05080257 'CITY OF CUPERTINO �.'P�eik'3V's+ +s 4&- '•°'r+�' '�` °a
BUILDING DIVISION PERMIT `*ECONaT1Ct�CTOIv�NPwORMATTW
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BUILDING ADDRESS: MBROWN CONSTRUCTION, INC PERMIT No.05080257
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sIrOWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 260-1260
ARCHREC(ENGINEER: BUILDING PERMIT INFO
BLDG . ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION
V I hereby of@m Net 1 am littvcd under provisions of Chapter 9(commencing Job Description
IN Section TOM)of Division 3of dm Businevand ProfnsaiouC d/�Iiccnmis
In full forte end.Re t Q ` .�pp
❑Z Lkenm a Lk.M REROOF-T/O SIMWOOD, .ADD S E',t'HRlNG &
Dale_�canlr.ter COMP. a day}d �•��f'
e ARCHITECT'S DECLARATI N �m�I� IE'D
y I uncuntand my pons shall be tram!u public¢cards .L
� U c-
3a Lkemed Professional
H OWNER-BUILDER DECLARATION
I hereby afford Net 1 am exempt from the ConuactoYs License Law for the
i Bill, ` 5
o O fallowing mason.(Section 7031.5,Business and Professions Code:Any city or county y_
which requima a petal,m construct,alum,Improve,demolish,or repair any moscune
prior to its issuance.also requimg the applicant forsuch permit to file a signed statement
gFF< that heIslicensed pursuantmtbeprevisiansoftheContmmur'slimmeLaw(Chancr9 Sq.Ft.Floor Area #(/ V CryL,V�arolpittisryOOO
a $ (commencing with Section 7M)of Division 3 of Ne Business and Profmsions Cruel or
Net he b exempt Nemm fraand the bub for the alleged exemption.Any violation of ��.-.•
Section 7031.5 by my applicant for a perodt subjects the applicant to a civil penalty of APM Number Occupancy e
not more than five hundred dollar($5W). p y Typ
0l,uawnerof Nepropeny.mmymployeeswWwaguudtebsalecompemdm,
wllldo Nework.md NettfucluRis Ml imanded Oraneredimmict..7OM,thim eV Required Inspections
and Profeeelons Cade:The Conummh Liwne Law dors rot apply m anow ter oe nsf q p
Property who build,or improves thereon.and who dohs ouch work hlnutl f in through hit
own emplayeu,provided than each Iap...enu art vol intended oroRW fm We.IL
however,Ne building or improvement is sold words ane year of completion,tae owner.
builder will have the,burden of proving that be did not build or improve for purpose of
uleJ.
0 1,u owner of the property,em exclusively contracting with licensed contraction m
construct res project(Sec.7044,Business and Professions Code:)The Camnemr's Li.
came Law does not apply m an owner of property who buil&or Improves Ithacan,and
who contracts for such projects with a commuma(s)licensed pursuant to the Commutor's
License taw,
0 lm uemp,uncut Sec .B d P C for this mason
owner Dau
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penally of pedury aro of the following decbntions:
I have and will maintain a Certificate of Consent to mIf-lieu.fm Workmen Compen.
nation,as provided for by Section 3700 of the labor Code.for the performance of Ne
work for which this permit is Issued.
0 1 have and will maintain Wwkeri Compensation Insurance.as required by Section
3700 of dte tabor Cede,for the performance of r e avork for which this permit is issued.
My Workefg Com nsuion Inwrana enrtiu and Polley number Lac:
CERTI CATEOFEKEMPrION FROM WORKERS'
COMPENSATION INSURANCE
(This saulon need no,be completed If the permit isforane hundred dollar(SIM)
or lug.)
1 cenify that in the performance of the work for which this permit is hound,I shall not
employ anypmaon in my mannerm u to become subject in the Worken'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this COel0ate of Exemption,you should
become Subject to the worker's Compensation Provision of the Latour Cade.you most
.J O fOrhwirr comply with such Provisions or this permit Nall be domed revoked.
Z r"' CONSTRUCTION LENDING AGENCY
aN-r F
1 hereby affirm that dtert is a construction lending agency for the Performance of
ai the wish for which this permit Is issued(Sm.7097,Civ.Cd
W�0 Lender's Name
w7 z landeta Addacat
t)Q I certify that I have rend this application and ruin that the above information is
U,',^. correct.l agree to comply wed all city and county ordinances and sum Inn testing be
0 rU^ building corswction,and hereby suthorim Minrxnxthoul of this city m enter upon Ne
[i7 above-mentioned property for Inspection purpwev
gy (We)agree in ave.indemnify and keep harmmu Uta City of Cuperino against
fIl IiabllWa,Jedgmenu.ensu and expenses whin may in any any amore agsimt aid City
U Z in commmonce of the granting of this permit.
^-� APPLICARRE ULATIO
NT UNDERSTA AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO II__
bo Re-roofs
Sig re of Appli VContncror 'Dam
AZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant stem or handle hnurdou material
as cu0ned by the Cupertino Municipa .Chapter 9.13.and the Health and Safely
ObitsuL?
ak.section 2533z(e)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ne
Wits Nc sppikanl ter roam bundin amupan,um equipment or devita which If a roof is installed without first obtaining an inspection,I agree to remove
It hmardou,air conum con=.u den by the Bay Ama Air Quality Managcmcm all new aterials for inspection.
IhYeg u
I have mW the hauNomg mau5mmcnu untrer rp' of the Cal
HealthuryS0,25573n175574.Iudemand tha building
ildem not currently be.a en"t,theIhas "y
requirements be moil rissuance of.CmulicamofOc �( Signatur of Applicant Date
Owner or. ed ager Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
i Telephone(408)777-3228
aClOF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
2(o ciIOS ve r-jes f 'z so e- 0 a c�
OWNER'S NAME: v�, e4 w a-v—p PHONE #qng
GENERAL CONTRACTOR: AX #
C
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
Roofing oYI /09 2Z
Septic Tank
Sheet Metal
Sheet Rock
Tile
H V
Owner/Contractor Signature Date
Community Development Department
Building Division
'k City of Cupertino
p 10300 Torre Avenue
ISCITY OF Telephone: (408)777-3228
UPEkTINO 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another insvection can be scheduled
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: 1
job Site Address: ___0 l 2- V� (,cI b S
Roofing Company Name: C61, )Y1 U �Z,v t,_
Applicant's Signature: G Date: 0 f US—
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
r . CITY OF CUPERTINO
REROOF ° zs
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: y 3o O�
Building ddress:
12lo a IoS e a 12,
Owner's N e: Phong#:
edw�.12.
Contract Phon #: License #:
Y OZvYI ��N S �( u i(�✓t _►�( -z?r o S2 Z
Contact: Phon #: Cupertino Business License #:
cs�-ung ��a1/1
a �' 26c� 12`0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shinglesk Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
YOther(Specify) SI lin W D Oc ❑ 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 D cription: I / 5 ,� _ ��
vl� S4: - 4(jcP S j'I Ft"n-Yv 1 t K C p wt U t 10✓�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: oU O Type of onstructnO: l) Occupancy group:
Qty. if
Applicable 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