05060008 CITY OF CUPERTINO ,a x T**�»,.xxjat -ate+' `�-,r•r
BUILDING DIVISION PERMIT CONTRA.CTORINFORMATION 5
BUILDING ADDRESS: """05060008
ERMIT N00 5 0 6 0 0 0 8
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO,
ARC HITECf7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lo� LICENSED CONTRACTOR'S DECLARATION Job Description
5 1 hereby affirm Net I am lim eed under provisions of Chapter 9(commencing
IN Section 7000)of D,icon 3 of the Business and Professions Code.and my license is
In full force enQfff
S�z Lkensu Class Lk-
I REROOF W/COMP. SHINGLES
p Dam - Conu,mr CONTRACTOR: EXECUTIVE ROOFING
ARCHITECPS DEC ATON
1 understand my plans shall W used as public records
IsC Licensed Professional
OWNER-BUILDER DECLARATION
S 1 bemby AM.than I am exempt from that Cortrac ads License Law for the
i O 0 following mason.(Section 7101.5.Buincas and Professium Code:Any city or county
$ which requires a permit m construct,alms improve.demolish,or repair any structure
F- i^ prior to its issuance,
also requires the applicant for such permit to file asigned summem -
�y that he is licensed pursuant m Ne provisions of the Canuecter'sUensc Law(Chapter 9 SCI. Ft. Floor Area ValuaLlOs1636
$ (commencing with Sectim,70DO)of Division 3 of the Businessand Profm]Dn,Code)or 4'x
that heIs exempt Uterefrom and the buis fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects Ne applicant An a civil Penalty of APN Number Occupancy Type
not mom NN Rve hundred dolhars(5500),
❑1,As owner of Ne propmy,or my cmployeez with wins As timh sole compensetian. 36908032 . 00
will do the work and the auumure Is Out intended or offered for sale(See.7044,Business Required Inspections
and Profession,Code:The Convmtor'a License Law dace not apply m e an owner of q P
property who builds or improve,thereon,and who does s uch work himYl f or though his
own employees.provided that such improvements are not Intended croffenE for ends.if,
lwaac c,lie building or improvement is sold within am your ofcompletion.the owner. FAN/Wild.wiE have the boMcn of proving that W did not build m Improve far purpose of (I\`(1
tate.). III/// ��
❑1,As owner of project
See.property..Business siandely cofessi ns witCoe )The
contractors t.
constructLad es not (Sec.o an owner
ofand property
who but Code)lire Contractor's red /
ecus law dans rsuchp rr m ts owner of propmy who builds m improve Centra,and +(
whocontractsLaw or each pmjeN with aeonutemr(,)Ilmnxd pummnlm the Conueclor'e v �OQC
0
License acr law, J
❑lam uemPt undo Sce .B@PC fm Nb ream D
r(f�ff
Date-
Owner I hereby ALm under penalty of perjury ore of the ff 0.n0WORKERS COPENSTTION {dmlamions: O ��D� \�nf
1 haw and will maintain a Cenificam of Consent in self-iuum fm Wodtel,Compcn.
7037.01[)
on,Y provided for by Section 3700 of the labor Code,for One performance of the
rk for which Nis permit is tested.
1 have and will maintain Workers Compeuadon Insunnce,Y required by Section of the Labor Code.fm Ne Performance of Ne work fm which thin permit h iumd.
Worimes ComFemadon Insunnee eerier end Policy nmber am:
rico Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This seetian need not mcampkmd Iran,purml,is forme hundred dollen(SIM)
ksm)
1 certify Out In Ne performance of the work for which this permit n issued,1001 am
employ any person nay mannersaumhecame subject m the Worked Compematim
Law of CA ifaroia�Date SID' oc'
App'
NOTICEaTTOO APP he Work If,ager making NU Gislono or of Exemption,you,house
become subject y the Worker's Coons or
is provisions of the labor Chan you meet
.J O forthwith comply with such provisions m Nis Permit hell bo deemed ranked.
?"' CONSTRUCTION LENDING AGENCY
I hereby affirm that then B a coruuucdnn lending agency for the performance of
FL
the wok for which this permit ts iumd(see 3097,Civ.C.)
aQ Lender's Name
]z Leader's Addrum
U Q I certify Nu 1 have read this applicvion and tum that the above Information is
{i.U context 1 agree m comply with all city and county hollowness and me,haws relating to
Q building construction,and hereby Authorize:npreantstiwa of Nu city m enter upon the
w above-mentioned pmpeny for inspection louposes.
S (We)agree to saw,indemnify m0 keep hamtku Ne City of Cupertino against
•r h Iiabilides,Judgments coats and expenses which may In any soy accrue Against aid City
V In consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOU�RCE�R,cULATIONS. _
—�I/T/ &-at-B C Re-roofs
Signature of ApplicaUCcoun cmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future building occupant none or handle hammou material
As defined by the Cupertino Municipal Cade,Chaser 9.12.and the Health and Safety
W
e. Dyer r353g(e)T All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It 1147AMohe air cooWnimnu u dermad by the Bay Area Air Quality Management all new m erials for inspection.
suictT
❑Yes ON.
I have read the heYMnts materials requirements under Chapmr6.95 of the Califm- NN
Health@ Safety Cade,Sections 25505.25533 w125534.1 understand that ifthe building
haw•Ima4 that it k mss re,pomihility m notify the occupant of Ne
uiremen whit mum kMel priormissuance afaccriRcateo!Occupancy Sig re of Applicant Date
Dia-a- All roof coverings to be Class"B"or better
nc unwhoriacd agate Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
coo Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: n PERMIT#
/015-9 kedwzoO 0S6 EOeo f--
OWNER'S NAME: f5p t4wi oA A-j PHONE # 0- 1-4 .3
GENERAL CONTRACTOR; FAX #
I am not using any subcontractors: $-
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
7 Linoleum/ Wood
�\ Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing tic Ecu f JL Acro FV
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-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: ��rlbtallA,�
Job Site Address 10158 Fic1�u�0 pXl�
Roofing Company Name: -Cu IJP I��^
Applicant's Signature: Date: os-
Greg
5Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
Seo
aclor
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 (5(/ S o f o3
-2—� Date:
C6-01-
Building Address: pp
X0158 FtCr}Wvo4 Df1-
Owner's Name: I 0�-
Phone#: �s7 g29�
66 16AM 1kr�
Contractor: Phone#: License#:
5�ecufljc RmF1A6 qx-kisv- wo 5Sq ao I
Contact: Phone#: Cupertino Business License#:
�JAVI A PjERK� L X151( (SOH,
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 01 Asphalt Shingles
11 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings t ❑ Provide I.C.B.O. Report#
A To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Je WW 54k5. J j5j-A ( 1 t, DS6 , .,J51-mL� -&> p— wt 0S1-r1D j
Residential M - - Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: I
Type of Construction: Occupancy group:
Qty. if
Applicable 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