04040074 CITY OF CUPERTINO �a a.>� n n7�k,P '* 7 7'y
BUILDING DIVISION PERMIT �A+� 7RA OR INF' 4`tMATIONI
BUILDING ADDRESS: PETERSEN-DEAN INC IERMITN004 04 0 0 74
1134 SCQTT�AND DR
OWNER'S NAME: PERMIT ISSUE DATE
BERNARDO DEL MUNDO 7980 ENTERPRISE4
ONE:
SANITARY NO. CONTROL N0.
(510) 494-9982
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CI 0 0
u o o LICENSED CONTRACTOR'S DECLARATION '- SCT) IIOn
C I hereby arum that I am livansrd under provisions of chapter 9(commencing p
G with Section]IXNgnf Divi' Sof dee Businasa an PJufaminna ci a,andmylicenaeis
NNALLU
in fall I.=And diel 3 w b��y REROOF
n Liccnsc C Dins fa�'V NOV t' - 2004
Date EIO S l�rraet�v
3 qFq� ARa l0
d a 1 und.easeJ my plans hall he used as public record.
BUILDING
iiG l- Licensed Professional
i OWNER-BUILDER DECLARATION
Z20 I masa affirm that 11. exempt from me Contractors o License Law for the my
Z20 O which fahiwing reason remit
91131.5,Business and improve,
demons Coda:Any city or county
K m as which it,iscs a pmmit re construct.the
h alms improve,Jcermitt ore a sir anygned structure
°acy panic slicenedpurssant it)rhe provision (ifnt
such Cormanrmitaoicer. ow(Chatham
£ a (comma cing ithSecusmmthepmnsision3 of
onsaanirenofessi (Chapter Sq. Ft. Floor Area Valuation
yip (cit he is
(commencing Section 7000)and
of basis
rsh ehc alleged
exempt on.A aians Crnlc)or
y�� mal he is exempt therefrom antl dm basis for me alleged exemption.Any violation of
Section]031,5 by any applicant for a permit subject the applicant o a civil penalty of 3GXTNa Llb6er00 Occupancy Type
not more than fin hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and me structure is not intended or offered for sale(Sec.]014,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves mercon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving mal he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively Contracting with licensed convectors Io
construct the project(Sec.704,Business and Professions Code:)The Contractor's Li.
cense law dues not apply to an owner of property who builds or improves mercon,and
who contracts for such projects with a comractor(s)licensed pursuant 1.the Corimeana
License Law.
❑I am exempt under Sec. B a P C for this mason
-Loure, Data
WORKER'S COMPENSATION DECLARATION
1 hereby off.under penally of perjury one of the following duclarmions:
I have and will maintain a Cenlficale,Of Consent to self-insum for Worker Compen-
sation,ax provided for by Section 3700 of the labor Code,far the performance of[be
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,ns required by Section
]IXl of the labor Code,for Be pcdurmance of the work for which this permit is faster.
My Worker's Compensation Insurance confer and Policy number art:
^ � 0399P le,0J
Cartier.Z CRT)CERTIFICATE OF
Policy FROM
CERTIFICATEOF COMPENSATION
FROM WORKERS'
COMPENSATION INSURANCE
(Thus section need not hocamplcmJ if the permit is for one hundred dollars($100)
to law.)
1 codify)hat in the performance of the work(or which this permit is issued.l shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Data _
Applicant
NOTICE TO APPLICANT:if,after making this Cari fiewe of Exemption,you should
become Subject to the Worker's Compensation provisions of the Labor Calc,you must
Q O forthwith comply with such provisions or this Permit shall be deemed invoked.
„zt� - CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a conservation lending agency fin the performance of
!Yi> the work fur which this permit is issued(Sec.3097,Civ.C.)
W�Q Lender's Namc
D
z
Laurie'A Address
V Q 1 certify that I have read this application and sate that the above information is
Iy H coned,l agree to comply with all city and county ordinances and state laws relating It '
Q V building construction,and hereby autharin representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
gys (We)agree to save,indemnify and keep harmless the City of Cupertino against
pF'y 16 liabilities,judgments,costs and expenses which may in any way accrue against said City
U^t on ca if the m
APPLICANDERSTDgflh oWILL MPLYFWITHALL NON-POINT Issued by: Date
SOURCE A C q/131
Re-roofs
Signature of ApplicaHAZARDO Dea
HAZARDOUS MATERIALSDISCLOSUREsSCLOSURE Type of Roof
Will the e C applicant or future building occupant store or handle Has
material
As ticEnod by the Cupeninn Municipal Code.Chapter 9.1 i,and the Health and Safety
nnikodc,Section]5532(-)? Col All roofs shall be inspected prior to any roofing material being installed.
Ycs
Will the applicant or future building doctrinal no equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
of hazardous air contaminants as refined by the Bay Area Air Quality Management all new materials for inspection.
indicts
❑Yes
I have read Be handaus materialsrcquiremems under Chafer 6.95 order Califor-
niaHealth Si SAIy COM,Sectors 255(15,25533 and 25534.1 undersand mal if the building
does not cunamty a anan4 Nal it is y rasgmsihility o nouly the eacupam of thc
mquimmenaw mtalbcm anranr ertlficaaorae a - Signature of Applicant? - Date
owneroraumofizedopent a Date All roof coverings to be Class "B" or better
B4/08/29BA 13:53 5186383252 LEGALITIES INK PAGE 02
Community Developmaat
10380 Torre Avenue
Cipestinc CA 95014
Te e_phonc(408)'7?'-322#
Fax(406)977-3333
CUPEkTINO _ - -_ z j 2--
Building
Building Department
JOB AA RE PERMIT*
O'WNER'S NAME: ,' , -/!- PHONF.# .t5P' /L_... �.
X . GENERAL CONTRACTOR:
)t 1 am not using any subcontractors:
yi ignature Date
Please checkapco
applicable subcontractors and mplete the folio information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork _ —
Cement Finishing --__-- ------__--
Electrical
Excavation
Fencing -- —�.— --
looeCarpeting —
Linolleuu m! Wood
• Glass/ Glazing — ---- ---
1
Heating f
Insulation
Landscaping —
Lathing --.
Masonry
Ornamental Sheet Metal ^- ----
Painting/ Wallpaper _
Paving — — —
Plastering --
Plumbing _—_-- —
Roofin —
Septic Tank —_
Sheet Metal _
Sheet Rock—
Tile
Ow -/Contractor Signature Date
IOl28ro3
Z '�. LL06=464 019 1d30 3008321 e90 :00 b0 60 adb
Community Development Department
Building Division
�N Ci of Cupertino
4 % h' P
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO 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.
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. p 7 /
CD
)
I understand and will comply with the above stated policy on re-roofing. /
Homeowner's Name: ( �J 2
q �C
Job Site Address:
Roofing Company Name: A.ogfeAy,A,t Lo.", loitiC�
4'icanYs Signature: Date: 0 y
\�ll�+l�uXX1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
• CITY OF CUPERTINO06 ��
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# .p. �� � • Date:
Building Address:
Owner's Name:, � Phone#t
Contractor: hone#: License
G #:
S/o /9V-99SZ- ' 68// 7
Contact: Phone#:� Cupertino Business License#:
Z/D 3 b
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
X Asphalt Shingles )Hr Asphalt Shingles
,C2 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job scrint;on- p /�D-alGY s0
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: Ll
Cost of Project: Type of Construction: Occupancy group:
7 096• E-D
Qty. if
A licable 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
X1137. 8°