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CITY OF CUPERTINO -
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BUILDING DIVISION PERMIT
COb�1TRAC'�TUI2 I FORMA'
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BUILDING ADDRESS:
GUAARANTEED ROOFING CO.
PERMIT NO. -
04110078
RICHWcob
OWNER'S NAME:
_
PERMITL'SUEDATE ' .... _.-
ONE:
(4171A) 4A9-41 a3
SANRARY OL NO.
ARCHITECIVEHGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB" MECH
LICENSED CONTRACTOR'S DECLARATION
'Job Description ..
1 Mreby tlRms that 1 .m licensed under provisions of Clupter 9 (mmmcndng
with ] Iof Division Jaf BC Busine,*1mfculum Code.andmyliccmcia
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REROOF W/ COMP. '
Dau G�c vacmr=
ARCHTrECrS DECDA Tod
I ondlWany p1.A.11 he used as qui) ords
Licensed Professional
OWNER-BUILDERDECLARATION
I hereby of rom that 1 sea exempt from the Contractor's License Law for the
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following reason. (Section 70715, Beano, and Profosviou Cade: My city or ceunty-
which requires a Permit to towner. ales[ narrow. demolish, he repair any Yrucum
prim to its issuance..lsurequire, the applicant forsuch permit refile angoed wham nt
Concmr; License law(Cloprou9
_
Sq. Ft. Floor Area
- Val a Ion
of the
heislicensedpuranttothepmvislmu ua
that an
(commencing with Section 7") of Division 3 of the Businessland Profusions Code) or
that he is exempt therefrom and the basis for the alleged coemption. Any violation of
3 7AMfN q.i.eo O
Occupancy Tpe - -
Section 7031.5 by any applicant fee a permit subjects the applicant m a civil penalty of
OutmomthanRwhundreddollalaf0B.
_
I, u owner of the pmperlY• ormy employees wIN wage u Uelr ask cempansstlon,
Required Inspections
willdo the work. and deauucture is notuundedarortersd forule(See 70th. Business
and Prefedons Code: The ommossmes Uanse law does cars apply to an MM of
q_.
property who bulldsarimpmw+uereon,andwho dauauch work Mmselfmduaugh his
- -_„- �. ,, „„ �._ . ;�-' �,, .-, _•p:;;: -•I i'�, - ,,, - .+_.t -
owncmplayrs;pm`iO that such improvements.rtnot Intended oeoRered for de If.
however, the building ar tmpmwment Is sold within ane year of completion, Ne owner -
w10 haw the burden of proving Nat he did not build or improve for purpose of
sale.).
sale I.
❑ I, as owner of the properly am exclusively contracting with licensed contractors in
construct the project (Sec. 70th. Business and Professions Cade:) Ile Conhacur'tU-
-
cc= Law does not apply to an owner of properly who Wilds or improws thereon. and.
...--..• - - _.. - - -
whocansumsforsullprojCNwithacontracur(s) licensed pmsu.nl roue Conmmor'a
nse law.
amcsemptunder See ,B&PCforthu.on
I n
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury osis of the following declanuons:
..
Ihow and will maintain. CeruOule of Consent to self-baum fm Worker's Comport-
..
sstion, u provided for by Section 37M of the Labor Code. for the perfmmaxe of the
woes for which this permit is issued
❑ I haw and will maintain Worker's Compansauon Insurance. u required by Section
3700af the labor Code. for tha perfarmana of the were, fm which this permit Is issued
My Worker's Compansadon Insurance carrier and Policy number am:
Cs era Polley Na.' -
CERTIFICATE OFEXEMPTION FROM WORKERS'
.,
COMPENSATION INSURANCE
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(ThswdmnacdnmWcompleunliftiem mitafor°xhundmddnll.ts(5100)
or leu)
I certify thv in the pmfermance of the work for which this Permit u Would, I shall not
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empl�ryany pc�' ry manncrpSasu kis^Imtt7o,tM�warkcrs'Compen+adon
Law of Cali a. Da M ^ y -Y•
-
t r n
_
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NOT APPLICANT: If. after making Nis Ccnincotc of EamPuon, you should
b co subject u the Worker's Compensation provisions of Ne lahm Cod°. You moat
' fo with comply with rotes provisions m thi+parmit+htll be famed rooked.
