04090097 it CITY OF CUPERTINO ate fez 's"� `
BUILDING DIVISION PERMIT WN'�RAC
BUILDING ADDRESS: PERMIT NO.
R.J. PEREZ CONST INC 04090097
' OWNER'S NAME:c; qAbITA TliciA pp PERMIT ESUEDATB
ONE:. SANITARY OL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o l�
:00 LICENSED CONTRACTOR'S DECLARATION Job Des 1
yd 1 hereby affirm Nat 1 am licensed under previsions of Clnpter 9(commencing
witaSpud 701gBef Di umut3of NCBusinman rolessiuru Codc,andmylverox is
^�R• NALED
infull yy�andeffWb C_ �
Lta� Dcen Caste con Macer � 4'U6 REROOF W/COMP. -��y-ra
1q- �te\� ARCHITECTS bBehaRA'jIION SEP^f 2004
$ `—rundc.I.W my plena shall W use.as pts ON
;0°� BUILDING
Licensed Four
OWNER-BUILDER DECLARATION
S I hereby.(See the 1 1. exempt from the Conimmoh License Law for the
i p o following reason. anent t 703 onstr,Businessand ver. funs demolish.or:Any city nr county
$ which requires a permit rc construct,pabler,plic imprve,h permittfi repair try awmun
Oat
itscensed puruarequires the applicant for Contrarmiuofilc.icense ave statement
Nomm is licensed pursuant to Ne pre visions of the the Business
License Law(chapter 9 Sq.Ft.Floor Area Valuat on
zZF$ Oat
et(commencingwithStenon)7")of busedson3o,NCBusinexempton.Ayvi Cede)or
Net W u eumpl0mnfrOm and do hues for dm alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3 4p�T11-M"gr0 0 Occupancy Type
not mom Nan five hundred d.lb rn($500).
❑I.as owner ofthe prepeny,or my employees with wages as their sole compensation,
will On LW work and theavuclum is notlntendedoraRered foraale(See.7004,Business
and Professions Code:The ComncLOrs License Law doer not apply to an owner of Required Inspections
propeny who bullets or im proven thereon,and who dos such wars himself or Nmugh his
own employees,provided No such improvecommau notintendN ora@red forswe.If,
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving Nat W did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed comments O
conswct the pmjm(Sec.7044,Business and Professions Code:)The Coombsi U.
creme Law does not apply on an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conuacter(s)licensed pursuant to On Convectors
Liccnu Law.
❑I are exempt under Sec. ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
t41 I hereby affirm under penally of perjury one of the following declarations:
I have and will maintain a Cenifiace of Consent to self-insues for WorkersCompcn-
nation,as 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,as required by Section
3700 of Ne Labor Code,for the performance of the work for which this permit is issued.
My Wekeri Compense0on Immrancc carrier and Poi' ue"r am:
Polity N —
CERTIFICATE OF EXEMP ION FROM WORKERS'
-� COMPENSATION INSURANCE
f russection need not becompleted if tW permitis forom hundreddollars($101)
less.
I certify,that in the perfermance of Ne work for which this permit is issued,I shall nut
employ any person in any mammru as in Wmare subject to the Workers'Compensation
Laws of California.D.
Applicant
NOTICE TO APPLICANT:If.after making this Cer ifa:ate of Exemption,you should
become subject to the Worker's Compenution provisions of the Labor Codc,you must
O forthwith comply with such provisions or Nie permit shall be deed re
mevoked.
„zm tZ) CONSTRUC'DON LENDING AGENCY
(ti Ihereby affirm Nat them is a construction lending agency for due performance of
6i > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
Z Lenders Address
U Q 1 ceNfy Net I have read this application and gutta Net the shout information is -
W H COMM I agree to comply with all city and county ordinances and SOLO laws Misting to
0U building censwenol,and hereby Unhorlu mprcammlives of Nis city meow upon be
r a shove-mentioned property for inspection keep ha
(We)agree m save,indemnity and keep hay in m dte City of Cupcnst against
nF"y rq Ilabilitiea.Jud'men ssendex nes whichmtyln any wayattruc against mid City
fJ z in eon a thcgr (holm, i permit.
NT UND TANO�A WILL COMPLY WITH ALL NON-POINT Issued by: Date
CE RE U IONS.
Re-roofs
mgnoure ofAp11cant(Con r Data
HAZARD US MATERIALS DISCLj16ORE Type of Roof
Will the applicant or felon building Occupant st or handle hurardous material
as defined by the Cupertino Municipal C .Chapter 9.13.and the Health and Safety
ode,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑
Yes
I Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IDU havardnm air centamin ts o define.my Nc Bay Arca Air Quality Management n r els Mection.
`.Disuin7
❑Yes NN
Z hvw read thehazardous2M5.larequlmmon534.1rChepted6 aifthc Calding J�` / `• /
nice,O enrol, Nona 25505.35533 and 2553a.IuntlmaOnd thstiftW huiidins
dos n riawhhave nano Nal it is ttymnodl'S�3I pmupent of the
nyuircmcnaa which v W met poor iasuancc of aScrLLllU 0ccupucy. SI at re of Applicant Date
ndruraul rmvadagent Date All roof coverings to be Class "B"or better
Community Development
' < 10300 Torre Avenue
/' Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
UPEkTINO
Building Depqqtpent
JOB ADD SS: _ PE IT #
O(.! O OGI D
OWNER'S PHO
GENERAL CONTRACT E,', FAX # p,
I am not using any subcontractors:
ignature Date
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
04( T'
•/ ontract Signature Date-
Community Development Department
Building Division
r City of Cupertino
10300 Tone Avenue
1 Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
AUPEkTINO
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 wi`th/the above stated policy on re-roofing.
Homeowner's N..4:
Job SiteAdressl-' )061.�'
Roofing Company Name:, 2 rc C',
A plicanYs Signature:- / Date: J�/
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper -
i
CITY OF CUPERTINO
REROOF C)
S,n CUPEkTINO PERMIT APPLICATION FORM
NW' APN# J 2c�Z l 7 � / Date: ` J
l F� L
Building Address:
i dG IS S a �•u 0
Owner's Nam Phone#:
SCG evaA s cyq) 3lI — 02°10
Contractor: Pho e #: License#:
JZ . 4 ,pert (t 09) -� 13 -'t523 6SqoEQ
Contact: Phone#: Cupertino Business License#:
ZcA,_ �F✓Ar,& cqI — 02 Ci 0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Q�Asphalt Shingles Q; 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 With Cu ertino's Tear Off Policy:
Job Descripfivhl
T- �,&
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. i
there are any restri
Cost o Type c n: Occupancy
Qty. if
A ale 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
" � z7 ° � 7