05040065 CITY OFCUPERTINO °° .'sem '.k s�rr� �' �'��"`""
BUILDING DIVISION
PERMIT
BUILDING
BUILDING ADDRESS: WOODS ROOFING phlit"'90 5 04 0 0 6 5
4/12 1200S
tARMITE�IENGINEER:
NEWS NAME: PERMIT ISSM DATE
NE: SANITARY 0. CONTROL NO.
BUILDING PERMIT INFO
BOLICENSED CONTRACTOR'S DECLARATION �rpI rrrsTTTT�����1 Immby )of Wt 1 am Ikeued under provtsioG of CMpmc 9(mmmencln{ �'■ d�� pSation]g10)a(Dividon3of the Buinwantl Profeulnm Com.aM mylketrse4 AllfomeandortnseC "�= 9 Ix.g Z -3REROOF W/COMP.
Cmtrc
ARCHITECTS DECLARA ION T wi aToo[
i undersand my plans Dull K use0 as public tanr& L J
3 gy.
, cad] Licensed hereby affirm
a•Ll I rs ®'
OWNER-BUILDER DECLARATION L®J L G
I I hereby,(firm that 11. exempt the ConionsCo License Law for the
followa0 which
ga Permit
7Business and improve,
demolish,
Code:Any oily orCounty
$ whichitsIsrequires a Permit re uiresOconstruct,alms ntProve,demtnti o nr repair any atmaute
t• i~^ that In its mnecd p elm requires the applicant(Much retention fileLaw
(mmmem
(ame ilimnsed pursuant mdse of Divisio of theeBusbb/enLicense l4w(ChapterCods)
Sq.Ft.Floor Area Valuation
$ (cot he is en{with green.tion and of beads
r the
the BGinev and Proon.My
Cade)of
But he ts exempt them(rom antl the bub for de Jlo{W esemp0on.My violation of
Secdon 7831,3 by acry applicant for a permit subjeeu the applicant the a awl penalty of 3 jta N'4r0 0 Occupancy Type
not mom than five hundred dollars(f588).
❑I,as owner of tit properly.or my employees with wages as Onto anle compeuWon,
.111 do the work and ibemomm.is.1 imcnded or offered for sale(Sec.7044.Butiucss Required Inspections
and Profc sdom Code:The ConuactoYa Limue law does ret apply m er e an ownof q P
property who bait&or im proves thereon.and who doe such work himself or Nmugh his
own employcea,provided Nat such improvements am ant intended oroRered forale.If.
however.the building or Improvement is cold within an you of completion.the owner.
builder will Mve the burden of proving that he did not Wild or improve for purpose of
able.).
❑I.u owner of the property am exclusively contracting with licensed mnuscton be
construct the pmkct(Sec.7014.Bmlata and Professions Cade:)The Contractor's U.
mean Law does net apply to an owns of property who WII&at improves thereon,and,
who commacts for such p.jeeu with aeonusebs(U licensed partum to the Commutes
Lkev4 law.
❑l ace exempt under Sec .B g•.P C fm this mason
Owner Data
WORKERS COMPENSATION DECL RATION
1 hereby a@rtn under pentlry of perjury one of On following declarations
I Mn and will maintain aCWBcate of Co...,to self•insum for WmkeYaCompms-
137",00
0on,u provided for by Section 3700 of the Labor Code,for the peefmmanm of the
rk for which this permit is Issued.
I have and will maintain Workers Compensation Wuranm,a required by Settlor,
of the L4WrCade,fur the performance of the work for which this permit is issuctl.
Workernmggnu 18ymenmGrti andPoli�num rare
Polty �'cder. �� JL' _
CERTIFICATE OF EiIEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(17&ucGorl coed but becompkm(If the permit Is f Baro handed cultures(SIM)
M leu) •
1 certify that in the performance of the work for which this Permit is Issued,I¢hall not
employ any Person in any manner an as be become subject to the Workers Compevadon
Laws of California,Dow
Applicant
NOTICE TO APPLICANT:If,after making this Certlncam of Exemption.you should
become subject to the Worker Compensation provisions of On labor Cade.you must
3 O forthwith comply with such provisions at this Permit shall M deemrevoke
ed d.
z� CONSTRUCTION LENDING AGENCY
[-r (hereby.flim Wl Nen is a cmutmclinn lending agency for the Perfurmanm of
Cri D the work for which this permit Is issued(SM.3097.Civ,C.)
