03090161 CITY OF CUPERTINO. m ^^ zr e '.r k'=�' r tr n' '.`.•• 4 `� '.
BUILDING DIVISION PERMIT �,,p,ONTRAC�TOR INFORMATION.
�qA
BUILDING ADDRESS: - PERMITN00309016I
OWNER'S NAME: PERMIT ISSUE DATE
)NE: SANITARY NO. CONTROL NO.
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I" LICENSED CONTRACT'OR'S DECLARATION �'�
iC 1 hereby affirm that 1 am littnud under provisions of Chapter 9(commencing ■■■ VSER
s i with Section ))of Division Sof NC Btminey(end Pmfcssions Code.and my license is /7
-ore in full force n ef ! -
>R? License Cl Lic.N �` REROOF NOV 2 4 2003
=Fp D — cantradA Q
� `ARCHITECTS DE RATION
1 m I understand my Ilam shall W used as public records
BUILDING
yto
`0 LiccnseJPndcssinnel
OWNER-BUILDER DECLARATION
<0 1 hereby reaso .('firm on 1 1. exempt(rum the Contractor's License Law for the
p D which
toms.(Semon 7101.5,Business and ve deio l Cole:Any city or county
Im which myuiru a permit m construct,alcor.improve Jcmnlixh,or rpair'eny sructum
_Zt prior to its issuance,also myuims the applicant for such lermifao file a signed summent
amp That he is licensed pursuant to the finividons or Me Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation -
,1- (commencing with Section 7000)of Division 3 Of the B usineu and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35602048 . 00
.. Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of , T _
not mole than Rve hundred dollars(5500). - -- —" -APN Number Occupancy y ype. '—-
❑
1,sit owner of the pmpcny,or my employees with wages as their solo compensation,
will do the work,and the structure is not intended or offered barrette(Sec.7094,Business 305 — E Raired Ins ect10DS
and Professions Code:The Conuacmh License law does not apply to an owner of p
property who builds or improves Hereon,and who does such work himselforthmugh his 307 - INSULATe ON
own employees,provided that such improvements am not intended proffered fortax.IL 6O1 — ROOF TEAR OFF
however,the building at tmpmvement is cold within ane year of completion,the trivial.
builder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sate).
01,as owner of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
embalmer he project(Sec.7044,Business and Pritfssims Code:)The Comracmr's LL 604 — ROOF IN-PROGRESS
cense Law does not apply to an owner of property who Wilds or improves Bunion,and
who contracts for such projects with a contractor(s)licensed pursuant o He Contractor's
License Law.
❑I an,exempt under Sec. ,B 6 P C far this moon
Owner Data _
WORKER'S COMPENSATION DECLARATION
I hereby anion under penalty of perjury one of the following deeler bone.
I have and will maintain a Certificate of Consent to xlGinsure for Worker's Compcn- ,.
130710"0
on,as provided for by Section 37W of the Lather Code,for the performance of the
rk for which this permit is issued.
I ban and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,(or Be performance of the work for which Bis permit to issued.
Worse ,Compensation houren earierand Palley num harem:
a Polity Na.
ERTIFICATE OF Ly EMPf10N FROM RKERS'
COMPENSATION INSUR
(Thlssemton need nolbeesmpletedlfthe permft (mono hundred Jullars($100)
,Or less.)
1«oily Bat in me performance of Be work for which this permit Is issued,I shall not
employ any person in any manner sen as us become subject m that Worleco Compensation
Lawn p(Califamia.Dasc
Applicant
NOTICE TO APPLICANT:If,after making His Cenificsm of Exm prion,you should
become subject to the Worker's Compensation provisions of the la wo Code,you must
:iO forthwith comply with such prnvislons or this permit that l be deemed mvokcd.
CONSTRUCTION LENDING AGENCY
I hereby anirm that dere is a construction lending agency for the performance of
Nc work for which this permit is Issued(Sec.3097,Civ.C.)
17 Leader'.Name
3.
3. z Lender's Address
;) Q 1 ani(y Net 1 have reed Bis applieutan and sum Bet He above mram ore.is
.L F correct.I agree to comply with all city and county ordinances and state laws misting to
J V building construction,and herby authorise Minemnollocs of this city to enter upon the
G above-mentioned property for inspection purposes.
ti (We)agme to mw,indcmni fy and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City,
J7 in consequence of the granting of this perm it.
rPPT N STANDS AND L COMPLY WITH ALL N -POINT Issued by: Date
ONZ�pda o� Re-roofs
pbcanUCantrxmr arcHAZARDOUS MATERIALS DISCLOSURE Type of Roof
the applicant or forum building ucupanumre nr handlehasankme muerul
the Cummuns MunicipalCode.Chapter 9.12,and the Health and Safety
s 25572(a)? �Nu All roofs shall be inspected prior to any roofing material being installed.
the applicant or future building accupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree io remove
us air contaminants u defined by the Bay Area Air Quality Managementall new materials for inspection.
❑Yes T�Nu
1have mad He c,,Scema 25505, 5533adnattircro55 undc'Chapter6.95 Ralifthe Califon
ratasOuBdu nil,Code,unctions 25505,8513 and 23511, untkrsmnd NaiftW Willing L O
does not curtemly haw a lona Not it u my res 'hI it,m mmy Ibe ucupam of N
m mcuivt us pro aCc 'marcof Ocapan I ureo plicant D e
O raulhoriu cn m
° All roof coverings to be Class "B"or better
r Building Division
10300 Torre Avenue
' Cupertino,CA 95014.3255
Telephone: (408)777-3228
Fax: (408)777-3333
*CO
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:. fs "�4z
Address: y
Reroofing Company Name:
Applicants Signa Date: G I�
• �Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO o 3 ,s -7
yof REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# 71 Date:
V z o
Building Address: i
3 G�^o ee C l i c
Ow er's Name: Phone#� :
D M ct evN vi D 0*' '
Contracto : License#:
Contact: Phone#:
YOe-- - 97/- Y/
Applicant/Co tractor: Fax#:
in y0
Building Permit Info:
Bldg Elect Plumb -Mech
4 Job Description: T-� ?A CC'S'aY Yr-,
Residential: Floo Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
d d
Architec ngin er: Valuation:
Type of Construction: Occupancy Group:
Kd-
if
y.
i able Fee ID Fee Description Fee Group
BPERMFEE Bldg Pemut Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
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