05080221 CITY OF CUPERTINOa �
BUILDING DIVISION PERMIT WONTRACTOR INFb1;MATIONkf
;
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT ND05080221
1051 PENNINGTON LAME
OWNER'S NAME: PERMIT ISSUE DATE
PAUL BUTLER 125-B GROBRIC CT 08/24/2005
]NE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EO
PLUMB MFCH
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30'6' LICENSED CONTRACTOR'S DECLARATION escr
Job Description
I hereby affirm that 1 am licensed under provisions of Clupur 9(commixing P
Z wlN Sado.]0111B of Division 3 of the Business and Professions Cocmmd my lmene is
^< unfullfomeandaffy.3 9 » REROOF-T/O COMP. , RESHEET. OSB &
Lear LLaa LL
Lk
Dam 7/917 i Co.— ADD 40 YR. COMP. SHINGLES
ARCHITECT'S DECLARATION
I uteenuod my puts,lull be mad as public rtcmds
G Licensed Pmfcaional
Oat I am exempt
fr DECLARATION
0 S: I herby affirm that I am eempt from We Cssions o License Law for the
02 following meson.(Sidon](1314,Business atar. and Na.de oli Code:My city m County
42 which requires•permit re cora prion in its issuance.Alan es the alley.improve,APPHCML for h Permit
a or e a sil my moment
madminument
££ CMet
ecommescmmcdposuan in BeWIN)of Division
of Nc Me
LicenseLaw(Chapm9 Sq.Ft. Floor Area VaIU Ib0(](]
Y that WI mucroping NSerefon7 and
basis for of the Budwe pion.nd An vl Cade)or
..
that he u exempt therefrom and Ne bull for Ne alleged exemption.Any violNon of
Semon 701.5 by any applicant for a permit subjects Ne applicant In a civil penally of 3 6 2 0 4 er 0 0 Occupancy Type
not mom Nu A.hundred dellen(5500).
❑I,ummr of t e property,or my employees with wage as their sale Commando",
and Professions
and Ne he Ctm actuct;in¢Mns,La does
to an Business Required Inspections
anti property
who
oro Cade:The ves Cher on. rad who{ave duct rot apply a an.war of q P
propertywhon.Idamimpmwch haon,endwho logiasuchwork oroffe m!Nrou{h Ma
own troweneremp.Me building provided mat such Improvemw t ere not year
oftded mo@cad Me ownformle.If.
Wilde,r,Ne avethe
Or Improvement)s sold within one year of mprove far
Ne Owner-
builder will haw the Wrdcn of proving Nat k did Out dd10 or Improve(or pury.se of
sales. �(tsg A
❑1.as Owner of Me property.sm exclusively contracting with Bansed mnuacers at ((j//J LuV/7J�ti
consumerLadoes
(Sao]044,Businessand
rtywho mCade:)Thves Memon. rad
terve law dots nm apply e ts owner of property who Wilds er Improves Cmusc and
who c License Law.for Cab projects with•conuanur(s)licensed pursue a Ne Conuactofs
01am exempt
❑Tem eempt under See. ,B k P C for this region
Owner WORKERS COMPENSATION DECLARATION mFL9% �r �e`�k
I hemby a"Ins under"rally or perjury one of Ne(allowing declarations: °y`y„�(',y'I�[S�
1'.. a,
will maintains CeniOcemof COnsomeself-alum for Worker's Compere- f///1�� A
sanon,as provided for by Section 3700 of Ne Labor Code,fm the performance of the
work for which this permit is issued.
Ip 1 haw and will maima)n WOrtmes Compensation Insurance.as acquired by Schon
]00 of the Labor Code,for Ne performaneeorthe work for which this permit is Issued.
My Worker's COmp:madan Insurance carrier and Polity number are:
Cartkr.. ��M.abYt'1^�`x-Polley N-A I 0 �l
CE FlR ISL F1AP170NFROM WORKERS'
COMPENSATION INSURANCE
rads sccMa rad not beconpktad Ift e permit is formm hanNeddoOan 15100)
Or has.)
1 anify that in IAC performance or the work for which this permit is issued.I shell not
employ any person in my manneran u to became subject in Me Workere Compemadion
Laws of Cslifomla.Dam
APPlicmt
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in Ne Worker's Compensation provisions or the Labor Coda you must
w,O fothwith comply with such provisions or this perea tmall W decmad levaked.
z CONSfRUCDON LENDING AGENCY
i{Y0 I wroby of firm that thew is a construction lending agency for Ne perrormanec of
r Ne work rte which Nb permit LL issued(Sec.3097,Civ.C.)
L0 Lendefe Name ,
a Z lender's Add.
f,O 1 cenify that I Iuw eW Ws application and too Nat Me above informum m is
If.F Corea I agree to comply with all city and County ardinatee and sum law calming to
O V building construetion.and hereby suthadrempresenmiwLLofthis city In enter Upon Me
{5! ahow-mendoned property for inspection purposes.
gL (We)agree in save,indemnify and keep hannmu Ne City of Cupertino SO=
iA liabilities.judgmenW emit and Caperton;whim me,In my way seems against said City
In COmCmX Of Me�Ung OfC)z PCMIL
APPLIC Nr UNDERSTANDS AIN WILL COMPLY WITH ALL N -POINT Issued by: Date 2
SOURCE REGULAS. ^ n
C� J 1115 Re-roofs
Signeace or Appliaan OntMATERIALS DISCLOSURE
HAZA
Type of Roof
Will the applicant or future building=open,store or handle huArdous mamelal
as deMcd by the Cupertino Municipal Code.Chapter 9.17,and the Health and Barely
we.Section 2553Ean All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building accupem tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haeardou air aormormnLL u defined by Ne Bay Area Air Quality Management all new materials for inspection.
Witt?
❑Yes R%---
I have ad the hmardws materials requirements order Chapter 6.95 of the Califon.
Health Code, 25505.25533 and 25534.1 madomel Mut Mere holding _ `--��• � ,—tis OS
does let currently have a mum.Nu It a my responsibility a notify the mcupmt or the
mquimmenLL which must npdor issuamcufacmuricaeof Ocmpm Signature of Appl' ant Date
nuse
Owners ..Mrm.d e.t Data All roof coverings'to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: /U S 1 —tay. tea^,-�— PERMIT 5 d & O 2 -z-
OWNER'S
OWNER'S NAME: amt� PHONE# 9 75 - Z 53
GENERAL CONTRACTOR: 0 LaP gn�n�
D / FAX#
I am not using any subcontractors: Q1u0C4
Signature Date
Please check applicable subcontractors and complete the following information:
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
lel jUA q
Owner/ ontractor S gnature Date
i Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY 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-inanufacturers 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:
job Site Address: �4S� Avz, u n-y
Roofing Company Name:
Applicant's Signature: - Date: �N o S
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPElkTINO PERMIT APPLICATION FORM
APN# 3 6 L _v N — 03 -3 Date: 2 /off
Building Address:/0-5
OS- / L4,,
Owner's Nam wa� Q Phone#:
/moi Z
Contractor: Phone#: License#:
O l d 82, -8300 (a 2,2z_7 3 J
Contact: r�� Phone#: S ay.� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles -16: Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
umber of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
Al I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: T z
lJ
15
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: U
Cost of Project: Type of Construction: Occupancy group:
/U o oo • 6b
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