06020073 CITY OF CUPERTINO
BUILDING DIVISION PERMIT vC0NTRACTOR INF.�OORMATION
BUILDING ADDRESS: PERMIT N0.0 6 0 2 0 0 7 3
10151 PHAR LAP DR
OWNER'S NAME: PERMIT ISSUE DATE
CRAIG FORNEY 02/13/2006
NE: SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� 0
in LICENSED CONTRACT'OR'S DECLARATION Job Description
m 1 thereby affirm that I am liceucd under Provisions of Chapter Y(coencing p
n< with Section 70B)of Division Sof the Business and Professions Code.and mylmcnm is
_<=,n in full forte and effc�k;S �N4/off REROOF--T/O SHAKE, INSTALL DURALITE
z Littre cl Lic.g
-rp Dao contmclar AnuyFr w WEIGHT TILE ER 2656
understand ARCWusS DECLARATION CONTRACTOR: KNIGHT ROOFING SERVICES
U
m I ucrsunJ my planshall all bo useu d public rtcorda
a
goI Licensed Pnsfcssinnal
S OWNER-BUILDER mDECLARATION
ZeO hereby affirm that T 1. exempt from ds Comms Co License Law for the
ZOO followwhichingmason.(Section]onstr Business andw,dcauns Curie:Any city structure o;V. which myvires a permit re construct,alsm improve,h Permit
m repair any swans
'tie prior NiuiensedPalw uquimstW applicant for uchpermi'm tilt a.Law(Charm,
harm,9
Eipdust
comencing wdpursuanl blhe provisions of orceBusi tessnimuclJon,Code)or Sq.Ft. Floor Area Valuation
j l-$ (eat he is(commencing Sectionfom and the
Division r of NC alleged and
Professions Cqk)or $15600
a�.• that he u exempt therefrom end Ne buil for IM alleged exempllon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mos Nan five hundred della..(MM). pane y yp
El
I,u owner of the pmpmy,m my emploYces with wages u their Bolt compcnsadon,
will do the work.and the structure is not intended in offered forule(See.704,1,Bonn. 32639957 . 00
and Property who
Code:The Contremon. rad who
law dots not apply lf an owner of Required I l NALED own enywbobuildsorimpmvsuh improve who dcesmindenrk himselfor through his Ilrglf�7��_
awn employees.er,the p ing or i that such improvements as ne you f c moRertd for sale. r-
builder.,the buildingh r improvement is sold within one year of completion,the o se,of
builder will have ds burden of proving Net be tlitl not Wild or improve for purpose of
Bak.). a�
❑1,u owner of the property.am.1ionvely contracting with licensed contractors m d�-• /Oa�
construct the project(Sec.]OCG,Business and Profession.Code:)The Contractor's U. FEBr CD Ot/ a•
ecus law does not apply N an owner of property who Wil&or impmAra thereon,and
who contracts for such projects with A eemori licensed pursuant in the Contractor's BUILDING License law.
❑l am exempt under Sec. ,B&PC far Nis mason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penalty of perjury one of the following daluations:
T have and will maintain a Certificate of Consent to self-imure for Worker's Compcm
1wnur
un,as provided for by Section 3]00 of the labor Code,for the performance of the
rk for which Nis permit is issued.
1 hale and will maintain Worker's Compensation Insurance,u squired by Section
W of Oc labor Code,for Ne performance ofNe work for which Nis permit is issued.
Workes Compensation Insuraanc caarrrrier and Polity number art:
rier. 5'a"P4M1" �O^""a Poliry No.: of b 1 Y r0 `3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sce ioe aced not W complcwd dome permit is forone hundreA dollars(SIM)
mr leu)
I eenify that in the performance of ds work for which this permit is iuood,I shall not
employ any person in any manner an u u become subject to one Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificale of Exemption,you should
tacome,subject to the Worker's Compensation pmvisiom of the Labor Code.you mut
.,O forthwith comply with such provisions or Nis permit shall W dcemcd revoked.
ZN CONSTRUCTION LENDING AGENCY
cd I hereby affirm that then is a construction lending agency for the performance of
G' Ne work for which Nis permit is issued(Sec.3097,Co,C.)
W Lender's Name
4' Lender's Address
oz
U Q I o nifY Nat 1 have read Nis application and Auto that the An,information u
D,, corsm I agrce to comply with all city and county oNin tai and soon laws totaling in
OU building construction.and hereby authorise repexionavu of this city in enter upon tM
shove-mc judgm property for expectionenses purposes.
F 9L (We)agree to save,indemnify and keep harmless the City of Cupertino against
(n
liabilities,judgments.of is cosgunindof this expenses which may in anyway acerae agaiut.taid City
V z in eansequenec of Nc granting o!this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S44
SOURCERE�LATIK / Y Date
Signature pprcanuventrxctorOxm Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant gore or handle haosandous material
an defined by the Cupertino Municipal Code.Cbapmr 9.13.and the,Health and Safety
code,Sotontion I5532(a)' All roofs shall be inspected prior to any roofing material being installed.
❑ �Jo
Will the applicant orfuws Wildingoccupanwse cyuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havartlous air contaminanur in defined by the Bay Area Air Quality Management all new materials for inspection.
ianot'
❑Yes �Nu
I have mrd the havardous maserialsrequirements under Chap,r&95 of the Califor.
nit Reallh&Safcty Cook,9cctians 23505,15533 am1255M.l undcrsutM door ifthe Wilding
does-1 curendy hese a moot,that it u my respmuibility u ratify the occupant or the
mquimments w h man.be mer prior u�of a CrruEcale of Oce anry.
/eri/'F Signature of Applicant Date
z -
Ownmmaathedag r Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPERTIN0 ,
Building De artment
JOB ADDRESS: t o-r I i1H4jZ/- 4P 04, PERMIT#
6 02o07
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: .i/j,-r ffT jZ0o cjw / FAX#
I am not using any subcontractors: ,A —�" Z �j b
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signature Date
Community Development Department
Building Division
• City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
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 are-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: Craig Forney
Job Site Address: 1051 Phariap Dr .
Roofing Company Name: Kn ' ht Ro fin Services
Applicant's Signature: Date: 3
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO b Z
�=- REROOF
IRCUPC TY OF
ERTINO PERMIT APPLICATION FORM
Date:
APN# � 2 / 12,
b o --
Building Address: f ��
105-± Phar ap Dr . Cupertino
Owner's Name: Phone#:
Craig Forney 408 896 6707
Contractor:.----- ------- Phone#: 510 License#:
----.. . ...._ . - ._. .._-- --- .--------- 84..4.10.8,----- ------ ---
Knight Roofing Services 438 9077
Contact: Phone#: Cupertino Business License#:
Greg Knight 510 438 9077 aipplication attached
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
JZI Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ other(Specify) A Other(Specify) Li gh+w e(ah f T)b
Number of existing coverings ❑ Provide I.C.B.O.Report# Z6 S6
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will ('-111,With Cu ertino's Teaz Off Polic ❑
Job Description: Tear off shake . Install sheathing. Install Duralite Light-
weight Tile ER2656 . 24 sq.
Residential X Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: $ 15, 600 Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EnergyBUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING