04040140 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT CONTRACTQR INFORMATION:'
BUILDINGADDRESS: ADVANCED ROOFING\ TECHNIQUE ERMITNcC)4040140
1483 SHANNON CT
OWNER'S NAME: PERMITISSUEDATE
CHRIS LIANIDES 1179 MYRTLE DR Q4/21/2004
ONE: SANITARY NO. CONTROL NO.
(408) 249-4937
ARCH1=11NIGINEER: UI DI ERMITINFO
MME,MB MECH
BOO LICENSED CONTRACT'OR'S DECLARATIONastir
Rd fIOb DBSCTI hon O
ee p I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
ZR lin Scctim]0 ) fDivision3uf the Businea Pmfcssinns CoJc,andmyliccnscis
force 9, ue C6 ' REROOF NOV f:� 2004
3w camm=mr
.AR HITECTSDEC ON BUILDING
a 1 understand my plans shall Mused as able records
odu
;off Licensed Pnsfcssiunel
S OWNER-BUILDER DECLARATION
Qg< I hereby affirm that 1 am exempt from the Contractor's License Law for(he
❑O following reason.(Section 7131.5,Business and Pfnfeal.m Code:Any city Or county
which requires a permit it construct,alter,improve,demolish,ar repair any structure 87500
ptiorto its issuance,also requires the applicant for such permit to Pte a signed statement
pZ<
that he is licensed pursuant Rt the provisions of the C.nmeator's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
yt� hermmn¢ing with Section 701 of Division 3 Of the Business and Professions Cade)or
y 3 Nat he is exempt Ihemfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofBInn� - ccU OType
no,mom than five hundred dollars($500).
vOccupancy YP
❑I,a owner of the pmperty,or my employees with wages u their sole e.mpcnatlon,
will do Nc work,end Ne stmcture is not intended.,offered for sato(Sec.7044,Business
and Profcaions Cede:The Contactors Liana Law does not apply in an owner of Required Inspections
property who builds or improves Neuron,and who does such work himsclfor through his
own employees,provided that such improvements are not intended or offered for ata If,
however,the building or improvement is sold within one year of completion.the owner.
builder will have Ne burden of proving that he did no,build or improve for puryose of .
ale.).
❑1,as owner of the property,am exclusively contracting with licensed Convectors to
consumer he project(Sec.7044,Business and Professions Code:)The Contractor's Li-
ccnae Law does not apply to an owner of property who builds or improves them.n,end
who contracts for such projects with a contracmrls)licensed pursuant t.Ne Contractors
License Law.
E]1 am exempt under Sec. B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury one of the fallowing declarations:
I have and will mainmin a Certificate of Consent to self-homy for Workers Compete
73�71,00
ion,as provided far by Section 37W of the Labor Code,for the Mo ommor..f the
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for the performance of me work Or'-which
ythis permit is teemed.
Workers Compnatr�i�er aPNoy Io / a �II(/�. x CERTIFICATE OF EXEMPTION FROMWORKER '_ _
COMPENSATION INSURANCE g/55/oS
(This section need no,beCOMPlelcd If the Permit is for one hundred dollars($100)
Ices.)
I certify that in the parrotmancc of the work for which this permit is issued,1 shall not
employ any person in any manner s i as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccni fiesta of Exemption.you should
become subject to the Worker's Compensation previsions of the Labor Code,you mus,
.J. O forthwith comply with such provisions or this permit shall M deemed revoked.
z� CONSTRUCTION LENDING AGENCY
(r I hereby affirm that there is a continuation lentli ng agency for the performance of
Ri> Ne work for which this permit is issued(Sac.30!D,Civ,C.)
W Q Lender's Name
6, Lender's Address
�z
V Q I certify that 1 have mad this application and start that the above information is
ly correct.1 agree to comply with all city and county ordinances and stare laws relating to
�O building constriction.and hereby authmiae representatives of this city to enter upon the
�a ahave-mcati.ncd pmpcny for inspccfion purposes.
(We)agree to save,indemnify and keep harmless the City of Carenino against
tF.t h liabilities,judgmeme costs and expenses which may in any way accrue against said City
V 7 in consequence of the ganlingOf this permit.
r7 APP ANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RC REG ONS.
d Re-roofs
Sign m of App icanUC dor - Data
HAZARDOUS MATERIALS DISCLO RE Type of Roof
Will the applicant Or future building Occupant store or handle havardous material
a dchned by the Cupertino Mar,SjPN Cuda,Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? [�-Q'`N
❑YCs / All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building o=capam.a equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
ti,hazardous air contaminan road by the Day Arca Air Quality Managemen, all new materials for inspection.
uisuict] Yr(Cq/
❑Yes
I have read he honallous materials requirements under Chapter 6.95of the Califoo- ,
maHcatth&Safety Code.Sections 255,15,25533 and 25534.1 understand tha,ifthe Milding - Ii( 1 D f I
dues not eumcmly have a,���}}}]]]nt Nal i,is my responsibility to nomy the occupant of the -((recur L! hlCh m�I�dlnCl IIUr ItaM Id CCNhCd f DCCa C. _ 1
q 'u p f Sl oat eofApplicant Date
o hoavcdagem `' ,e All roof coverings to be Class"B" or better
Community Development.
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
�UPERTINO
Building Department
JOB A KESS: PERM' # OT d
OWNER'S L t A v PHO1aT$'#
GENERAL CONTRACTOR 1kk FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Sheet Rock
Tile
j —�
/C tract afore Date
Community Development Department
p Building Division
(j City of Cupertino
10300 Torre Avenue
I Telephone: (408)777-3228
CITY OF
UPEI�TINO 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.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Narn2 ( C f `2 1 1 A A2 l 6 if S
/
job Site Address:4y A I ygZ 07 t'1 h of( 0,4 C��\
Roofing Company Namy n G�Cd �I�—r t✓V Ci
A plicant's Signa Dt
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO �o
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 204, zi a 0 59
Date:` ,
Building Address:
s
Owner's Name: hone#:
C' i L. t� t�e S SIC
Contractor: Phone#: yprd icense#:
AeLy ,,cel t .ct„vt a`�`� y537 )S -
Co act: Phone#: Cupertino Business License#:
ol�
w00)- C?
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles K Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings AQ 6n ❑ 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: (2 ZOC4
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit n Dept. if
there are restrictions: LJ
Costo c . 1 Type of n: Occup cy up:
r-
. i
c le Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
ENERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING