05040049 CITY OF CUPERTINO ^ - • :ry ) > xu". 'i . '' " `
BUILDING DIVISION PERMIT 'G`C1�.TRACt'UY2I�N 'l7RMAx`TUi �.
BUILo1NGADDRFss: RICHARD BATSFORD PERMIrrvo05040049
OWNER'S NA E: isamETESSURDATB
RICHARD RATqpnpr)
E: SANITARY OL NO.
r
ARCHITECUENGINBER: BUILDING PERMIr INFO
BO LDG OELECr PLUMB MECHO
306 LICENSED COMRACI'OWSDECLARATION JobDescri hon
IYI I hemby tfRrre WE I ren licensed under provialans of Chapter 9(commencing P
U� wird Section 7")ar Division3of he Business and Professions Code,and my license I.
1.full to=
jLL Z� ht,
Clad Lle.g
REROOF W/COMP. SHINGLES
Dan_
Contractor
plansARCHr
W use DECLARATION
'�all 1 undenunJ my phos shall he used as public ranNs
tSer Licensed Poor..ionJ
3 OWNER-BUILDER DECLARATION
gy I hereby.Rion that 11. emmpl from the Contras Co License Law for me
O O following mann.(Section co L5.Business and Pmfesaluns Cade:Any city or ro sure ^-�
3:$� which reyulrcs.Permit m consuucn ellen MProvo,demolish,m repair any structure
pAormiuinuanee.alwmqui=Lheappllcml(orwchpermilmrnl ...edsuument t 1
ggggFE< mat M is licensed purwanEro the pmvialons of tite Contncmrs Licenae law(Chapter9 Sq.Pt. Floor Area l Valual 00
Ss (commencing with Section 7000)of Division Sof Else Baincuand Pmrasions Code)Or
Out he Is exempt dtereftom and the basis for the alleged eanmption.My violation of
Section 7031.3 by any applicant for a permit subjects the applicant m a civil penalty so ! I I _
notmam dun fl.bumbed dollars(M). -+�. /773 a er00IOccupancy Type
Ol,as owner of the property,a my employees with wages as duo auto compensation,
will do the work,and the tuumum Is not intended or offered for sale(Sm.7044.Isusinear Re u)re�'Itis eations
and Profesalolu Code:TM Conuamoes License Law dons cot apply m an Owner of q P
propeny who build.orimprover deso m,andwho doessuchworkhimselfatmorugb his
own employees,pmvldcd that such Improvemmu arc notinteMed orofferW fasala If.
however.the Wilding or Improwneem Is mid within oro your of completion.the owoer-
builder will have the burden of proving this he did not Wild or improve for purpose of
isle.).
0 1,as owner of the property,am exclusively cons ring with licensed conu.cun to
construct the pmied(Sec.7044,Business and Professions Code:)The Conmcmr'a Li-
cense Law dans out apply in.n owner of property wM Wilds ar improves t omen,and
whocanractsforsuchprojects withaconv�herU nand punamtomeconumsofr
Licence Law.
❑Ism use tp nde aSc .B&Pcfa this
Owner Dau
7Ca314 BR'S MPENSATION DECLARATION
I hereby aBlon under penalty of perjury one of Ne following decluudons:
I asm and will maintain a CeNOate ofConeent m self-insure for Workees Compton.
ion,u provided for by Section 3700 of me labor Code.for tin performance of me
M
n for which ibis permit is issued.
1 have and will maintain Waken Compensation Insurance,u resulted by Section
ofme LubaCode.fa me performtt mofsite wont fa Medwhich this permit is us .
y Worm's Compensation Insunme terrier and Policy number am:
rtier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section nerd not be completed if the permit is faanchundmd dollars($101)
or REX)
1 ceni(y that in the performance of dm work res wEd is h i ,I Nall nut
employ any person in any mm u bcco 1 ton or Orn Don
Laws of Califamit Dau
Appli ant
NOTICE TO APPUCAAT.IL after rrCc ' EdW Exemption,you N uld
become subject in me Worked Compensetian pmvi nes mf Ne Lahr Cede,you muv
.,O forthwith comply with such provisions or this permit shall ho deemed revoked.
z CONSIHUC ION LENDING AGENCY
P:y (hereby M.0.1 dere is a comrucdnn lendingagency for me Performance of
CL> the work fur which this Permit las issued(Sec.3097.Civ.C.)
6W.� Lenders Nurse
z Lenders Address
U0 1 cenifY that I love read this application and sou dw the show information is
U correct,1 agree to comply with all city and county ordinances and sum laws misting to /
0 Wilding connotation.and Mreby sudurise representatives of this city to enter upon the
W shave-mentioned Property for inspection indemnity
pugmsen
py ehoc)agree m saw,indemnify and hi ch may
In m dm City n Cupertino id City 1 /J
Incmuseq.tomJudgments.the an and ef th, swhich mrythany w.y.caue sgalnal said City
t) Inconsequence of me goosing err this it,
APPLIC D
EST
WILL P ALL NON-P NET Issued by: Date
s0 U ON
Re-roofs
ignuum ofApplicunV r ate
HAZARDOUS 1,46TERIALS DISCLOSURE Type of Roof
Will tie appliant or future Wilding a PMLsmm or handle huudoa mautid
u de0ncd by the Cupertino Municipal Conde,Chapter 9.13,and ma Health ad Safety
Code,Section zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yoe �.
Will the sPP11cmt or future Wilding occu sant use esuipment er devices which If a roof Is installed without firs[obtaining an inspection,I agree[o remove
it meardrus air ecru ninmu u dcMcd by tie Bay Area Air Quality Management all new mate 'als for inspection.
I.vict7
❑Yes kNo
Ih wmWmehuardmumeutialtmsuiremcnu and ChmuA Ofthe Califor'
rah Halm&SalmyCode,sccMas2350 sJ3 uW255 i(mc Wilding
Jana not currant ow a umn my 4-
map
y u tin oaup t of¢sol m - anee cards orOca Signature of Ap a[
wne/wthaa ad a D All roof overings to be Class"B"or better
acloF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
UPERTINO
Building Department
JOB
B ADDRESS: PERMIT
4 1 S
OWNS N PHONE # YqF F,57 —3Z/
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
66 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/Contractor Signature Date
Community Development Department
Building Division
r City of Cupertino
10300 Tone Avenue
4CITY 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 inspection 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: Rill,
Job Site Address: 1043 Z &L:3
Roofing Company Name: &A z�2
Applicant's Signa e: Date:
tGreg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO .
REROOF
CUPS TINO PERMIT APPLICATION FORM
APN# 2 Z�f Date: p
0
Building Address:
0 e
0 's Name: a / Phone#:
Contractor: Phone#: License#:
Co ct: Phone#: Cupertino Business License#:
C 0 — 7=43
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Z Asphalt Shingles ® Asphalt Shingles
❑ Wood Shakes ❑ 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 D caption: ,pp
!C -
6esidentiar Commercial ❑
Fire Zone: Yes ❑ No J�g Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: b� Type of Construction: 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
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