04050172 CITY OF CUPERTINO 'x" �^- 7 "" "
BUILDING DIVISION PERMIT CANTI7A.CTORINEOWATIONb`
BUILDING ADDRESS: ALLEGIANCES ROOFING FERMIrr1D.04050172
110673 MORENG0
OWNER'S NAME: PERMIT ISSUE DATE
JOHN LEE 1566 HARVEST DR nr1?'7 /?QQ4
NE: SANITARYNO. CONTROL NO.
(408) 937-9757
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�O p LICENSED CONTRACTOR'S DECLARATION I Job Description
�n I tannery affirm that 1 an limned under previsions of Chapter 9(commencing p
with sadary)OM)of Divixion SoflM BuvnProfmsiom ande'1 mylicca.is mmnldande /' �0 REROOF W/ SHINGLES
j Z DaenhaC Lic,g
41 De Canlr E1
ARCHI7ECI'S DEC ION
1 un csmnnd my plans shell he uutl as public records
a Licensed Pmfcsaiunal
X03 OWNER-BUILDER DECLARATION
<� 1 hereby writ.that I am exempt from Ne Conuumr's License Law Tor the
130 following rens...(Smdun 7031.5,Business and Prefessi...Code:Any city m county
K$P. which require.a permit to construct,also,improve,demolish,or repair any structure
nnn
°lin prior to its issuance,also mquims the applicant for such permit to File a signed statement
-pp that he is licensed pursuant to the provisions ofthcContractor's License aw(Chapter 9 Sq.Ft.Floor Area Valuation
yI ZF (commencing with Scotian 7M)of Division 3 of she Business and Professions Code)or
E R$- hat he is exempt hcrefrom and the been for the alleged eumpdon.My violation of
Section 703 1.5 by any applicant for a permit subjects the applicant to a civil penally of 3713`1544iliht9Ser 00 Occupancy Type
not mare Nan five hundred della.($500).
0 1,u owner of Ne property,or my employees with wages u their tele compenution,
willdoth..rk,end Nesnctuuisnmimmndadoroffs forsale(SM.7W.Businus
and Pra msions Code:The Contractors License Law dors not apply to an owner of Required Inspections
own
property who builds orimprovns hercoR and who arl intended
omue edthrough his
own employees,provided Netsuch imps midw t art not intended ar p@sed formins If.
however,Nebuilding arimprovementlahathwithinone yew of completion, e
owr-
Wilder will have he burden,of proving the he did ret build w imimprove(w purpose of
❑1,as owner of the property.Sec.704,B exclusively competing Cod:)The
cn=ubesa t. r /
construct d project(Sec.o an Business and property
whoWilds
Code:)The Canmanmis and come few dem not apply je an owner of property who builds or imprevns thereon,and rj
woo contracts for such projects with econuusor(a)licensed pursuant a the Contnctoh �
nu Gw. �C
1 un exempt under Sec. .R&P C(or Nia rcmon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby afBnn under penalty of perjury one of the following declarations:
I have and will maintain a Certifcau of Consent m ulpinsure for Warkcr'sCompen-
aetion,as provided for by Section 37M of me labor Code.for the podasmenm of he
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation murcom,as required by Section
7700 afar rCodeformeperfmmueeaflheworkforwhichmis Pmmitisissued.
My W madam Insurance carim and Pul nu am:
Poli
CERTIFICATEOF SAT( MWORKERS'
COMPENSATION INSURANCE
(Tbls section moil nm uncompleted if the permitinfarone hundred della.($100)
ns less.)
1 certify but in the p afmmanee of the work for which this Permit ls issued,l shall not
employany pe o' in erlb mann ecomesubjeclmme Worken'Campensatlon
Lawsof Califr §�
Applicant
NOTICE T PLICA :If,of r m in Nis Certificate of Exemption,you should
become uh t to me W kef amp ton previsions of fee labor Code.you must
.J O fo.hwith comply wire sue viii..w his permit shall M deemed cooked.
Z iCONSTRUCTION LENDING AGENCY
I hereby affirm that mere is a construction lending agency for the performance of
fYi > he wank far which his permit is issued(Sec.3097,Civ,C.)
CA Lender's Name
n7 z Landers Address
C)Q I certify that 1 have pad his application and suite that she above information is
LL (•' correct.I agree to comply with all city and county urdinanma and suite laws relating to
Q t.7 building conswction,and hereby auharice repreunuitivea of this city to calm upon he
[Il shove-menfioncd propeny for ins ction Purposes
y (We)ag one,lode ify and keep harmless the City of Cup nine agaiml
HcO habilidaujudg n .cosoand Inman which may in anywayaccu<spureuaid City
(„)•^[ incansequn ofdWgsantin- hhispmorth.
�+ APPLICA UNDERSTA S AND WILL COMPLY WITH ALL NON- DINT Issued by: Dale
SOURCE GULATfO
Z Re-roofs C7
.0 pplicaMCoalcor Data
HA, RDOUSMATERIALSDISCLOSURE Type of Roof
Will he applicant or future building occupant store or handle hax ra our material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cade.Section 25531(01 All roofs shall be inspecite prior to any roofing material being installed.
0Yes Na
Will the applicant or fuwp building occupant tau equipment or devices which If a roof is installed with [firs[obtaining an inspection,I agree to remove
mit haurdeas air contaminants m defined by he Bay Arca Air Quality Management all new ma lel fOr 1 Ction.
District, ����,,,,LL[L'''' r
❑Yes Byno /l
Ihevc dad hebmardousm ia. requirements under Chapter 6.95 or the Califar- /✓/
nu Health d: c Codd.Sectio 5(15,25,53 534.1 under thazic' building —
Jms mol cu at hvsc a dna et il' y respo ibility w nodl'y he mcupont o he
ten
me wuhram, 'or uancc f NRcate of Occupancy. wirgDatO Of Applican Dat
per or ummi..ad age oat 1 o co •ngs to be Class"B"or better
Community Development
�y�.. 10300 Torre Avenue
�l F Cupertino CA 95014
Wim° Telephone(408) 777-3228
SCITY 0 Fax(408) 777-3333
CUPEkTINO
Building De artment
JOB ADDR ERMIT # b
/06 117--3 M0p-E"C;,o
OWNER'S NA o M (,IE P119NE # -W— 22'}(�
GENERAL'CONTRACTOR: FAX #
I am not using any subcontractors:
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
->4 Roofing fELLd n/C� /2FC7
Septic Tank
Sheet Metal
Sheet Rock
Tile
v"
W-2-710dl
/Contracto ignature Da e
10/28/03
1
Community Development Department
Building Division
aAM
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
qUPEkTINO
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 Nam
Job Site Addres5ti
Roofing Company Name?
A plicant's Sig4e• t 'a— r Date: zf��
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o / 7 2__
REROOF a S
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Ad ess: /M �3 MD�F�/G70
Owner's Name: Phone #:
Contracto 4&rCaAPhte�6 93�� _� License9 �y��84.
Contact: Phone#: Cupertino Business License#:
J'�'4+�o Tj4.vt✓pd cr+nsCn a D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof �❑,/ Built-Up roof
¢� Asphalt Shingles l( 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 Willi Cu ertino's Te az Off P lic : ❑
Job Descri ti n: MO fA
� ,•o ter, ��+o✓%vy a�zr �/L't+'�� / ,l-1c�si ,u�ts�
Residential /P0, Commercial ❑ D apo
Fire Zone: Yes ❑ No ❑ Confirmed Dept. if
there an restri s: LJ
Cost of Project: o onst ction: O upanc ou41�7 .
Qty. if
A l a 1 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
7 �ti