QLeucfs Name
.7 Z LmOms Addma
U O I ccnlfy that I ban read this application aW won Ihu the above Information k
V, comet,1agree to comply with til city and cowry ordinances,and slam Laws mWn{b
0 Wilding combustion,and hereby authorin representatives of ibis city to now upon the
IT7 shove-mentioned property for inspection purposes
(We)agree to save,indemnify and lump,harmless the City of Cupertino against
na f/i liabilities,judgments.costs and expenses which may In anyway acme against aid City
U F7r In consequence of the gambling of this Permit.
APPLICANT UNDER NDS AND WILL COMPLY WITH ANON INT Issued by: Date
SOURCE GUL N .
" j -0 1 o S Re-roofs
Signature Of Appll VCanuactor DM
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future Wilding mcupanlstore rehandle haallou mmonal
as dented by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
IDiwict?
m.Suction 25532(4)7 [4NO� All roofs shall be inspected prior to any roofing material being installed.
Y.
Will the applicant or future Wilding amupril use equipment or mvicas which If a roof is installed without first obtaining an inspection,I agree to remove
It harudnus air contaminants u defend by the Bay Area Air Quality Management all new materials for inspection.
❑YesIhacmW the huardausm 5505, tcyuimmcnuunmrChapmr6.95 hat ifthe Calling He Ihav Safetyhe do Salons undal23533 andquirem nts 4,1and rChapt r .95or tc Cilifn.es not currently hon a meant,lost It Is my roapaulbility b notify IW nempant oeul be met prio issumccofa CenlOcam ofOcc Signature of Applin t Date
Ow at a a> Dam�J All roof coverings to be Class"B"or better
04/31/2000 21:63 9106303202 LEGAL71IES IW PA06 01
COMMMO ry DrokVilo l
10700 Son Av=w
CupaMev CA 93_014,
Tsl (40 )m.) r
Fu(408)M-331)
CUPS INO
Building Department
JOB ADDRESS: R S 8 8 �0.«.�.r �• Q,w� PBRMIT Y o fti y
OWNER'S NAME: raddsa 5PU IPHONB# ;- 53 -0304
GENERAL qqNT CTOR: ,v(#
I Ain not using:any sµbcontraetor:
Signahlre Date
ease k applicable and corn late the followin inforaution:
SUBCONTRACTOR BUSINESS.NAME BUSINESS LICENSE N
Cabdatets&lwwork
Cement Finishing
l;xcaVatioll'
P
Linotem/ wood
Class Ghudn
• Iiea
leuulatiorl
La Am '
ornamtental Sheet M"
P. / Wall
paving
""
1�1
90040
Ro
Ta*.
ShaecMeW
6heatitodt ;
Tile
OwnerlCm%ftw- or gMtun Data
i
Community Development Department
Building Division
t � l' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U rn E kT I N O 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
i, 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
r Homeowner's Name:
Job Site Address: :12-3 8'ff - -
Roofing Company Name: �V'�1 _r /r uV Ste'
Applicant's Signature: Date: 2 kS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
1�'' RE ROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 53— z 05, a� Date: q11 Z/ S
0
Building Address2 2 3 8 ' 67 „•Cer pn�o
Owner's Name: • 1� Phone#:
cl" ?'Vu �4 5 3 —0 30
Contractor: O Phone #:G &(oLicense #:32-5131 S 3
1,10IT7, s 2
Contact: L Phone#: G 40 o$p Cupertino Business License#:
Z0 8-/U
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ). Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ 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 Description:—,/ Agj,4wy0L Y"C&:t - mc0d SO�n ( ov p- n
Residential jg Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project: Type of Construction: Occupancy group:
//, 493 • n
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
9