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CITY OF CUPERTINO't�rr
BUILDING DIVISION . PERMIT
CONTRACTOR INFORMATION ' x
aY1F°tSfbA°P�isl`NBOW DR
CHAN NORMAN AND VIRGINIA
PERMIT NO. 03040109
��W"RgORMAN AND VIRGINIA
PEa1116 a"22/2003
NE:
SANITARY NO. CONTROL NO,
ARCHITECDENGINEER;
BUILDING PERMIT INFO
-
BLDG ELECr PLUMB MF.CH
0 0 0 0
LICENSED CONTRACTORS DECLARAToar
Thereby ef0rmohm1amfdueStlunderprovisionsofs Code,9(commencing
with Section ecDivision Sof the Business and Professions Code, and my license is
Job Description
p u n/ r.
I�C
o B�1id Leo
and
end clrccr.
in lull aforceClass
License clan Lic.N
REROOF '
°am c°"DE
REPLACED W/ COMP. SHINGLE MAY 0 8 2003
ARCHITECTSCon DECLARATION
1 undersand my fish. shall be used ea public records
BUILDING
Licensed Prefesaional
OWNER -BUILDER DECLARATION
I hereby Ilam 11. exempt from the Contractor's
Law for thefol
_
Anyccense
. (Sce Business and Pe, doli Cole: Any city m counre
re ,curt.. (Section ID
which rets a peons, re cors
which Construct. alma imfmve, demolish.o
nr,pair anyod
rim h parmitu
p arse require, the applicant for such permit m f Ic License signed nuumem
heat,
friar o its I licensed of the
shat lam es licensed purstion7 rhe
Sq. Ft. Floor Area
Valuation .
of Diviow
Division S the and
eBusiness aPosLaw simC Code)
Cac) of
(commencing with Section7")and
'
the axe
that he u exempt therefrom and the buts for IlY alleged aemprihn. Any violation of
the alleged on. Any Vii
85000
Section 7031.5 by airy, applicant for a permit subjects the applicant to a civil penalty of
APN Number
Occupancy Type
nut mo, Nan five hundred unit... (S500).
P y YP
❑ I, as owner or the property, or my empleyces with wage, as Nei, Me compensation.
3 6 6. 1 0 3 % . 0 0
will do the work. and the.wnurt farm Intended oroRe ed for sale (Sec. 704N, Business
Professions Code: The Contractor's License law docs
Required Inspections
and not apply in an owner of
property who builds or improves thereon, and who does such work himself., through his
305 — FRAME ,
own employes, pol that such improvements art not Intended or offered for sale. If,
30.7 — INSULATION
however, the building or improvement is sold within one year of completion. the owner
builder will ban the burden of proving that he did not build or improve for purpose of
601 - ROOF TEAR OFF
sale.).
602 - ROOF PLYWOOD NAIL
❑ 1, as Owner of the property, am exclusively contracting with licensed contractors t.
convect the pmjecr(Sec.TUla, Business and Professions Cade:) The Contractor's LL
603 — ROOF BATTENS
ccrue law does not apply to an owner of property who Wild& or improve rhemon.and
who contracts for such pm? -cu with a coneurpursuant (s) licensed pursuano the Contractor's
604 - ROOF IN -PROGRESS
i ease Law.
I to exempt under Sce. T, B A, P C for this reason
Dau ? O
Ow A WO.
.
WORK ER'S COMPENSATION DECLARATIOt.'�
I hereby affirm order penalty, of perjury one of the fallowing declarations:
I have and will maintain a CeniOate of CO..COL to selbinsure for Workers Comprr
nation, as provided far by Section 37W of the Labor Cod, for the pe,fmmanm of the
work for which this permit is issued.
