04080241 ;OWNER'S
ITY OF CUPERTINO 1-71771777777777-777771rz fgra41
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BUILDING DIVISION PERMITsdd '' s
ILDING ADDRESS: CUPERTINO PLUMBING PERMIT NO04 0 8 024 1
105 SCOTLAND D
NAME: PERMIT ISSUE DATE
JOE MONTANEZ 10297 S DE AN
ONE: SANITARY NO. CONTROL NO.
(408) 253-0618
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm thus 1 am limed u r provisions of Chapter 9(commencingsis Job DESC
with Section 7IX111)of Division Sof thcBsand recisions Code.and my license is 14
in m0 force and effect �[ �p REPIPE/WATER HEATER/WAT
S Z License Cl s n�.3 Lm.X
n U O Da¢ - C SIDE r 52-. ®
AR 1I II°S asC B TION" (1
c� Iundeman ,yP ItQai dsspuhli Ns V�p
d
3 a Licensed Profmas... '10
3 � O ER- ICOER DECLAR N / C O,
i I mhy afFIF Del 1 am exempt from the Co h License Law for the
ED O following reason.(Section 7031.5,Business and Prof aians Cndm Any city or county 1A $SOOO
$ which mctimo a renis to,nnsWCl,alms improve,dcmoli h.nr mPar any swcmm
r '�+ priormilsomm c,also mquiros the applicant for such forest to file a signed statement
Nmhcislice dpursuammthcpmvisimuofthe Conlrusori Liccnts Law(Chaplor9 Sq.Ft.Floor Area juation
y i-S (commencing with Section 71)(0)of Division 3 of the Rusiness and Professions Cads)or WV
that he is exempt themform and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects dm applicant to a civil penalty of
mat more Nan five hundred dollars(5500).: of �C WpanCy Type
❑I,as owner cribs property,or my employees with wages as their sole compensation,
will do the work,and Be structure is notimended oraRered forsam(Sm.7044,Business
and Profusions Code:The Contractor's License Law does act apply in an owner of Required Inspections
Property who buildsorimp uvns Neuron,and who doessmh work himself orthrough his
..employ=,provided that such improvements art not lot."moRemd Result.If,
however.the building or improvement la sold within one year of compledan,Ne owner-
builder will have de burden of proving Nu he did not build or improve for purpose of
sele.)
❑I.as owner of the properly.am"elusively contracting with licensed commemra to
construct Ne pmject(Sec.7W,Business and Professions Code:)The Contractor's 6i.
cents Law dam not apply to an owner of properly who builds or improvns Nem.n,and
who contracts for such pri eels with a contmemr(s)limed pursuant to the Contractors
License Law.
❑ I am exempt under See .B A P C for this mason
Owner Due
WORKER'S COMPENSATION DECLARATION
I hereby affluent under penalty of perjury one of the following declarations:
I have and will maintain a Ccnifimteof Consent to self-insum for Worker's Compeer.
sation,
o peen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of thc
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
7 of Ne Labor Cade.for Nnec
e perfarmaor the work forwhich this permit is mound.
My Wmke�Z,n tion Ins race courser end Poliry numbc
Currier. /✓Il Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nothecompleted if the Permit is faros,hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any Person in any mannerso as to become subject to Be WorkersCompensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcam of Exemption,you should
become subject m the Worker's Compensation provisions of the Labor Cede,you most
.`O forthwith comply with such provisions or this permit shall be deemed revoked.'�y CONSTRUCTION LENDING AGENCY
F+ I hereby aRrm that these is&conswction bndingagcney for Ne Performance of
tri Be work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
z Lender.Address
U 0 I wooly Nat 1 haw mad Nis application and sum that Be shove information is
U, Fcorrect.I agree to comply with all city and county ordinances and suits laws misting to
building convection,and hereby aushorim representatives of this city to color upon the
Uabove-mentioned property for inspection Purp.tsa •'�
I (W.)agree to save,indemnify and keep harmless the City of Cupertino against
ar y Iiabili0,s,jud menu,coau.md carm ans wh' may in anyway accts,againsl.mid City
V Z mconsequ coft ag tmg.fthi cr I.
" APPLIC UNDE TANDS D ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR A S.
q"770 L/ Re-roofs
7sat of pplic HAZARD ar TERIALS DISCLOSURE Date Type of Roof
will the applicant or future building occupant store or handle hatowdous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
w,,odes 2ss3x(.)7 `— All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yu No
I havemad the vNousmWoolensaire net under Chapter 6.95ofthe Califor-
.t.HcalN&Safety c.Smuon�25X15,2553 25534.1undemomdtharif Om building
dam nos en fly raw alonolar' . , my, ihility m notify the occupant of the
requimm c be cpoo- -im a c am of Occupancy. Signature of Applicant Date
claimer.r, honxcdagenl Dao` I All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
` . Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
�
SUPEkTINO
Building Department
JOB ADDRESS: PER
//OS � �/��� �Y PERMIT f6,2-1/
OWNER'S NAME: OrMa4e,Z PHONE #T#, Q q
GENERAL CONTRACTOR: FAX #N7,45S (973
I am not using any subcontractors: 8,21�- en
tgnat Date
Please check applicable subcontractors an6 complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
c Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Shee Rock
Til ;
ILYG�
er/C gnature Date
no
cit-.; or C 10300 Torre Avenue
Telephone (408) rr;,,-379
CITY OF Fax: (408) , ,-3333
SUPEkT]NO
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 CiL 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 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.
Homeow'ner's Name: :'TC5 y a— SC4115y'J<
Job Site Address: 103_-I
Roofing Company Name: QL-Dx C OW!� ��/44 /Z.DO f--) A)
G
A plicant'sSignatur� / Date: _CS
• Greg C eel
Building Official
Revised 1/30/03
Premed cn Recycled Pete,
CITY OF CUPERTINO ` s� ° Z
- ' REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN #
2Co
Building Address: ' J��
c�nc( Tr.
Owner's Name: Ph ne #:
Jb6 M,0n+-a ne,Z v Zs2��yz
Contractor: Phone: License #:
:�' nc��l l�rn��r� � 2S3•bbl� 2��toS
Contacts / one: CupertinC siness License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial. ❑
Cost of Project: �VU
•
Qty. .
A e Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING j
BPFIXTURE PblI. Fixture PLUMBING -
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSI
sLIC Business License BUILDING