04070129 CITY OF CUPERTINO &
BUILDING DIVISION PERMIT 'CONTRACTOR INI<'URMATION'
BUILDING ADDRESS: PERMIT NO.
KEVIN SULLIVAN ROOFING 04070129
OWNER'S NAME: PERMIT ISSUE DATE
NE:HENRY qrT40CK 1TALLRY 0A.149 DR SANITARY qRkOL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�pp LICENSED CONTRACTOR'S DECLARATION �I_ T., m,,,..,v;�
a 1 Wmby 0).f that I am licensed under provisions of CWpter 9(romm.ring Iw`'Y■p' `�L�•rpt"
a<
with ScctlOn]0110)af Division 3of the Buainesand Pr caalens Codc.and mylicens la
imm�m .naercea / EROOF
D0? Licen¢CI Lk.g
Ell Date ConumtOr r AUGplans shall W used as pub 's
Isend est a records G _ 2004
3 G Licensed Professional
OWNER BUILD A
OWNER-BUILDER DECLARATION BUILDING
+� 1 Wrthy am.dust I em.scurpfrom dm RATIO a/a License law for to
C.0 o following moon.(Section 7031.5,Business and precarious Code:Any city or county
n a which requires a permit m construct.altar,improve,demolish,or repair any structure
Fly prior m is,isotone,also rectums the applicant for such permit Ale a signed statement Valu
FFss< thanhe is licensed pursuanto the provisions of the ConnecConnector'sLicens,Law(Chapter 9 Sq. Ft.Floor Area ator
Cs'm mommncingwiNSecuon]B00)o(Division3ofdte Bunnessand Prafesians Coda)or
$
that me u exempt therefrom and the basis for On alleged exemption.My violation of
Section]031.5 by airy applicant for a permit subjects the applicant 10 a civil purely Of 3 6TF20VAI 0 0 Occupancy Type
not more Nn Eve hundred duties(S30D).
❑1,u owoer of the property,or my employces with wain an their sok compensation,
will do the work end Ne eruc um u not intended m.ffcmd fo...is(Sec.7041,Bounce
.it Professm.Code:The Canbacmfs License law does rt apply to an owner of _Required Inspections
property who builds or improves thereon,and who does such wark himself or through his
own employer,provided Nu such Improvements arc not Intended or offered for ale.IL
however.the building or improvement is wed within one year Of nmpletion,Ne owner'
builder will have On burden of praying that he did not Wild or Improve for purpose of
❑L as Owner of the property,am exclusively contracting with licensed conmdon to
consumer the project(Sec.7W,Business and Professions Code:)The Contractor's Li.
cons,law docs not apply to an owner Of property who Wilde or improv daemon,and,
who concocts for such pmjcm with a conuactnr(O licensed punrm to ON Coronation
License law.
❑Ism exempt under See. ,BAPCfermismnon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under perky of perjury oro of One follmving declanor:
1 have and will main Wn a CcrtiAcate of Consent to selFinsum for WorYeri Compm.
sari..,r provided for by Section 37W of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 haw and will maintain Workers CompcoWion Innrance,as required by Section
37W of me Labor Code,fr me performance of Ute work for which this Permit is fund.
My Workmen Compensation Insurance carrier and Policy number are:
Cam E IFICATE OOP E7(EMPI'IOPoliN FROfd.3)WRRERS?Z ,
COMPENSATION INSURANCE
('ruin malar need norbccmnplcwd if Re permit is forms,hundred dollen($100)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shale not
employ any person in ray mnnerso as in become subject to the Workri Comperflon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become tuhj=t in me Worker's Compensation provisions of the labor Com.you must
O foMwith comply with such provisions or this permitshall o deemed revoked.
Zy CONSTRUCTION LENDING AGENCY
,4 1 hereby efirm mat inert is a construction lending agency rat the Performance of
G'> the work for which this permit is issued(Sec.3097,Civ.C.)
IA Lender's Nun.
Des I<nder's Address
VQ I certify that I have tend this application and state mat the move information Is
(y building I agree m comply Mm all city and county odtrncex and cote lows relating e /
I,,E Correct.
I agree
to co and with al aumorid representatives origin man l ws septi the /
W movamenlioned property for inspection purposes.
tF^y d (We)agree to raw,indemnify and keep harmless On City of Cupertino again,
p) liabilities,Judgments.costs and expenses which may in ray way serve against said City
U F'•r 7 in consequence of the lamming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 4Da
SOURCE REG}}��TI�O�N_�5�..,,,,,
/ 7 Z/ Re-roofs
Srgr H RDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building oceupnlsmre or handle himadous material
as deRrd by the Cupertino Municipal Code.Chapter 9.12.and ma Health and Safety
AMILCosla,Sguon 25532(a)] All roofs shall be inspected prior to any roofing material being installed.
Y.
Will the applicnt or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as dc0ned by the Bay Area Air Quality Management all new materials for inspection.
Dishes]
0 Yes KN.q��
I have read IW haraduus materials reyuimmenu under Chapter 6.95 of me Califor.
ria Health&SafetyCode,Sections 25505.]5533 and!25534.l understood ren if me Wi
w lding — i!1(,�
does not currently have a Irr
cnt,that in is my responsibility w dry ted«'cupnt of me G�"7� t/ �'
reyutremenls which most JmCL prior m houtace ora Certificate of OecopaOGy� re0 Date
owner o Dam All roof coverings to be Class "B"or better
1
Community Development
.' . - 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEkT[NO
Building Department
JOB ADDRESS: PERZA #
OWNER'S NAME: PHONE # 08 05">,- 2
GENERAL CONTRACTOR: _ 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
umbing
Roofing _
Aj
0
Septic Tank
Sheet Metal
Sheet Rock
• Tile
ac or lgnature Date
Community Development Department
Building Division
: City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
U P E IST I N O 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: A `J" s
A
Job Site Address: S S� (r✓lr �17. /�//tcP•
Roofing Company Name: �ii.✓ 64s /lrJG1.f/iC.��o#�i�✓�
A plicant s Signature: iEk% ate:11yir-
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper -
CITY OF CUPERTINO
REROOF D <' 7 o Z �y
CUPERTINO PERMIT APPLICATION FORM I
APN# Date: 7
< b
Buildin Address:
T s. .S7F5Z ,fG-
Owner's Name: Ph ne.#:
sc 2� --o—"
Contractor: Phon Lic se#:
�i/1"' r_—, S'u-6x4 vn� 617
C- 03wj—
onta r honelk: upertino Business License#:
�u-
P _fLII �9 V (�"� — '
Type o Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles q/Asphalt Shingles
C7�/ Wood Shakes ❑ Wood Shakes
1-1 Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings— ❑ Provide I.C.B.O.Report#
a./1`o be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:
IA,Lve L-VoDS aF fth.�Gr�3 /.�tiAzt. "� 3 G , ql 7 Su,,,
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Co of Project: Type of Construction: Occupancy group:
Qty. 'f
A tc bl Fee ID Fee Description Fee Group
PERMFEE Bldg Permit Fees BUILDING
NERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
• Z�-3