04060154 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'C(�NtA�"i.' 'OR INk }RMA.TION' ';
9UILDINGADDRFSS: ECONOMY ROOFING PERMIT NLb4060154
10638 NATHANSON AV
OWNER'S NAME: PERMIT ISSUE DATE
ERNEST BONELLI 2988 NEAL AVE. 4
NE: SANITARY N0, CONTROL NO.
(408) 615-7200
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� 0
uoo LICENSED CONTRACTOR'S DECLARATION �"f„ftrlption
U 1 Wroby affirm that 1 em fibiued under previsions of Chapter 9(commencing ��YIREII �& %W
withg run 000).17DIAime3 o(thc a main vs dein coach,Code,andm liccnm(s
'. �� mmum neem 3 Lic�Y(�' REROOF
ED
S Linen
z�- D.m C.nmxt - r7 JUN 2,3- 2004
Iq-� AR HIM(TSD LARA 1 N
aI undersand my plana shell W tired as public ruoNs
"� Bl31LOGNG
3u.
Licensed Professional
3D OWNER-BUILDER DECLARATION
E I hereby affirm that 1 am exempt from the Cantactuts Limem Law for the
i p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
$(v which requires a pconit m construct,alma improve,demoliah,or mpair any Aviation, $11000
Fzy priorm its issuance.also requires thcapplicam forsuch permiim file asignedstsmmcot
< math.islimmed meamolt.Nepmvisk.m.f0mCommctm,LiccnxLaw(Chapua9 Sq.Ft.Floor Area Valuation
RIA
(cummencingwi@Section 7")of Division 3 ofthe Business and Professions Code)or
"ly that he is except marefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of a Occupancy Type
not more Nan five hundred dollars($500).
❑1,as owner of Ne property,or my employca with wages as Neirmle compensation,
will do mcwmk,and me swctme(motimmhided or offered forage(Sec.70/4,Business
and Profession Code:The Conuacror's Licata,Law dna not apply in an owner of _ Required Inspections
property who builds or improves thereon,and who dais s uch work himsel f or through his
awn employers,provided that such impmvemenLL are not intended merited for ale.If.
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 I,ea owner of the property,am exclusively conmmting with licensed connmmrs to
construct the project(Sec.7044.Business and Profusions Cutler)The Commuter's Li.
scan,law does not apply to an owner of property who Wilda or improves thereon,and
who contacts for such pmjmas with a contamorm)licensed pursuant to me Contrseats
Lkense law.
O l run account under Sec. ,B&P C far this mann
Owner Dam
WORKER'S COMPENSATION DECLARATION
7C3371M
Ihereby affirm under penalty of perjury one of Ne fallowing declarations:
I haw and will maintain aCco ifiam ofConant to self-itu en farWmketsCompen-
rhthirk for which Nis pennil is issued.
I have and will maintain Workers Compensation Wurame,u required by Section
.(the Labor Code.for me performance of dm work for which Nis permit is iaued.
Worker's me�alion 1psuance ertiennd Policy number ea: //11//--II
Polis No S111L7
CERTIFI ATEOFE(EMPION WORKERS'
COMPENSATION INS NCE
mets station need not W c.mplemtl lime permit is notion hundred doll.($1011) '
or Ito.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject in the Workers'Co rfa matlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,arm,making this Cenifimm of Exemption,you should
become subject to the Worker's Compensation previsions of Bad Lon,Code,you must
0 O forthwith comply with such provisions m this permit shall W deemed revoked.
„zCONSTRUCTION LENDING AGENCY
I hereby affirm Oat mem is a conuroction lending agency lot the performance of
Cal,7 the work for which this permit is issued(Sec.3097,Civ.C.)
W�Q Lend.r's Name
z Lender's Add.
U Q I certify mat 1 haw read this application'end tam that the above information is
Dr H correct.1 agree to comply with all city and county ordinances and sum laws relating to
O V building concoction,and hereby authone,ormse nulivem of this city to enter upon dam
W ahow-mentioned property for inspection purposes.
04 (Wc)agree to on.indemnify and keep harmless the City of Cupertino against WP�
ti rn liabilities.judgmena,costs and expenses which may in my way acerae against mid City
(�z iAnPPL CgAeNT thERSTANDSof thrNO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE IO
Re-roofs
natumof Ap is IlCommetor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will c applicant or future building weupxl store or handle haolous maknal
as defined by Ne Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
sen, Ely.zss3z(a)a All roofs shall be inspected prior to any roofing material being installed.
Yes No
Will the applicant or fawns building occupant use equipment or devices winch If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conaminmta m derined by Nc Bay Area Air Gustily Management all new materials for inspection.
Channel' ((
❑Yes dl No ppp
Ihavemad the Inamedousmaterials requimmcnavunder Chapter6.95 of the Califs- D!
nia Halth&Ssi'ctyCodc.Swc ons75505,25533ad25534.1 undemantl Natif Nc Wilding -Z)
K
_Qhaldocs not currently haw a tenan,that it is my rmponsihility m redly the occupant o(thc
rcquircmcna VK#7or m issumce of.Ccmflcam of Oce cY. Signature 0 Applicant - Date
acme agent Dara 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: PERMIT#
3 A/C 1 040& 015
OWNER'S NAME: S PHONE #
GENERAL CONTRACTOR: ( FAX #�/0� S -
I am not using any subcontractors:
S; ature Date
Please check applicable subcontractors and complete the following information:
60 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
Ofl / 7/U
er/Contractor Signature Date
w Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
�` CITY OFA Telephone: (408)777-3228
k U P E INTI N 0 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: C11 l z� Ai
Wce,.��/
Job Site Address:
Roofing Company Name: (
AA12PIicant's Signature: Date: J L 7/
GregJteel
? Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
•- REROOF D
• CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owner's Name: Phone#s
Contractor: Phone#: License#:
72
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles Mfi'
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:
�1 f0
Residential Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are anv restrictions:
Cost of Project: Type of Construction: Occupancy group:
Qty t '1
Applic le 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
a �� S