04080211 CITY OF CUPERTINO
BUILDING DIVISION PERMITCdNr12AkCTf?RNFC21�I�1.' T01
BUILDING ADDRESS: KEVIN SULLIVAN ROOFING PERMITND04080211
994 C)rTr)T4PR WY
OWNER'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY O. CONTROL NO,
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
too LICENSED CONTRACTOR'S DECLARATION
�a F1 hemby affirm that I am licensed under provisions of Chapter 9(commencing Job DesGn
with Section 7001))of Division 3 of the Business and Professions Code.and my license is VoINALED
?�� in full fomaand cffen.
pz ucanre lass Lim.
REROOF W/ COMP.
�� Dam rstebe Con SEP F - 2004
ARCHRImuse DEC OEC R TIO
I undend my plans shall used as public records
O�
;OI Licensed Profcaionai BUILDING
OWNER-BUILDER DECLARATION
I I alum I am exempt from the Centramfs License Law for the
M O following mason.(Section
]1131.5,Business and Professions Code:Any city or county
a5 m� which requires a Permit In construct.alter,Improve,demolish,or repair any Structure
m_y prion oxiccuance.also requires lhcapplimmuforsuchpermiva fileasigned statement
p�p�< 'hot he is licensed pursuant to the provisions of the Contractor's License Law(Chaper 9 Sq.Ft.Floor Area Valuation
at $ (commencing with Section 70)0)of Division 3 of the Business and Profusions Cade)or
Nat he 4 exempt therefrom and Jx basis far the alkgad aamption.Any violation of
Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penally of 3 OXN310iMuO 0 Occupancy ' e
nut mom than five hundred dol4u($500). P y •m7 P
❑L as owns of the pmpeny,or my etimm as wife wages u al.(Sete c0mpananes,
will dothe work and thThe Core4ur'sLnded LAwitdfonds(Sec.7094,Business
and ery who
cads:The Cu memans Liana Law doh not apply lf an owner of -Required Inspections
pmpenywyebuilro orireproves Hereon,endwho dosstintwork orofffen through his
own employers,provided that such emimprovemmu an not intended aro0eatl for ale.R,
however,the building or improvementissold within one year of mprome for
the uwncP
builder will have Jte burden of proving Jul he did not build or improve for purpose of
eek.).
❑1,as owner of the property,am"elusively contracting wife licensed contractors to
construct the project(Sec.70".Business and Professions Code:)The Camracter's Li- .
cense Law docs nit apply to an owner of pmpeny,who builds or improves Jureon,and
who contracts for Such projects with a contractor(s)licensed rumored to the Contrecsota
License Law.
❑I am exempt under Sec. ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury sac of the following declarations:
1 have end will maintain a Certificate of Common 1.self-inaum for Work esCompen-
snion,u provided for by Section 37M of the Liber Code,for Ne performance of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance.a required by Section
3 of Jm nbor Code.for the performance or du work for which this patten is issued.
My Worker's Compensado psummm Laurier and Policy number tic:
Carrier: Policy No.: _
CERTIFI ATE Op EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(164 seed"bond net W completed ifshe Permit isfar.nC hundred dollms($IM)
or less.)
1 certify that in Ne performance of the work for which this permit 4 issued,I shall not
employ any person in any manor so as to become subject in the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become abject to the Worker's Compensation provisions of the Lehr Code,you muse
.J O raMwith comply with such provisions or this permit shall In deemed mwked.
Z "' CONSTRUCTION LENDING AGENCY
[tet 4 I heathy Mute that there is a construction lending agency for the performance of
tai > the work for which this permit is issued(Sec.3037,Civ.C.)
Q London's Name
= z Lender's Address
U Q 1 cenify that 1 have read Nis applicable.and sum that the above Infmmatiun is
(L (✓
Correct.1 slime to comply with all city and county ordinances and seem laws relating to
Q C) building construction,and hereby aothedre mprosenalivas of this city to corer upon the
W above-mentioned property for inspection purposes.
0. (We)agree in ave,indemnify ad keep harmless the City of Cupertino against
fq liabilid jud6 us as and expender which may in any way accone against City
Uz in iou
pe it. ^
AP -co I WITH ALL NON-POINT Issued by: 60 Date Oy
1,2
Re-roofs
P16:01
sere of Applin HAZARDOUS MATERIALS DISCLOSURE Da Type of Roof
Will Om applicat err fuwrc builtling aceupat stere err hentlle haardous materiel
Us dolumd by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes J®No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
it h"afdous air contaminants as do0netl by the Bay Area Air Quality Management all new materials for inspection.
107'
strict]
Yes pyre
I have mad theh=a ousm'amrialsmquimmenuunJ rChapmr6.95ofthe Califor- /k
Hculth&SafelyCod,S b.ns25505.25533and25 9.r'undersuandfemirthe building Oy
cs nos cu hove a rent, tit tiny nedfy the occupant of the
vire ichmust a r0ecup Y. g ore of Applicant Date
rorauthoriedagat Dal All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
JCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
a2 cTut3e41 0 Y00 oat/
OWNER'S NAME: " CA e,v PHONE # i'p - - 3 0
GENERAL CONTRACT SPCC.✓ FAX #
/�6 SeKv
I am not using any subcontractors: A
Signature Date
Please check applicable subcontracrs and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Ak Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
JA
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U��— '�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 stated policy on re-roofing.
Homeowner's Name: �p LAe4 Al
Job Site Address: i/�/a
Roofing Company Name: !\0 d 4OSet v 1000) //V G s&,#-U(CL°.-s
A plicanYs Signature: Date: ?/y
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
p»
CITY OF CUPERTINO
RE:ROOF 0 .y °� o 6�
CUPEVINO PERMIT APPLICATION FORM
APN# 3 / 2, '— 1 3 O 3 y
Date: 87-P
y
Building Address: 9 Z 41
/ 0 C7-0,6� /i �j(J ,
Owner's Name: Phone #-
/7�2 . (2_1e� - hod'- 9 .96-30j-2
Contracto : Ph gpe#: ns�2v � iA4 License#: O of
oc� — 84Z - �oS l�ppf
Contact: Phone #: Cupertino Business License #:
N �
V uGc,id N �S�,q Z 3 8!O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof /
❑ Asphalt Shingles Asphalt Shingles joy&/ ?ke
Wood Shakes ❑ Wood Shakes GGG
❑ 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: ,' LR P 2 pa S qPM e, /NSTsiGG ' (, 451�� &044,
SD 2 CO^f� e,s
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Co§t of Project: Type f Construe n: Occupancy group:
/D Sivaeed 0O 7LsF2
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 5-1dg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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