04080009 i CITY OF CUPERTINO /� *=Try^�T , ry,I�. �tyss�'"n �xs3"fir
BUILDING DIVISION PERMIT w�llkl l[ti '1IZk1Ll.L',VL�AYIsII�A\:a
BU ILDING ADDRESS: PERMITNO.
04080009
OWNER'S NAME: PERMITIS5UEDATE
NE: SANITARY OL NO.
ARCHITECnENGINEER: BU PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ua0 LICENSEDCONTRd under
DECLARATION Job Description
Q 1 hereby(form that I am licensed under provisions of er,C.dC, 9 my hear.is
p
n< with Section d Iof Division Sof Ne eusincv anJ Profcuiom Codc,end myliccnu is
<�a in fail force antl efrect.
�?
Lice nscClnss tab.« a _ REROOF W�COMP. V
Da TS Dc G CONTRACTOR: CASTILLO' S ROOFING
it
ARCHITECTS DECLARATION OpFfN(
Y�U IundersmnJ my plans shall he used as public rtends 7 / s�
a Qo, Licensed Professional
'• 3 OWNER-BUILDER m the Commodes
Oy
E n C 1 hcrcby.form the 11. exempt from the Cssions Code:
:Any c taw for my
i p o following massa permit
1 7D1.5,Business and Pmfessinns Codc:Any tiny at aunty
x m�+ which requires a permit a cnnswct,alley impmw,ticmnlish,or repair any urvmum
set�to that
hor e its ceased c,also requires Provision Of for such Convertor's Lk
o a signed staemenl
p�s< that he is limned pursuant to previsions of the Convector's Licence law(Chepmr9 Sq.F[.Floor Area `7alua(}o�I
apt$ (commencing with Section 7")of Division3ofthe Business andProtestationCodc)ar 8400
a 3
that he u exempt dutchman and the basis for the alleged exemption.Any vinlation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
mom Num
Nan five hundred dollars(5500). Occu anC
01,an owner of the pmporty,or my employees with wages u their sole compensation, 366552076 . 00 r
will do the work.and Ne navaum is Out intended or f..d I...1.(Sec.7144,Business
and Professions Code:The Contractors License Law docs not apply to an owner of - Required Inspections
property who Inuilds or improves thereon,and who doessuch work himself or Omagh his
awn employees,provided that such improvements are not intended oroRered fmaale.If,
however.the building or improvement is sold within me year of mmpleuan,the owner-
builder will have Ne burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the propony,am exclusively commeting with licensed convectors to
Consumer the project(Sec.7044,Business and Professions Cade:)The Contructar's U.
Come raw does not apply to an owner of property,who Guilds or improves themon,and
who contracts for such projects with a conlraclons)licensed pursuant to the Contractors
License Law.
❑I sm exempt under Sec. ,B&P C for This mason
Owner I Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
1 haw and will maintain a Certificate dConunl to elf-Insum for Worker's Comfort.
sation,u provided for by Section 3700 of to tabor Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u required by Section
3 of the tabor Code,for be performance of the work for which this permit is issued
My Worker's Cnmpenselion Insurance c tier and Palley nu Mr em
Carrier. •{.e F. Polity Na.: �38-ODOO 99
CERTIFICATEOF EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This uclisn need not he camplced tithe permit is forme hundred dollars($100)
nor[Co.)
I certify that in Ne performance of to work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Lawn of California.Data
Applicant
NOTICE TO APPLICANT:if,Iter making this Cenifrcae of Excopthri.you should
became subject to the Worker's Compensation provisions of the labor Code,you mut
,J z foMwith comply with such provisions M this punnit,r all the dmmcd revoked.
rO CONSTRUCTION LENDING AGENCY
'pr 4 l hereby affirm that those is a conslrvctin,lending agency for Oc performance of
rl 7 Ne work for which this Pamir is issued(Sec.3097,Civ.C.)
W�Q Lender's Name
z Lcnder's Address
U Q I ccnify that 1 have read Nis application and slam Nal the chow information is
C f"' building l agree to comply with all airy and covey ordinances and sem laws r upong to
�U x1mv.ngcunswctian,and hereby autharim representatives of this city menmrupnn Ne
r~a (hove-(We)..Meed to sa property for emnifyaad keepers
(We)agme to cove,indemnify and kith hay in an the City of Cupertino against
Z in
equnce of thecosuang Of thisexpensesmit. may in any way(terve against said City
U Z in consequence of UNDERSTANDS
of this permit. Issued b
^' APPLICA UNDERSTANDS AND WILL COMPLY WITH A NON-P INT y: (7�
Date ..
SOU EGULATIONS.
n' e Re-roofs
5 nal c ofApplicaHAZARD On 'Type of Roof
HAZARDOUS MATE RIALS OISCLO RE
Will the applicant or future building occupant store or handle Heudousd Safer l "
as de.See by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.smBanlss3x(e)? All roofs shall be inspected prior to any roofing material being installed.
❑r a N.
Will the applicant d/future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it mandou air contaminants u defined by the Bay Area Air Quality Management
District? all new materials for In$peC[I00.
❑Yes N
I haw mad the hoar ammah rials reyvircments under Ch,h,r6.95 of the Califmr
nia Health&Safely Code, bm25505,25533and35534.1undemmndthwit OC building o
does not"Coen ly haw a moan,Nat it is my mspansihility to natily the.upwt ofec
mgture L h,Nm;nbeMCIpn issuanc g. crdocamo"."My gn are of Applicant ate
Gw r Omived...of ?Da 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- DCA,
PE T OG
OWNER'S NAME: IC L PHONE # o S
GENERAL CONTRACTOR: � �' 03 FAX#
I am not using any subcontractors: 8 a
Signature Dat
Please check applicable subcontractors SQ 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
Owner lAte
Community Development Department
Building Division
' f ' City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OFO
��'�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: Y� r s 11 U n
Job Site Address: d 'i in r,
Roofing Company Name: C L` S \N C4
A plicant's Signature: Date:
\�1F61h1DCX1
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CUPER
CITY OF
REROOF TING 0 � Q � 60 ,D7 0 >J
CUPEkTINO PERMIT APPLICATION FORM
APN# ,% 0 / Date: i Z v
Building Address:
1 (aSS
S
Owner's Name: Phone#: ` �U� Z,l_ 3S(oJ
V S . L) o V,� '7
Contractor: License #:
Cris I l LL O,S t-3 C 5�S
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles A Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report#
❑ To be Removed ❑ Provide Mfgn Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
em ve, exot sh"n (lon J ins .(Z lyeio 50!4D .p-
Residential ommercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
UD.0
Qty. if
Applicable Fee 1D Fee Description Fee Group
1 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
76 z
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