04030169CITY OF CUPERTINO
BUILDING DIVISION PERMIT
�kC0NTT0'aMATIN5,
BUILDING ADDRESS:
KNIGHT ROOFING CO
PERMIT ND.04030169
OWNER'S NAME:
Y
PERMIT ISSUE DATE
ONE:
SANITARY OL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG EI-F.CT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Descriptiopy
1 hcroby tMen Net 1 am Iiaved ppmeqproviso. of Chapter (commencing
with SOU� 7"")Of Dlvid. rare Bus"hggShnd Prof ovC andmylle.rseis
t ��
r �I�®
in retire ✓_� �5j
REROOF
men€ eTrss Lie. a
MAR 2 8 2004
ARCHITECTS D RATIO
`'s
1 uromma nd my pl.n.hsll be wed a He records
Licensed Professional
OWNER -BUILDER DECLARATION
BUILDING
1 hereby ,(five that 11. exempt arum d eantranaia Law Tar the
Any
: c county
following masa. (Sadao 7fe Buser. and P r il Code: Any city my
e, der structure
which mquirea a permit re clover. aline Impmn, demolish, or mpsr any
car
Also resthe the umna
Tar such ConaraT11111 Licenselm a Low (Chapter,
ail31ensedpursuantcommnaucenxlaw( 9
Sq. F[. Floor Area
Valu tion
Lima hprior
ursuae.
tto ovisio of
none
Cole) or
merru imull it puwion7 aro of envision 3 or Cotic)
with Section Prom.
the al egBusinessand
that he 1. cnS
Any
I Nat he ts e¢mpt Netefrom and the buss for the alleged excmptlm. Any violation of
and the
3MVA18*r00
Occupancy Type
Section 7031.5 by any applicant for a permit subjects dm applicant to a civil Penalty of
nal mom Nan five hundred dollars (5500).
01,uownerof Uepmpmy,mmymnploy withwageruUUGsolemmpevadon,
Required Inspections
do Newark, and Ne suunumis mss 70M,
Owner of
LicenseLaw las apply lf an owner
and Profession Code: The Contmcmfs LawuW s not Apply
and
q p
his
who uch it
Wilds or improver thereon,andwho Armssuch work
propertywho and
unded aroffrmthrough
ownemployers,provided such improwmmolamml ewofcmoedon.ered!
s.
the Ownif.
pr year ofcompletion,Neowner-
builder, Nebuilding orimpronmentsa sold
adidnone
have Ne burden of provin[ Nn M did not build or Improv fm purpose of
sam.).rwill
sale.).
0 1, As Owner of the property. Am exclusively Contrc7ing with licensed contractors m
convect Ne project (Sec. 7016. Business and Profeamms Code:) The Conwnm's L i-
'
revs law dors not apply m an owner of property who builds m imprews thereon, and ,
who Cannata for such protocol with a emtnnor(s) licensed pursuant to the Cormommes
License Law.
❑ I Am exempt under See . Bk P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby e(Urm under penalty of perjury arc of the following declarwov:
1 hen and will mainuia a Cenificue of COnsent maelf-inum for WOrkchCompen-
satlon, as provided for by Section 3700 of the labra Code. for the pedowaae of the
work for which Nis permit is issued.
0 1 haw and will maintain WOrkefs Compensation Imuranul, a required by Section
37W of are labor Code. for the perfam acc of de work for which this penitis Issued.
My Work O .shad^J �•Insuranc canner and Policy number Am.
LT[SL N
Ss
CERTIFICATEO{� ' FROM ORKERS
An
COMPO An
(This sahan need noWcomputed If the Permit Is foram hundred dallan (SIM)
or Icu.)
1 ceoify Nat in the performance Of the work fm which this permit is issued. I shall not
employ anypersen in any manner an As to become subject to NC Wor Bari Compensation
laws of Califomia. DAM
Applicant
NMCE TO APPLICANT: IL afar making this Certificate of Exemption, you shouW
become subject to the Worker's Compensation provisions of the Labor Code, you mum
forthwith comply with such provisions or this permit shall be doomed ranked,
I
CONSTRUCTION LENDING AGENCY
I hereby al0rm dolt drum is a Conswction lending spne, for the performance or
' the wort fm which this permit is issad (Ser. 3(97, Civ. C.)
'
Leadefs Name
Lendres Adders
j I certify dial I haw read this application and sum that the awn of emnmn is
' cower. I agree to comply with all city and county ordinances and auto lawn reading to
building consuuetion, and hereby Outhouse representatives of aria city to enter upon the
abon-mmtianed properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Capcnino against
i liabilities.judgments, costs and expenses which may In any my accme against said City
in conequenm of the of 'A
`•
granting Pewit.
' APPLICAWJ#4DERSTAND ND W LL COMPLY WITH ALL NONPf11NT
Issued by: Date
SOURC LATIONs. , J.
Re -roofs
Type of Roof
i wrc OfApplicantlC ata u
HAZARDOUS MATERIALS DISCLOSURE
Will the applicam or form building acupanlstom mhandlc hazardous material
As defined by Ne Cupenim Municipal Code, Chapter 9.12, and the Health and Safety
Cma.Section 25532a)7
All roofs shall be inspected prior to any roofing material being installed.
❑semNo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or lure building occupant use equipment or devices which
emit havmdam air contaminants a droned by No Bay Arta Air Quality Management
all new materials for inspection.
Disuicl7
)!u
GYcs
I have ural are mordants mam$ rc yimmcnu underCMpu:r 6.95 of the Califon
.is Health&Sof lYCode, Sectors 2}585.23 )7
aNe�"'a`
S7
docstrot CI n haws". athu y �blltymmuly do oauparit of
requirem ire mnst be ej ri wi uanccofa CmiEcama ampanfY-0-/
V'
Signatures£ Applican ate
All roof coverings to be Class "B" or better
Ow, r sumarind agent V Njrate
CITY OF
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADD: O
I
PERMI
D�fo3or6
OWNER'S NAME: C x
PHONE
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check anolicable subcontrarmrs anri rmmnlP+P +},P fnllnterino- ;lf�F
,
/Contractor Signature Date
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 14
,
/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
4UPEkTINO CITY OFFax: (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.
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 N
Job Site Address:
Roofing Company Name:
Greg CaAeel
Building Official
Revised 1/30/03
Printed on Recycled Paper
•
CITY OF CUPERTINO Q
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # D
Bldg Permit Fees
Date:
3-17-04
Building Address:
Energy
1586 Popp Way
Cupertino
Owner's Name: Cathryn Lui
BUILDING
Phone#: 408 255-4088
Contractor: Knight Roofing Co.
BUILDING
License#: 755799
Contact: Greg Knight
BUILDING
Cupertino Business License #:
Business License
BUILDING
21191
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
X 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 Com 1 With Cu
ertino's Tear Off Policy:
Job Description: Tear o s a e. Insta
s eat ing. install Ciass A
11 Composition Shingle.
Residential ® Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Plannin
there are any restric ' ns:
Cost of Pr2ype of Cos
do Occupancy group
10,500
^
Qhs'
An �cah�l
10119
Fee ilescrintinn
FPP l Y nlm
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