,
❑ I have and will maintain Workers Compensation Ituura oc. as required by Section
3700 of Inc labor Code. for thc performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier: Policy No.:
'
CERTIFICATE OF EX EM MON FROM WORKERS'
COMPENSATION INSURANCE
OTH section need not be complcled if the permilis foroac hundred dollar¢ nIm)
or leas.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
cmployany pe nymannersoastobecomasubjeeno the Workerien�pG l.10,in
Laws of Celif...is rseu sff sNNo�
-
Applican �� k
NO p�PPLICA�fT: If, .fret making this Ccror". of Exemption, you should
Men Objectto the Worker's CompenMrion provisions of the labor Code, you must
for with comply with such powomi, or this permit shall be deemed mvoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm liar there its construction lending agency for the performance of
the work for which this permit le issued (sm. 3M7. Co. Cd
Lender's Name
Lemicr's Address
I Certify Nu 1 hare reed this application and sou that the above information is
'
COMM, I agree to comply with all city and county ordinanttt and sum laws relating I.
building construction, and hereby mlhorim mp,senutims of this city to enter upon the
above. mentioned property for impecuon purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way seem against Mid City
in Consequence of the floating Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dat
SOURCE REGULATIONS.
zI
Re -roofs
Type Of ROOF
tore.! ApplicanUC.mm mrDa,
HAZARDOUS MATERIALS DISCLOStIpe
Will the applicant or future building occupant marcor handle haxardous material
M dcland by theuranin" Municipal Code. Chapter 9.13. and tbe Health and Safety
ewe. soden sssfixan
Z) Yat AN.
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 future building occupant use equipment or devices which
mit hamrdous air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Distli"7
❑Yes tKN.
Ihave thehaasNtmns a5(ala5533armcnuu 6.95 afthe
has & Safet 1m adleapudthatr
Safety Code.how.
'``
does
s net Co aotat.uo it is any rawosiniol to hadI she
not curtently M1ae a mnank liar it u my re.pamihility u notify the aeupent or the
., 4orthe
N
requirements which must be mer prior to issuance.fa CcmrC.u�upan
.9 tut o Applies ant �" Date -
a 207X�
All roof coverings to be "B" or better
cr ser amhorircJ
.Ecol Dam
Is
1.
9
OWNER -BUILDER VERIFICATION
(Check one) I or my immediate family (parent, spouse or child) will perform:
A. V All the work authorized by this permit
B. _ A portion of the work
C. None of the work .
If B or C is checked, complete 2 or 3 below
A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete sectior
Contractor Address/City
Phone # Stife License# e of work to
be r erformed
. 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner -Builder Information ((reverse side).
Property Owners SignatureX 4 )6l/n---Z / DZ �/2 �1' O 3
Job Address: , A Permit # /
Department.
ap,
CITY OF
CUPEkTINO
Dear Property Owner:
City of Cupertino Building Departunen
10300 Torre Avenin
Phone: (408) 777-3228
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improyernWR specified.
For your protection, you should be aware that as owner -builder you are the responsible party of record
on such a permit,. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
if you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration).. For more specific information about your
obligations understate law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Recycled Paper
CITY Of
CUPS T]Na
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.
Homeowners Name:
Job Site Address:
Roofing Company Name:
A pli
Greg cant'
Date:�Z�o 3
\il/QSiJCtOCX) �
eel !
Building Official
Revised 1/30/03
Printed on Recvded PaDer
f
CUPEkTINO
11
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
BUILDING
BSEISMICOM
Owner's Name:
BUILDING
Phone #: <40
Plan Check Fee
BUILDING
BUSLIC
Contractor: Phone #:
BUILDING
License #:
Contact: Phone #:
Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
1( Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
A 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 Wi Cu erti
o's Tear Off oli : ❑
Job Description: / ��
Residential �4' Commercial ❑
Fire Zone: Yes ❑ No
Confirmed ith PI if
there are an trictions:
Cost of Project: Type of Cons t' r
Occupan gro :
r7Ze�s
r
l/
QtY•
Ao tcab epi Frr m
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
#Zi66, 2-
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