04060018CITY OF CUPERTINO
'
m
INFORMAT ON
BUILDING DIVISION PERMIT
,CONTRACTOR
� '•($; ear. '£, a. 4� q, cYt0 I,%��„�.r4wa3. '33i A�AFf'
BUILDING ADDRESS;
172 PART,TZTT PT
PERMIT NOO 4.0 6 0 018
OWNENAME:
PERMIT UE DATE
ISSUER'S
JAMES AHN
E:
SANITARY N0. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
ELECT PLUME MECH
t
O O
LICENSED CONTRACTOR'S DECLARATION
I hereby atfrm Net I em licensed under provieiom o(CluPier 9 (commencing
with Sado. ]QQ��1v of Division Jof tan BuGnafard ProfeWuu Code, entl my license is
Jo escrition
P
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in con mice and let •/ 5
REROOF Jo n•
Lken,e los VV Lk. Pram31��
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Dam
CONTRACTO A ALROOFVING
LTS�EQI/S O
I uMermanJ my plea shall ho used as public records
X111
Licensed Pmfeuionsi
OatNEDECLARATION
j
1 Wrthy affirm than 1 amm exempt ucmpl farm t Contractor's License Law for the
Buaincss and Pm(usiuu Cale: Any cin m county
allowing noon. (Saito 703 o
recaneWeL simr,ImPmw,demmah, orrepaira enyxtmetun
Which requbess rsor
sig
Phos m its i ormcd p also requires the applicant thaCforsuch Pennit w file sc Law(tukmrnl
.also
that to Rn
andPnClJw(CInP1erY
Sq. Ft. Floor Area
(�
Valua�rv000
ofDivinM0llbsheEast an Crede) or
cin with Section 3 of the Busiese and
(commencing
axe with Section ]IDD)
ft occur on. Any vi
that he u exempt therefrom and tan buts for the sikgrA exemption. Any violation of
that he is
APN Number
Occupancy Type
Secdon 7031.3 by any applicant for a permit subjects the applicant o a civil Inanity of
not more Nan five hundred delta. (5500).
31626056 00 -
01.mownwof Wepmimrty,ormyemployceawiNwguuNeirmkcompenu.Ion,
Required Inspections
willdOtnwon. and the svucturt lsmt intended orortemd mruk(See. 70M, Bunneu
and Profession, Code: The Conlueur's License Law does coapply to an owner of
et 9 P
proper who buildsor Improves thwmn, and whodoesauch work himselrort rough his
own employees. provided that such improvements an notimended or oflcmd faraak. IL
however. Ne building or improvement is sold within ane year of eampledon. the owner.
builder will have tan burden of proving that W did rom build w improve for purpose of
ulcJ.
0 1, as owner of the property, am exclusively contracting with licensed contractor. to
Consumer the project (Sea 70th, Business and Profession, Cade:) The Convaemh U.
neve Law dots not apply m an owner of pmpeny who Wilds Or improve thereon, and.
who contracts for such projects witha canvumr(s) licensed pursuant to use Contractor's
Licence Law,
0 l son exempt under Sec. ,B&PC for this reason
Omar Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aRimt under Family of perjury aro of the following declarations:
now and will meinuln • CeniBate of CanunUo self-imurt far Worker'Compen-
n, u provided for by Section 3700 of the Labor Cak. for do performma of are
woh for which Nis Permit is issued.
0 1 have had will maintain WwkeYs Compensation Insurance, u required by Section
3700 of the uhor Code, far the peff...e of one work for which this Permit is iavad.
"
M)'WorkcI` CCgym/.�enuaon ineunn[wdartier end Policy numberam:
Cable / /�//ri1 %I(�fZ• I9C iryNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
.
COMPENSATION INSURANCE
(Thk.section need not W completed if the permit is faom hundred dollars (SIM)
or less.)
1 certify that In the permrmame or the work for which this permit is leaned, I stall not
employ any person in any mannerm an in become subject to the Wor seri Compewton
Laws of California. Date
Applkanl
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become subject to Ne Worker's Compensation provisions of the Labor Cam, you mum
forthwith comply with such provisions or this permtuhall W deemed naked.
CONSTRUCTION LENDING AGENCY
I Wrtby affirm mat them in a construction lending agency for the performance or
the work for which.Na permit is issued (Sec. 3097, CiN, C.)
Undoes Name
LeadeYs Address
1 certify Nal 1 haw read this apPlimasm and sum the, the shove infarmmWo is
'
conn.. I agree to comply with sit city and county ordinances and sum law. mining b
Wilding construction, and hereby authorize repmuentativu of this city to nous, upon the
ahavcmenuuned property for Impawd on purposes
(We) agree on cove, indemnify and keep harmless be City of Cupertino against
thoolhim,judgmcn.s,cov, and expenses which may In my way aecme again&, W d City
in consequence of the of this
v�
gnndng Permit.t�zw
A LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
E REG j 6
-
Re -roofs
Type of Roof
Sigmturt of ApplicaHAZAR car Dem
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or forum building Or handle huudons mamtsi
u dcOned by .W Cupertino Municipal Code. Chipmr 9.12, and the Health and Safely
alCe. Chapter
ado, Section 25532007
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or futum building Occupant use equipment or crevices which
havardom air contaminants as dc0md by the Bay Area Air Quality Management
all new materials for inspection. -
ict]
❑Yes - A.
Ihow read the hwaAnm mamriebrequinmenuunder Chepor 6.95 ofthe Calimr-
niceFleulth&Safety Cade,Sa9am 25505, 25537 uu1255Jd.1 undemmd thmif the Wilding
y O
/P �/ �� �� L
(�L
does net cartcad, new a mmaL that it m my reputability m cuPut of tan
s v S-2
//'C� It
requirehujoTurtW titsnameofacer(Ramor ancy.
?,7,Cr 86• 2.64
S ignature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorized agent Dam
IQ
CIT
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # 6
Date:
6 62. o `t
Building Address:
16172- . Pil�L_zl-1-7- mz_
Owner's Name:
Phone #c
-Ta 7 els 04M &Z
44 BSEISMICRE
Contractor: Phone #:
C/?L
License #:
Contact: Phone #:
Cupertino Business License #:
/i/e;L .�7Ttr�CSio� G6.y6.�t
BPLANCHK
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles V_ Asphalt Shingles
13 Wood Shakes El 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' I 4
BLCNO�Z �tol� ����ccL t���T /` Q`�C� •i- �7() `Sh• C
Residential ❑ Commercial ❑ ChIJr
Fire Zone: Yes ❑ No ❑ Confirmed with Plann• Wit. if
there are an ion • Lf
Cost of Projec of Constru o . Occupancy grou r-•
7 �
Qty if
ifs�
Avpli6aWe \ Fee ID
Fee Description
Fee Grout)
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
44 BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
4
CITY OF
PERTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 Narr
Job Site AddresPA /0 �
Roofing Company Narrye�-.
A plicant's Signature- !� C A 4 %�7 Dat
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
9YV//_
A-
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
sa�
poi . c (-7Ary�
PERMIT #
��fD6DO,
M
OWNER'S AE: ;rt � A
PHONE
GENERAL CONTRACTOR:
FAX #
/
I am not using any subcontracto a "`
Signature Date
Please check applicable subcontractors and complete the following information
FC70N,-el�4-C t�
r/Contractor Signature
6. 6z• 6�
Date
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
y GL �L O�uoF;
aG
Septic Tank
Sheet Metal
Sheet Rock
Tile
FC70N,-el�4-C t�
r/Contractor Signature
6. 6z• 6�
Date