05080114 CITY OF CUPERTINO ✓*» �^+ " sus"^"� `'�' r '%
BUILDING DIVISION PERMIT �CONTRACTQR'INFORMATION _
BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PTfWO-05080114
r10412
OWNER'S NAME: PERMIT ISSUEDATE
DAN & KAREN NITTA 15230 CLYDEL 05
ONE: SANITARY NO. CONTROL NO.
(408) 626-9320
7i— L
CHITECNENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 O 0 O
trLICENSEDCONTRACIDR'SDECLARATiON Job Description
td t1 wrobY affirm that 1 am licensed under provision of Chapter 9(Commencing
Scctian70u)of BusinwuMPmfcssm. a my licenxu
REROOF-REMODE 1 LAYER OF FIRE FREE,
' Data conmxwr INSTALL 1/2" CDX, 30 #ASTM FELT & ASPHALT COMP.
JJARC TECTSDECLA /
.mnandmy plensaha mad. u Curds �J
e Licensed Professional
OWNER-BUILDER DECLARATION
I 1 hereby affirm Nat I am exmpt from the Comaaaot's License Law for the
OO following measure.(Section 7031.5,Business and Profession Cade:Any city or county
5$ which requires a permit to comvuca,alter,improve,demolish.of repair any stmium
prior to its issuance.also mqums the applicant for such permit to file a signed statement -
G that he is licensed pursuant to the provision of the Contractor's License Law(Ch,Pta9 Sq.Ft. Floor Area Valu,*M000
(commencing with Section 7000)of Division 3 of the Business and Prefusiona Code)or
$
that he is eConcept therefrom and the basis for the alleged exemption.My violation of
Secdon 7031.3 by my applicant for a permitcubjecu the applicant in a civil penslty of APN Number Occupancy Type
not mora dun five hundred dal Wa($500). 35707021 . 00
0 I'm awns Orton,property,"my employes wide wages as Neirmle compensstian.
will do dee work,and Ne stroaure Is notintended ora((end fora4(Sec.7044.Business Required Inspections
and Profession,Cade:The Common's Liana e Law does not apply w an owner of q P
property w ha builds or impraxa thereon,and who does suc h work himsel f or through his
own employees,provided that such Improvements us not Intended oroRered forme.If.
however,the building or Improvement Is sold within one yea,of completion.the Owner.
builder will have she burden of proving Na he did not build or improve for purpose of
co su
4.owner a(the property ec.704,m exclusively contracting with:)lbeed contraction;t. p�
contra da es n a(Sea.7044,Business and property
who n Code:)Tie Cantnewn.Lid [(jyrySp�
sox law does not apply e ts owner of propery who builds or improm centro.and, �lf��
who cmtncu for such projects with a conwcmKs)licensed pursuant to des contractor's �fi-��
L enx Law. I4ryf-q`(' ._.
. Ham exempt under Sce. � ,BkPC(ar Nla reason. ,_�.. �. _ r.
. . . Owner onto
WORKER'S COMPENSATION DECLARATION'
f
I thereby affirm underpemty,(perjury arc of the following dalantiort,: -
Ilos.mdwill m,inuinaCCNfiaw of Conxnua xlNinsum for Worker's Campcm 3' Y 1 fJ
cation,an provided for by Section 3700 of the labor Code,for Ne performance of the,
,.Wy for which this Permit is iaued. ----- - na
@tllf.'
I have and will maintain Workers Compensation Insurance,u required by Section
J of Ne labor Code.for the per(mmaxcofdeework(orwhich this FormulaI
My orkefs can enation In Unna atria and Policy number art:
Grier. Policy
� own 6
C^ /^ICA ^ PnN FROM WORKERS'
COMPENSATION INSURANCE CE
(Tbb section wed not uncompleted if the permit is furore hundred dollars(SIM)
sir ICSQ
1 certify that in the performance of the work for which this permit is intend,l Nell net
employ any peaOn In my romnr W as w become subjuct to the WorkeW Cammendsomn
laws of Califomla.Data
Applicant
NOTICE TO APPLICANT:IL after making this CertlEau of Exemption,you should
become subjem w dee Worker's Compensation provisions of the labor Code,you most
.J O rrrhwith comply with such provision or this Permit shall W deemed evoked.
z ti CONSTRUCTION LENDING AGENCY
EIhereby&Mom that than h a eonwctim lending agency for Ne perfurmance of
ej the work fm which Nu permit ls issued(Sec.3097.Civ.C.)
