(We) agree to save, indemnify and keep haemes be City of Cupertino against
rp
liabiliuu.judgmens, costs and expenses which may in any way, Accrue againstsaid City
U ,'Z
in consequence of me gaming of this Permit.
r.
APPLICANT UND RS ANDS AyyyD ILL COMPLY WITH ALL N N -PO
D
Issued b 1
SOURC-ANT U is /
y'
g/
L62 r
Re -roofs
Signature of Airr ant or
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant stone or hnMle hvardou0 material
as d,frncd by the Cupertino Municipal Code, Charter 9.13, and the Health and Safety
Area
_b- A6- 2005
Required Inspections
Date
❑res �Na All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant future building occupant man If a roof is installed without first obtaining an inspection, I agree to remove
rr 6 p Area
equipment which g
It hazardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
isuiet?
O Yes Cblu
1 have read the hezardhmamamrials mqui.mmm under Cl,A,W6.95ofshe Califor-
his Halm&SafetyCoo,Sece.25515, 25533 and 35530.1 undersand mat ifshe Wilding 2
docs not curenely how a mmmL that it is my nop ouinlity u nobly the aeumm ggqfff the l.J
rtuirt
ymenu wry't to me w iuuana of v Cenifmam a> sv. /
L a anz 2j Signature of p an Date
of
Dwner cera or taxon yb.m All roof coverings to be Class "B" or better
•
10
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
�0/ Z /?%�aPr /
PERMIT #
VS6-f-0,12- /2 '--
OWNER'S NAME: i'se
PHONE # YO$
GENERAL CONTRAMM
FAX # og L y - W&P-
I am not using any subcontractors: 1 0 S—
Signai4re Date
Please check applicable subcontractors and complete the following information:
Owner/ tractor ignature
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
�L O
Date
Owner/ tractor ignature
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
�L O
Date
`M
• CITY OF
CUPEQ INO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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
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 _
Homeowner's Name: xPi - /7�kppe
�
Job Site Address:
Roofing Company Name: ^ l
Applicant's Signature: Date: Wd3__
•
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
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.
6.
If plywood is installed, a plywood nail inspection is required.
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.
7.
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 inspection 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 _
Homeowner's Name: xPi - /7�kppe
�
Job Site Address:
Roofing Company Name: ^ l
Applicant's Signature: Date: Wd3__
•
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
14
arr or
CU CITY
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN# 3/62(ol?-?
Bldg Permit Fees
Date:
BENERGY
Ener
BUILDING
Building Address:
Seismic Fee Res
AV'W
BSEISMICOM
Owner's Name:
BUILDING
Phone #:
440( iS
BUILDING
o s LS.r (/
O Q7,
Contractor: �
�f It / /Coa%i
Phone #:
OB Z Y
License #:
Contact: //
�eG L(3J4-1)e
Phone #:
Cupertino Business License #:
F
yd8 2 flZ-/ 6 3/
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
;d-- 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:
,�ewKe s� -
i�
i7 /o u, a ./ TL
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: /6 Doo Type
of Construction: Occupancy group:
Qty. if
Avolicable
Fee ID
FPP rlecrrintinn
Foo r--.
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Ener
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING