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CITY OF CUPERTINO
BUILDING DIVISION PERMITt
CONTRACTOR INFORMATION'.
BILDINGADDRESS:
44; RTANPORT)'PT,
PETERSEN-DEAN INC
PERMITN004060102
OWNER'S NAME: _
-
PERMIT ISSUE DATE
PATRICK LAW
7980 FNTF.RPPTITP DR
ONE:
SANITARY N0. CONTROL NO,
(510)494-9982
10 494-
ARCHITECT/ENGINEER:
ARCHITECT/ENGINBER
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� = t�
LICENSED CONTRACTOR'S DECLARATION
I hemby affirm that I me limned under provisions of Chapter 9 (commencing
Job Description ®k
wide Section 70(X0 of Divixime 3 of th, B.d.c.sand Professions Code, and my license is
full now and erre Ung tt 8I
L
REROOF
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'2,i
Dale • C.mrtcmr
ARCHITECTS DECL1 ION
I undnsund my plans shall be used u puhlic .10!
® ZOO4
Licensed Professional
OWNER -BUILDER DECLARATION
1 herchy affirm that I am exempt from the Cmmr9clora Lima. Law for the
!ds�
following mama. (Smtion 7031.5, Business and Professions Cade: Any city or county
R`4_•
which "does a Permit to Consumer, alter, improve. demolish. or repair any mucro¢
$51 A4
prior to its issuance, alio mquires the applicant for such permit to file asigned aumencm
Sq. FL Floor Area
Valuation
that he u licensed pursuant to the provisions of the conmcmrs Umnse Law (CTepc,9
-
(commencing with Section 7000) of Division 3 of the Business and Promasions Code) or
put he Is exempt therefrom and the basis For the alleged exemption. Any vuladon of
3 5'k9yB2`G iWer0 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
rot mom than five hundred dollars15300).
Q I, as owner.(the property, or my employes with, wages as their Ole compensation,
Required Inspections
will do the work. and the suunum is not immmdcd or offered formal. (Sec. 7044, business
and Professions Code: The Conusst.rs License Law does not apply man owner of
propenywho bulldaor improwsth neon, and whod.essmh wad himself or through his
own employees, provided that such Improvements ere not intended oroffered for side. If,
_
however, the building or improvement Is mid within one yeti of completion, the owner
builder will have the burden of proving mat he did not build or Improve for purpose of
selc.).
❑ 1. as owns r of sun property, am exclusively contracting with licensed mnuacmn in
construct the project (Sec. 7064, Business and Professions Code:) The Contractors Li.
cense law does not apply to an owner of property who builds or improves thereon, rod.
who confined; for such projects with a conuactor(U licensed pursuant to the Commences
License Law.
0 l am exempt under Sec .B&PC for this moon
Owner Date
WORKER'S COMPENSATION DEC1 RATION
I hereby affirm under perully of perjury one of the following decummoos:
1 haw and will maintain aCeulficateof Consent to self -insure for W.rkcrs Compere
scion, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
I haw and will enthrone Workers Compensation Insurm e, ss required by Section
700 of the 1 -mm Code, for the performance of the work for which this permit is wound.
My Worke�r/s Compensation lnsunrtm nrtk`ermd Policy numbenm:
Cartier. L �^ �Hga /T.Hey No.: 0 3 99 _I 3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Ihlsse lion need not he completed If [be Permit is!ozone hundred dollen Iglfg))
or mss)
I modify that in me perrmmanee or the work for which this permit is issued. I shall not
employ my permn many manner O as to becmne subject a the Workmi Compensated
Laws of California. Dna
Applicant
NOTICE TO APPLICANT: IL after making this CeniOcam of Exemption. you should
become subject to the Wm erl C.mpensali.n provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall M doomed rooked.
CONSTRUCTION LENDING AGENCY
1 hereby &M m mal there is a conssmcuon lending agency for the Performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
undies Name
Lender's Address
I certify that I have mad this application and sum mat the allow inrmmadun is
correct I agree to Comply with all city and county committees and sum hes relating to
building construction. and hereby aumoriae mpresenutives of this city to enter upon the
ahow-mendoned pmperty for inspection purposes
(We) agree to sew, indemnify and keep harmless the City of Cupertino against
liabilities, Judgments. costs and expenses which may in any way accme against said City
9
in consequence of the gronfing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
/
Issued by: Dat
SOUR ATIONS.
G /a
/1 N
Re -roofs
Roof
Signature o(A ueant/Cnn.aemr D; ,
HAZARDOUS MATERIALS DISCLOSURE
Type of
Will the applicant or furore building occupant atom or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu CrK.--
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future buiming.mupant unt equipment or devices which
mit hazallous air Onuminanu u defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑YC9
1 have mail the huvdems materialshequimmem under Chapmr&95of the Celiror-�`
25, 25573 and 25534.l undcrsmN
nuulN alc nd isi!the Willing
H&SsyCoM,Sections550
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does trot cummly have a rents, mat it is my responsibility se entry do occupant of the
mquim whos cmerprior 'aumm.f.Certificateof�
Signature ofAppli nt Date
//�oy
All roof coverings to be Class "B" or better
Ownn,mmuodved rot Dam
+ 06/10/2004 23:19 5105363282
CUPEkTINO --
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LEGALITIES INK p4GE of
)"AX Sid 37$-32$�O� IItty Ucvu�mmt
10300 Twm Ave°no
Cupertino CA 95014
Telepbono(408) 777-3126
Pax (409) 777-3333
Building D
PERMIT #
PHONE#
ontra s:
.-mss
Signature Date
t : . ...A &m n]Mp rlka fnllnwinp information:
Z"d LL06-106t, OIs
IW29103
x I.
Date
1d3G 300213N Bb2:60 b0 11 unr
SUB ONTRACTOR
i3USINESS NAME
BUSINESS LICENSE #
Ca & Millwork
Ceine t Finishing
_
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l7ec
Excav 'don
I
Pie g
PIob : Carpetir.
Liw / Wood
_ _
azing
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Landsdapin9
—
La
Ori talSheethfetal
—__
P g/wall per
Pavin
I'lastetU19
PI
Roo
Se Tank
—
Sheet, Vietal
_
_
Sheet Rock
Z"d LL06-106t, OIs
IW29103
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Date
1d3G 300213N Bb2:60 b0 11 unr
CITY of
UPEI�TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 Name: i� L�-r tr
Job Site Address: -3 �. /—
Roofing Company Name: �-�T ^' - De- "-- 4-n�
A plicant'
s Signature: Date: 61'.,10
5%
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
cin or
CUPEkTINO
CITY OF CUPERTINO `o
REROOF °
PERMIT APPLICATION FORM
APN # 3 1�1I
J G
Date:
G � 1/0 t.P
BENERGY
Ener
BUILDING
Building Address: 7 y
Seismic Fee Res
Owner's Name:
Ota �l
Phone #:
Contractors —
2 .,,,,
P one #:
5/0 45�-99SrZ
License #:
YG 81��
Contact:
Phone #:
Cupertino Business License #:
Alvt�
cSv—y.--"--.
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
Asphalt Shingles
❑ Built -Up roof
Asphalt Shingles
❑ Wood Shakes
t] 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:
Job Description:y,�v
Residential
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Plan g Dept. i
there are any res 'tions: LJ
Cost of Project:
Type of Consttu t' Occupancy gro p:
S! 8•�{ • rs:s
Qty. if
ADnlicable
Fee M
PPP t1PCPATt;,
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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ill 7, 6°