04100068 CI'T'Y OF CUPERTINO ' ' n "'"" `• "'% s r�
RTI Df VIS ION PERMIT CONTRACTOR INFORMATION"'
e
sROOF NG PERMlrN9.4DY LN
ME: PERMIT ISSUE DATEK BAHDATI 21458 OCEANVIEW DR. 10/12/2004
IONS: SANITARY NO. CONTROL N0.
(510) 415-6390
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT` PLUMB MF.CH
0 0 0 0
too LICENSED CONTRACTOR'S DECLARATION Job Description
I herion 70 affirm that l am Ilmnutl under provy ns or Chapter 9(commencingsI. FINA� ES p
�Sj rY with Section]pk)) fDi ixron Jof the❑uaincasa35inns Cndc.antl myliccnm is
<„ inlbum Can eros. vc - REROOF
q? Liccnu C Llc,x
�fw Dam '
Contractor
RCHrECTS DECLARATI T
�i � lar ccaandm a shmi be used a public a O�I raoo1
6 I L If
it LiccnseJ Pmfc
,3 -BURDBR DECLARATION
a E I hereby.(Sero that I Cm exempt from the Contractor's Liccnu Law far the
i 0 O fnilawing minor.(Sectun]O3 L5,Business and Professions Cadc:Any city or apunsy
— which regoires a Permit ,,coromel,elleve
r,narrow,demolish,nr rFrr any swcwre $10600
His prior In its,issuance.also rcquims the applicant forsuch minor to file sing ned gatement
�O that he is licensed Pursuonun the provisions(flhCCnnlmuor's License La,(chapter 9 Sq. Ft. Floor Area Valuation
$ (commencing with Scetion]I1tIB)of Division 3 of the B artiness and Professions Court)or
�..
that he is exempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 311M
one more than Rw hundred dollars(stoat. be Occupancy Type
1,as owner of the pmpeny,or my employees with wages as their sole compensation,
will do the work,and the s ractum is not intended or offered for sale(Sec.]044,Business
and Professions Code:The Contactors License Law does not apply to an owner of Required Inspections
propery who builds or improves thereon,and who does such work hindulror through his
Own employees,provided that such improvements are nor intended or offered for sale.If,
however,the building or improvement is sold within one year orcomplction,the owner.
builder will have the burden of proving that he did not hunk!or impmvc for purpose of
sale.).
❑1,as owner of me property,am exclusively contracting wish licensed eommelors to
Consumer the project(Sec.]844.Business and Professions Cade:)The Comracmrh Li.
cense,Law docs not apply to an owner of property who builds or improves thereon,and
who
o contracts for such projects with a conhactor(s)licensed pursuant to Ne Contractor's
comL h
I am exempt antler Sac. ,B6PCfm this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby art,.under penally of perjury one of she following dechralihr:
❑1 haw and will maintain a Certificate of Consent IU self-insum for Worker's ComPem
cation,a provided for by Section 3700 of the Labor Code,for the Performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,az required by Section
3](III of Me labor Code,for the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier: - Policy No.: _
CERTIFICATE OF EXEMPTION RKERS'
COMPENSATION INSU0.
(This section need not Mcomplemd if the Permit is forone hundred dollies{Sip))
,it less.
1 certify Out in the performance of the wo for which This Permit is nem d.I shall nrn
employ any person' anym azo c.me3ubjcctle the Workcri Compcnsatinn
LTw"D Califern'
Applicant ( 5
N ICE TOA LIC :IC iter making this Certificate of Exemption,you should
me subject to the Worker's Compensation provisions of the labor Con.you must
.,O nhwith comply with such provisions or this perm it shall be deemed revoked.
Z'`r CONSTRUCTION LENDING AGENCY
F l herebywhich
Nat there itsconstruction lending agency lnr the perfmmancc of
Bre work for which This peroral is issue!(Sec.3097.Civ.C.)
1 Q Lender's Name
=Z Lender'sAddress
V p I certify tion w at I have read this application and slim Nat the above information is
U F tomato.1 agree to comply with all city and county dNinamae and shot laws relating I.
O L) building Communion,and hereby authofim representatives of this city to enter uponthe
} 4 abo.cme judge caropeny Tari exenses purposes.
(We)agree In save,indemnify and keep harmless the City of Capetian.against
UFIn inconsequnce of the grandrs.costs atl of this expenses which may in any way acerae against said City
Z inconsequenceNDERSSTANDf this Pc WI
APPLICANT UNDER TANDS AND WILL COMPLY WITH ALL N NPO NT Issued by: Date
SOURCE RE ATI N .
Re-roofs
Signature SIT opricisho/Corranuar— Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of future building neeupaIL store or handle havardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Cndc,Section 25532(x)?
C]Ye3 g-,f, All roofs shall be inspected prior to any roofing material being installed.
nr 17 g occupant Liu equipment or Jcvica which If a roof is installed without first obtainingan inspection,I agree to remove
Will thea lican or fuwrc buil p g
.it hammnos air consaminan¢a recd by the Bay Arca Air Quality Management all new materials for inspection.
Ui it no
0Ycs No
I have mad the handmas materials requiremants under Chapter 6.95 Cf the CalifaP
nice licalm K SafetyCric,Seconds 25505.25533 and 25534,1 rad cr3h01hiclebuildingdIC3 nUl CYrtenly IIavC a ICntlnl,ma11113 my lCtpl1n31hllly m n.11lare of the �rcquircmc h hmustMmclpriortoba'a.cfaCcmphofy -Signature Applicant e
All roof coverings to be Clas r etter
,CsvMcr authmiucd agent Ic g
Community Development
10300 Torre Avenue
1 4 ✓° Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS:
Got L� PEI
OWNER'S NAME: 1' OJ-)"c.K 13A ,Q T PHONE #
GENERAL CONTRACTOR: mNgoZA FAX# (�Q —/
I am not using any subcontractors: Aa4te igna
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
1
C retractor Signature D to
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
SUPEkTINO
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 Name:
Job Site Address:
Roofing Company Name:
A plicant's Signature: Date:
Greg C44eel
Building Official
Revised 1/30/03 .
Printed on Recycled Paper ,
CITY OF CUPERTINO o
RE ROO F b "
'CUPEr�-nNO PERMIT APPLICATION FORM.
APN # 3 l 6 U Z Date: O
Building Address:
/02X3 RoNOY ZAYC
Owner's Name: _ Phone#:
Contractors Phone M �b License#:��a J
/� i
Contact: Phone#: Cupertino Business License#:
SAO
Type of Roof Covering:
Existing: Proposed:
— .❑ _Built-Up Roof__ _- _ ❑ Built-Up roof
❑ Asphalt Shingles ®Asphalt Shingles
Gr Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings S.Jp/,;= ❑ Provide I.C.B.O. Report#
IYTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential [vr _ Commercial .❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
�. there are es •coons;, IJ
Cost of P Sj'ect& Type of Construction: Occup c group:
Ia boa wtx�
QtY• . -
A 1'ca 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
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