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CITY OF CUPERTINO*-*.���
BUILDING DIVISION PERMIT
CONTRA.CTOR`INFORMATIO
BUILDING ADDRESS:
WOODS ROOFING
PERMITNO. O 6020108
10679 SANTA LUCIA RD
W NER'S NAME:
FERMff ISSUE DATE
BOB HILL
2179 STONE AVENUE STE 22
02/17/2006
NE:
SANITARY NO. CONTROL NO.
(831)637-5576
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Ib Description
1 hereby affirm Out I am liceread under provisions of Chapter 9 (commencing
OOSCTIp
with Section 1of Divinun 3 of IW and Business Prolossima Codm. and my lice.. u
n 0(10) full force an defy Z �3 1
Damn. Cl Lica
REROOF--T/O SHAKES, . ADD S EL TILE
"A"
Dam Co.'—FIN
CLASS
ARCHMIC" DECLAR ON
I uermand my plans shall W Dun d public ecnrds
M
Lumbacd Professional
OatNEm DECLARATION
exempt
1 botchy aRrm that 11. exempt from Nr Cortins License Law for the
following mason. 7W 1.5, Business and Calc: Any city
Maso Cod county
ys
?806
which improve. to structure
requires a permit to ennsuucl, alar, improve,
Permit t demolish.
Ana
its
prior m its issuance, also mquirs IW applicant for such permit to Glc License signed staemcm
h Permit t e a sianygned tme
that pursuant LNe de Comrutur'snroflaons
.
Sq. Ft. Floor Area Valu
Mornmecingwit
ofpmvisions sionf
Codrer9
exewit Screfro90W).f Division) of Business and Professions Calc) or
Om he al
li and de burs for the alleged exempn t Any violation of
Natio u exempt tang
Sermon to
by airy applicant for a permit subjects to applicant m a civil penalty of
applicant
pppN }Nsi r CCU cyafype
then
not more Nan fire hundred dollars (5500).
,.
'1 LL /U
3 4 217 �� 9 0 0
El 1, m owner of the property, a my employees with wages a their sole compenution,
will do Ne work, and the structure is not intended or offered for fele (Sec. 7W, Business
and Professions Code: The Conuactori License Law does not apply in an owner of
Required Inspections
property who builds or improves Lemon, and who does such work himalf or through his
own employees, provided Nm such improvements are nos intended oroRerad for sale. If,
however, the building or improvement is sold within one year of completion, the owner.
builder will have the, burden of proving Net he did our Wild or improve for purpo. of
sale.).
❑ 1, as owner of Nc properly, am exclusively convecting with licensed contractors to
conila..l the pmject (Sec. 7164. Business and Professions Cade:) The Con racmr's U.
come law docs not apply to an owner of property who Wilds or impmvu thereon, and.
who contracts for such projects with a eontr.mKs) licensed pursuant to the Contractor's
License law.
❑ 1 am exempt under Sec. , B & P C for this rtuon
Owner Dme
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
1 hs.a and will maintain a Cerdfiate of Conant to self -insure for Workers Compen.
adan. so provided for by Section 37W of de labor Code. for the performance of the
work for which this pernit is issued.
nave and will maintain Workees Compensation Insurance, as required by Section
3100 of Ne Libor Cade, for the per its m um, of Use work for which this permit is issued.
My Work!e Co�mpyswtion lny5unmc aria and Policy n�uma nCcr are:
Cartier. �' fI V""I\ Policy No.:_295-C5')'ff7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisaction aced mol W carpleed i(Ihe perm, is i.e. hundred dollars (5100)
or less.)
1 comfy Nat in to perf.rmanm of to work for which this permit is issued. I dell .at
employ any Noun in any manner. as in become abject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you si oold
become subject to the Worker's Cam Knsntion provisions of the Labor Code, you mum
forthwith comply with such pmvisinm or Nis Permit It he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat tee is a construction lending agency for On Performance of
the work fur which this permit is issued (Sec. 3091, Ci, C.)
Lender's Name
'
Under' Address
I certify Nat 1 have read this application and sate that the slow information is
correct. 1 agree to comply with all city and county ordinances and stale laws miming to
building convection, and hemby amhorim mpmumoivu or this city to enter upon the
shove -mentioned property for inspection purposes
(We) agoee to indemnify
ave, and keep harmless the City o(Cupertino against
expcnuswhich may in any way accrue against said City
incoitncluen uof thecostsand
granting of this permit.
ntconuyuNT of UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 7 ��
BOURCF gE(iSICAi'IOr1S, is
'��_-�•C--�l/</--- �7�d
Re -roofs
StgnMUM ofApplicanV om rano( tee
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant store or W rill, hvardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and Nc Health and Safety
we. Section 25532(.)7
❑Yes �_
All roofs shall be inspected prior to any roofing material being installed.
Will Nm applicant or future building =upon, use equipment or devices which
If a roof is installed without first obtainin g an inspection, I agree to remove
hazardous air contaminants as dermad by the Bay Area Air Quality Management
all new materials for inspection.
Dimrict9
❑ you, uv_u
T have nail the hvardous materials requirements under Chapter &95 of the Califor-
niaRulN&Safety Co .S =25505.25533ud25536.1uMcr ftir Nc Wilding
Z
Joe nos currently ham that it u my ra"nalility m roily the p nr IW
71-06
re
mqi rut[ mien mWm pri.rw menr.CcMifmma.r a ey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or ablihosized agpd, --hmc
} h'
CITY OF
�UPEkTINO
r
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS -.,"0677 u �d
PERMIT #0
(�0Zr7/U�
OWNER'S NAME:
PHONE # -73-7-2-309
GENERAL CONTRACTOR:
FAX #
V I
I am not using any subcontractors: "Dz& 62 ' $�„--t f --,x !1 06
Signa a Date
Please check applicable subcontractors and complete 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
Owner/ ontractor Signature
2/(7/196
Date
A .1 i al�
06
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
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:�0
Job Site Address: ��G %' . /c �cT /C-U�wi2la�%
Roofing Company Name, IAV �d-7 s
Applicant's Signature:] •=, Date: � 6
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
• ��71' OF
CUPERTINO
r
APN #
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CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
Z
° 1/Ds
17
Bldg Permit Fees
l� Date: /1 0
Oo
Energy
BUILDING
Building Address: /� /
I
BUILDING
BSEISMICOM
Owner's Name:
BUILDING
Phone #:
J'
n
?37-2--30
Contractor:
Phone!#: q -0803
�1 �(J L6L_ j �i'�
License #:
Contact:
Phone #:
Cupertino Business License #:
47W ZoS-s//s
-20c5/a
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
D Asphalt Shingles
D Asphalt Shingles
Wood Shakes
D Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
El Other (Specify)
.I.-
X- Other (Specify) �[� , O
Number of existing coverings /
❑ Provide I.C.B.O. Report # E�T/Z I SJ 7
�L To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Policy:
ob Description:
Tia ��PcP ��ta / S 5 ,
�c2��
Residential ,, Commercial
Fire Zone: Yes ❑ No 0—
Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project- 0-,1 Type
of Construction: Occupancy group:
000
Qty. if
Aunlicable
FPP IT)
FPP TiPC/�t`1.1+•/fit•
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'