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CITY OF CUPERTINO
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1 BUILDING DIVISION PERMIT
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CON¢¢TRACTaR�IN'UMA+CTU1�t:" s
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BUILDING ADDRESS:
CAL—PRO ROOFING
PERMITNO04050044
OWNER'S NAME:
PERMIT ISSUE DATE
14AZFT.T. TAYT.ng
2115 PRICE WAY
4
NE:
SANITARY NO. CONTROL NO.
(408)377-0241
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under of Chapter v (rommcndng
Job Description
provisions
widbScction 7") (Division 3 of the Businm dProfcytiuna Cade, andmyliccnse is
nmllI.L It R i (_% �}S 6
License Clu L
REROOF
Pdte eaCH fOSDa,e
I undo my plana aJ,all he m ^I,M1II, recn�a�
j
;tl
'=PD
Lmensed�mfcsarnnel
- OWNER -BUILDER DECLARATION
j�
1 hereby ¢lave that 1 A.1. nxempl from Ne Gammeroo License Law the
follwhich re mudn. (Salton 7031.5. B, aincss end em
au Code: Any tiny dr cdumy
ver de
which requires a pewit In construct, altar, improve, demolish, orfie pair eny awcmm
87000
than he islicensedwit pursuant Nc provisions of the
Chit he its issuance, alwn to therus nhovisiosOfthe Contruwilloicense Law
uazmr'and (Chapters
(Chapter
Sq. Ft. Floor Area Valuation
(commencing with Steuart 7000) of Division 3 no
7 eBusiness
exor
tham a I.
that u exempt therefrom and the buns for the alleged exemption.
al eged An
AnylProtests=maty of
io
Senior by t
3r j}I13er00OccupancyTrp
than veenyapplicantforapewitmbJecuNeapPlicanlmacivilpenallyof
not mom Nen ave hundred dalton ($500).
0 1. u owner of the property, or my employees with wages u their sole compensation,
will do the work and Ihm awclum is out Intended or offend for sale (See. 7044, Business
and Profession, Code: The Canuacthes License Law does not apply to an owner of
Required Inspections
property, who builds or improves thereon, and who does such work himsel f or through his
own employees, provided thatauch improvements am not intended drained forule.If,
however, Ne building m improvement is mid within one year of completion. dm owner
Wilder will have the burden of proving that he did not build or improve for purpose of
,akJ.
❑ 1. as Owner of the properly, am exclusively connecting with licensed conwnon to
convect the prejecl (See. 7W. Business and Professions Code:) The Conlrmlors Li.
cause law docs not apply to an owner of property who Wilda or improves themon, and
WW contracts for such projects with a commnor(s) licensed pumuanuo the Contractors
ae Law.
esempl under Sec. ,B&PC fm this moon
P
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby aBiw under penally of perjury, one ofthe following declarations:
I haveend will muista n aCmu ficam of Consent to self -insure far WorkeraCompen-
mdon, u provided for by Section 3700 of the LaWr 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 the labor Code, (or the performance of the work for which this permit is issued
. .
My'Wdrkers Compmaation Insurance carrier and Policy number am:
Came Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INS
1 is section need not W completed lithe permit is for one buntlred dollan(f IM)
or less.)
1 certify that in the performance of the work for which this Permit is issued, 1 shell not
em ployanyperson��n manners azmb me au b' act to the Worker!Compensadon
Laws o(Califdmia.
I
NOTI
NOTI 0 APP NT: f, alter raking thts Cenificale of Exemption. you should
berom object no Workeh Compensation provisions or Ne lahor Code, you must
fon M comply with such provision. or %is .it hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby alarm that Nem is a convection lending agency for the performance of
the work for which this pewit is issued (Sec. 3097, Civ. C.)
Under'. Name
Lender's Address
1 renify that 1 have read this application and auto Nm the salve infowadun is
towel. I agree to comply with all city and county ordinances and state laws relating to
building convection, and hereby aulhodm mpmacmadvca of this city in enter upon the
Purposes.
ahuvcmmrudned property for inspectionexpenses
(We) agree N save, indemnify and keep hewless the City of Cuperune, against
may
liabilities Judgments, costs and expenses which may In any way accrue against send City
in consequence of the granting of this
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOji-POINT
D WILL
Issued by: Date
SOUEGULATIONS.
RC
Re -roofs
2°+
s'_( I/
Srgnu o phanUCanwcmr m
HAZARDOUS MATERIALS DISCLOSIIRE
Type of Roof
Will pCupertor uture or handle rdandhous al
u dented no Municipalng Code,
the Cupertino Municipal Cddc. Chapter 9.12, end the HcaIN and Seely
Chapter 9.12, HealthSafety
io
ode, sotien zss3z(a)7 4'
Yes No
All roofs shall he inspected prior to any roofing material being installed.
Will the applicant or future building occupam um equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
It hazardous air contaminants as &rjncd by the Ray Area Air Quality Management
all new materials for inspection.
Distrinr
P
❑Yes JCI No
'
I have mad Ne hvardouss materials requirements under Chapter 6.95 of the Califor-
nia Health &SafnyCode,Sm,ions 25505,25533 and 25534. I understand Not if IW Wilding
�'41 19
dues crim Iy It a mem, a,1is wponsi1,01ty m nnd'y the occuPan, of du
Y
I
myuim tswhich moan W mel n9 to issue cadre Certificated capancy.
/
ignores of Applicant Dale
owner ser au prized seen, D,te
All roof coverings to be Class " or better
CITY OF
,UPERTINO
JOB ADDRESS:
OWNERS NA
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Buildin De artment
' PERMIT #
PHONE #
FAX #
I am not using any subcontractors:
Signature
n, ,.r.,,,,t, C„ hrnn+rarinra and complete the following information:
►�
Date
. , % 7-0U 7
er/C�o^nnttractor Signa a ate
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
C —Q o El
Septic Tank
Sheet Metal
Sheet Rock
Tile
. , % 7-0U 7
er/C�o^nnttractor Signa a ate
1 al
�CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408)777-3228
Fax: (408) 777-3333
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 with the above stated policy on re -roofing.
Homeowner's Name: 4' A U/ o K-
-7
C
Job Site Address: / a %^ � C C—T A 1 tp� IJ I �/ -
Roofing Company Name: G n — J- F- 0 1� � � � 1 Iy 2y
A plicant's Signature:
• Greg Jleel
Building Official
Revised 1/30/03
Printed on Recycled Paper
V/
Date: Y
•
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CU,PERTINO
CITY OF CUPERTINO
REROOF o y ,_r 6 o C` y
PERMIT APPLICATION FORM
APN #
391 OD, Q63
BPERMFEE
Date
Building Address:
)";l,9
�V
Phone
Owner's ame'7*
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CoCntr�ac or:�
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Phone #: 7 7da�i
Lic7se �
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BUILDING
7 Q
Conrt� e S
till
Phone #:
G 71— L% 6 a I q % f„
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
13 Asphalt Shingles
¢k 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: ❑
Jb Description:
T'Qft
Residential 93 . Comme cial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: T e of Construction: Occupancy group:
71300,9 c,
V, _R31z
Qty. if
AnnlicAs�ble I Fer m
Foo tlo ..t:..
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BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Ener
BUILDING
BSEISMICRE
R/JBPLANCHK
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
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