ON LENDING AGENCY
CONSTRUCTION
c°wuc. sending agency for see pMumums of
is a c
I herby alllthi thel there u
s 30
' the woes for which this permit u issued (Sec. 7097, Civ. CJ
endch Name
lender's Add.
l
I certify that I have mad this application and rote that the show information Is
' correct. I agree to comply with all city and county tom unces and some Iowa totaling to
Wilding construction, and bereby amhosive mpresenutives of this city to enter upon the
Move for inspection
-mentioned property purposes
(We) .gree to sew, indemnify and kap harmless the City of CupeNw against
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j liabilities. judgments, ewes and expenses which may In my my aces against dd City
in consequence of the granting of this penult.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
_ _ _
Issued by: Date `�— l q-'
SOUR E REGULATIO],;f _ � - � - �.�
f'y1%
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Re -roofs
-1y� Of Roof
Type
.ture of AppOunuconeacmr Dole
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant at futum building occupant aero orhandlc huardou+ material
u dented by the Cupertino Municipal Cock. Chapter 9.13, and the Health and Safety
Codc. Section 235324)?
All roofs shall be inspected prior to any roofing materia being installed.
❑Yu°
If a roof is installed without first obtaining an inspecti(i , I agree to remove
WIII the applicant or future building occupant use equipment or devices which
cmlt havardous air contaminants as dcfrncd by the Bay Arca Air Quality Management
all new materials for inspection.
District? \
❑Yu Nu
I how mad the buaNeusmaterahotmommoso.tdc,Chapter G95 hills: Califon.
,.is Health& Safety Cade. Sold. 255(15.25533 and23534. 1undemvN dwifNe Wilding
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does Out currently have o tenans that it u my responsibility to newsy the occupant of the,
requirements which mum be met prior to issuance of a Certificate of Oce`upancy.
Signature of Ap t - Date -
�I+
All roof coverings to be Class "B" or better
Own rauNorizcd epc� D
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I
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
I am not using any subcontractdr/s�/ moi V- / — o 4Signature Date
Please check annlicable subcontractors and comvlete the following information
60
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
— W-Cle t ..! l ^ 16--W4
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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.
51 G:If plywood is installed, a plywood,nail;inspection is required„
Any roofing which is. applied wittout first obtaining an;inspection,
will require,the removal of.alI new material down to the sheathing,
t' so a proper City inspection can be'performed.
7: NOTE: If you califor a plywood nail inspection and the joli'is not ready,
-you will be charged a re -inspection -fee of, $17638. -,There -inspection fee must
be paid before another insRection can be scheduled.
' IMPORTANT:
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: U, � c- rp V-
--Roofing Company Name: �/�y� 0
Applicant's Signature:G�-!" Date:
V
Greg Casteel
Building Official
Revised 11/2/04
Printwd nn Pacvcled PaPPr - "
1
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
0
APN #
37_ .- o l 12- Date: / /^• ` d
Building Address:
/ 94 Fp —o
Owner's Name: Phone #:
Mq4 65/l.e""-� / s-6
Coactor: 0 Phone #: License #:
`�0 Ad ff 21 -2� � 7i
Contact' Phone #: Cupertino Business License #:
MJLA
Moll_ / hal 3
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles >r Asphalt Shingles
YO Wood Shakes El Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
- Number of existing coverings p Yl -Q ❑ Provide I.C.B.O. Report #
XTo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
r� .
- 4. K 19 ne .w1
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Typeo Construction:.��ccupancy group:
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An icabIt Fee ID Fee Descrintion Fee Groun
BPERMFEE
Bldg Permit Fees
BUILDING
\ NERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
An icabIt Fee ID Fee Descrintion Fee Groun
BPERMFEE
Bldg Permit Fees
BUILDING
\ NERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
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