6iO Landces Name
a z Lendeia Address
V Q I certify Na I have mad this application and sues that the,hove Information is
Correa.I agora to Comply with all city and county ordinances and some laws muting to
Q SV: building construction,and hereby mcnrim representatives of this ity to Cour uPnn the
W above-mentioned property for Inspection purposes.
G (We)agree he save,wdonedly and kap humleas the City of Coniston against
mares Ilabllitia.Jedgmenu.can and expenses which may In my icy xcrue against said City
Ct.),z we of the gaming of N a permit.
APPLIC AND WILL PLY WITH A ONPoINi Issued by: Date
SOU ERE I�
7 U Re-roofs J �
sign of Ii HAZAtrxwr / Data
�NAZARDOUSMding oc IS DISCLOSURE Type of Roof
WIII dee applicant or(count building occupant atom or handle h afdaes materiil
as dcBwd by canCupertino Municipal Cade.Chapter 9.12.and time Health and Silery \
oda.pvG zss3zuj7 �N All roofs shall be inspected prior to any roofing material being installed.
Will dee applicant ar don ovilding occupant tau equipment or JCYitts'ViMa If a roof is installed without first obtaining an inspection,I agree to remove
In h iarhazardous air contaminants w wOned by the Bay Area Air Quuhl Mmagement a w in erials for inspection.
ict7 1___
❑Yrs ❑Nu q
lheve ted ceuvaNnus materials requirements under ter6.95 of Lk Calif..
n Sar ,Section las05.1ss33and
pmobila.l un me Ih=now,ordoon
rias not cu rel he nan6 u iyy spanihilitY w esti de oceupant of Ne
require. hic m t t'fWi um Ccrtih cy< SignatumcifAp giant-' Date
Oww erau(ho'xdkgenl Dou
All roof coverings to be Class"B"or better
Community Development
10300 Tota Avenue
G Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: I /�Cwt PERMIT #US
OWNER'S NAME: <A PHONE # — 2 - 7 U
GENERAL CONTRACTOR oUl=1 fv FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
S get Rock
f Tile
-----0wrer/Con mr-Stgnature Date
Community Development Department
Building Division
Z'!1TY0'F
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CUPE��'N0 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-rooting
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: aJ n N 1 `� 1 1 l A
Job Site Address: ` 12l
Roofing Company j (�(/
A licanYs Sign tures / _ —Date:CK
Greg Casteel
Building Official
Revised 11/2/04
D.inlnd nn Ourvrled Oaner
CITY OF CUPERTINO 0���,�1�
S1 REROOF
CUPERTINO PERMIT APPLICATION FORM
Date:
APN# � / o � .Z U
Building Address:
i
Owner's Name: S f i1 /A Phone#:4U
Contractor — - Phone#: �\v License#:
Phone#: E13 2,) Cupertino Business/tcense#:
Contact: vF�L Iwl�� � 2U6 (7
v J/ Iw l Type of
of Covering:
Fcj
sting: Proposed:
❑ Built-Up Roof Built-Up roof
❑ Asphalt Shingles , Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles r Li
Shingles
Ql Other(Specify) ❑ Other(Specify)
ber of existing coverings I ❑ Provide I.C.B.O.Report#
To be Removed O Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Com 1 With Cuper T---Off Polic fJ5 A1-
X55
Job Description: Mi l7l�IN tt' L�C`1�� �t itst 1 T C t`
Residential Commercial ❑
Fire Zone: Yes E] No Confirmed with Planning Dept. if
there are an restrictions: lJ
Cost of Project:
UUv,) Type of Construction: Occupancy group:
Qty. if Fee Grou
A licable Fee ID Fee Description
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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