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CITY OF CUPEWI'INO
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INFORMATION
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BUILDING DIVISION PERMIT
CONTRACTR F
BUILDING ADDRESS:
C)R A199
VILLEGAS FENCING & LANDSCA
IMNG03080123
OW0420 AV
NER'S NAME: -
1363 SAN TOMAS AQUINO PKWY
P,EtTr ISSUEDATE
NE:
(408)420-3724
SANITARY 0. CONTROL NO.
ARCH17iC1'IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I�
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70(k)) of Division 3 of the Business and Profcmium Code, and my license is
in full tome and effect.
REROOF
LicensClasse Lie.+
Dam Contractor
RCHItECCS DECLARATION
1 undersand my dAR.hall W used as public orchids
Licensed Professional
OWNER DER DECLARATION
License Law for the
1 hereby affirm tont I amm exempt from Ne Contorts
Co
following ares&. (Samsun 7113L5, Business and Code: Any city or county
t
dcootu
alter. i improve. e
demolish, or repair any structutatemem
requires a permit as cores
nor Thr such permit m lien a signed nammem
also myuires the t for such
prim Rr its issuance. the
Poor t
Sq. FL Floor ArBa
Valuat
he is cert wit pursuant 71 the inion the
on
of Diviomof
at the Business and Cale)ur
(coeBuacmthnd Profssims Code) or
(commencing with
mmncing Sectioof Division
r
Nat he i. exempt therefrom and the buss for the alleged exemp0on. Any violation Of
that he is cmfm and on, Any
357190F)4 nn
APN Number
Occupancy Type
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan five hundred dollars ($500).
❑ 1, as ..at of the pmpcny. or my emplhycn with cages as their sole emn,mation,
305 - FRAME ns Required Inspections
will do the work, and theswnure is ..I mended or offered for sale (Ser. 701 Baslnmx
and Profession& Code: The Consumer's License Law does nm apply to an owner of
q P
progeny who builds or improves thereon, and who does such work himself or through his
307 - INSULATION
own employers, provided that such improwmenu us not immnded or offered for sale. If.
601 - ROOF TEAR OFF
however, the building or improvement is sold within one year of completion, Ne owner
builder will ban the burden of proving Nat he did not Wild of improve for pumpOce of
602 - ROOF PLYWOOD NAIL
`ale.'.
603 - ROOF BATTENS
�Srl, a owner ej ci progeny, em exclusively consisting with licensed eontrumu to
cense Professionsvesnlfacton. Li
noctpplyt
604 - ROOF IN -PROGRESS
prono
an Ownsinwand
ds or
Low does not apply m an owner of property who builds or improves thereon, and
La dues
who contracts for such pmXca with a canvemor(s) licensed pursuant to the Contractor's
who
Liccnx Law.
❑ I ern exempt . B & P for this mush
Supndre�r�-�
Is, a I•..• V ^L\.J A Date! 0-3
')Id WORKER'S COMPENSATION 0 ATION
1 hereby &fano under pamlty of perjury ane of the following declarations:
I have and will maintain a Cenificale of Consent m art None, for Wari er's Comfort.sation,
as provided for by Section 3700 of the Labor Code, for Ne performance of the
work for which Nis permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, az required by Section
3700 of the labor Code, for the performance, of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Camcr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTuxnion need not he completed fine Ismail is Intone hundred dollars (SIM)
or less.)
1 certify Nat in the performance Of the work for which this permit is issued. I shall not
employ any person in any manner to az to Wcome subject to be Workers' Compensation
Laws of filiform.. Dam
Applicant
NOTICE TO APPLICANT: IL allcr making this CeniOcaor of Exemption, you should
becomesubjectm the WoherCompensationpmvisihu .(the ImCode,you muss
forthwith comply with melt provisions or this permiuhall be deemedmrotctl.
CONSTRUCTION LENDING AGENCY
I hereby alllrm that there is constructinn lending agency one the performance of
Ne work fur which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lcndcis Addmss
I certify Nat I have mad this application and Voile that the above information is
cancer. I agree to comply with all city and county ordinances and sale laws relating to
-
building construction, and hereby authenim mpremmmives of this city to enter upon the
ahovamenmihncd property, for inspection purposes.
(We) agree to to indemnify and trey harmless the City of Cupertino against
rf
expeis[s which may in my way acerve against mid City
��
of the
AeonxquNT of the RSTAN of this permit.
in
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
,V(`j
Issued by: Dale
SOERFv ATIONS.
Re -roofs
Type of Roof
�`ry1�
U� _� L�Io?
Sig to of Applicwi onfesstm arc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle haemim s material
az defined by the Cupertino Municipal Code, Chapter 9.11, and the Health and Safety
Cate. section 15532(.)7 N
All roofs shall be inspected prior to an roofing material being
P P Y g g installed.
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
it hwa.do., air cnnamm oto m defined by the Bay Area Air Quality Mmagcmcnt
all new materials for inspection.
vial
❑Yea �I No
-
Ihwcmad the haaardnusm25505,25533amenuunder 6.95 Calding
nimHcalNASafety Code,Seeduns2aLili55533an Mihilily Wnculmd NmiflhchuilC
Jana not curtcndy M1aw a mnana Net it is my respomihility m nastily Ne, occupant of the
\� <
tl\`C\ u I U}
�aipsapnaw nmry be met pdotmimamaeara cerdna.a of Deco ancy.
ignature of phcant Date
c 3
.
All roof coverings to be Class "B” or better
er igen Dam
CITY OF
UPEkTINO
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
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,.4- 0��(� I TV� V
Job Site Address. i 6 L� % 0 Ay f
Roofing Company Na 1 L Lia AS "bQ� C44- -D
A plicant's Signatu �i/L/_ ` Oo ` H:
• Greg eel
Building Official
Revised 1/30/03.
Printed on Recycled Paper
I
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date: c�
BENERGY
Energy
BUILDING
Building Addrss:
Seismic Fee Res
Owner's Name:
'i
BSEISMICOM
ne
/
BUILDING
BPLANCHK
Plan Check Fee
Contractor:
Phone :
License #:
�f ILLI°�J:S
Contact:
Phon #:
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
Built -Up Roof
Asphalt Shingles
❑ uilt-Up roof
A halt Shingles
Wood Shakes
❑ Wood Shakes
Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Cl 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 Descrip,,,
/Commercial
Residenti
�'
Fire Zone: Yes ❑ No ❑
Confirmed with Pla t. if
there are any re tctions:
Costo ject
Type of Construct Occupancy oup:
Z,111711)
ADDWi Ab1le Fee ID Fee De.ccrintinn Fee C'rnnn
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
J
1