04080223 " CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INF012NTA.TION i,
"atiA7i, n tau n.
BuaolNC ADDRESS: KEVIN SULLIVAN ROOFING PERMIT NO 04080223
Ll 27 q SMILING RD
OWNER'S NAME: PERMIT LeSUE DATE
ONE:
SANITARY O. ON
CTROL N0.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
Y00 LICENSED CONTRACTOR'S DECLARATION
a 1 booby affum that 1 am Beamed under provisions of Chapter 9(commencing Job D�SGitQ(IOtt
n<� with Section 70M9)af Division]o 0usinuaand Profesauns Code,and mylicense is .ATir`511'tn14■■1-rrr���ddd■lllwrr`+9,�'■
inrdlmneame a 3 803 / TEAR OFF 1 LAYER WOOD ALE
j g Z License lass Lk.N
Dare Contractor �S41 E INSTALL 7/16 ' CSB, 30# FELT & 30 YR COMP
ARCHITECTS DECLARATION ryB 15 J����-n1
I understand my pl....hell W uscJ u pupl0Dc7`/'Ufa e e V/ e„5 SEP l3 0�4
30 Licensed Professional A�
OWNER-BUILDER DECLARATION
giI 1 herehy alum o I am exempt from 0o Convenor's License Law for the B U I L D
p o fallowing mason.(Section,I L3,xempt fraud Professions Calc:Any city w county
$ which requires a permit to cruswct,alter,improve,demolish,or repair any structure
ING
rZi poor in its issuance.also requires tW applicant for such permit o rile a signed statement
F o
that he is licensed pursuant a the previsions of the Caroncwr's License Law(Chapter 9 Sq.Ft. Floor Area Valua
z� (commencing wish Section 7")of Division 3 of the Business mid Prool.ons CodetlOtlo tete
)or 9�
that he u exempt dextrous and the basis for the alleged exemption.Any violation of
Section 7031.3 by a"application for•permim subjects ton applicant to a civil Penalty of APN Number Occupancy Type
not mom than five hundred down($300). P y TYP
❑I,uownuofthepmpmy,ormyemployeuwlshwagnsuthehsalecompensadon, 355222011 . 00
will do Ne work.and theswcore Isnatimended m offered foi(Sec.7044.Buiness
and Pmfevtioru Code:The ConvacoYs Liaise law don Wt apply to an owom of Required Inspections
property who Wilds orimprmes thercan,and whodoessuch work hisonlrorthmugh his
own employua,provided met such improvements art net intended or offered forule,If.
however,the building or improvement is sold within one year of completion.dm owner.
Wilda will have the burden of proving that M did not Wild or improve for purpose of
sale.).
❑1.as owner of the property.am exclusively contracting with licensed convenors to
construct the project(Sec.71114,Business and Profcasiou Code)The Contractors Li.
ecus law does not apply an an owner of property who Wilds or improv thereon,and
who Contracts for such projects with a cmummr(a)licensed pursuant in the Conaai
Lie nes Law.
❑I em exempt under See. ,B h P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I haw and will maintain a Ccnifteam isconsenl to self-insure for Wei Cooper.
1107W
ids,a provided for by Section 3700 of the Labor Code.for the performance of the
rk far which this permit is issued.
I love and will maintain WeskeM1 Compensation Inawan¢,as required by Section
of she labor Code.for the performance of the work fu which this permit is issued.
y Worker's C7.q sxnation InsuTPra^nce carrier and Policy^ucticrram:
rtier. cs//�-re../��1/CJ��Policy No.:a 'd�d00 Z20
CERTIFICATE OF FXEMP1ON FROM WORKERS' OpU
COMPENSATION INSURANCE //
(TIels sutim need notorcomplemed If the permit Is formanuadmed dollsss($100)
or les&)
1 certify that in the performance of the work for which this permit is Issued,I shall not
employ any parson in any mannered as to hecome subject in the Worlmn'Compensation
Laws of Calif^mia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
become subject mo the Wei Compensation previsions of the Labor Code,you mum
O forthwith comply with such provisions or this permit shall W decreed revoked.
Z CONSTRUCTION LENDING AGENCY
[-mom IWrehy eRnn that there is acouuuctimi lending agency for the performance,of
Ci the work for which this permit is Wood(Sec.3097,Civ.C.)
aQ Us&'a Namc
Z Lender's Addm..
tJ Q I ce tify that I have read this application and some that the above Information Is
{T. F coma I agree in comply with all city tad county aNinanas and some laws relating to
DU Wilding construction,and herebyaushodee representatives of this city on enter upon the
>' D.1 above-mendoned property for inspection purpose&
gy (We)agree to save,indemnify keep harmless the City of Cupertino against
rF-m and V) liabilities,jitdgmeno,costs and expenacs which may in any wq Kc again suaidCfly
U Z in consequerm the gaming of this per
APPLIC DERSTANDS ANF C 1PLY ALL N-POI sued by: Dale
--
las -roofs
sig fApp ieanUConlracmr T
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Ethic
l the applicant ar fuwrc building mcupem more or fondle herardous marcrial
defined by the Curtino Municiptl Code.Chapmr 9.13,and the Health and Safety
can,Otitea oa zss3zrape)+ www ��/ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future builJing accupanl use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
it heaamous air cram minanu as defined by the Bay Area Air Quality Management all new materials r inspection.
Disrin?
❑Yns
Ihnvc real theCode, d amarcriebre amide u orb of cCalding
riaHcalkli
not to
Code.Sections 25 3 amid 3 . d tan cbuiWing -
dtrsnotcu hoveaon au- ms i oJfy upant or the
m m ream t r oe roe N or 'gnature Applicant Date
Ow or amhamed agate Da
All roof coverings to be Class "B"or better
Community Development
10300 Tose Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
'#UPEkTINO
Building D
gpAxLm,ent
JOB ADDRESS: PERMIT#
//,R �" 5 - G / o9aaa3
OWNER'S NAME: 1,26 TSG PHONE #
GENERAL CONTRA OR:
I am not using any subcontractors
Signature Dat
Please check applicable subcon ors and complete the followinginformation:
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
RoofingU 23
Septic Tank
Sheet Metal
Sheet Rock
e
LcSJ
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
U PEI�TIN 0 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 a above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: �C �,,�
Roofing Company Name: �2 /� J !�L/ ltd �OCIi �'�G
— v J ee v c e8
A plicanYs Signature: te: �// /�
Greg eel
Building Official
Revised 1/30/03
Printed on Recyclad Paper
CITY OF CUPERTINO pSEEM&
REROOF
�CUPEkTINO PERMIT APPLICATION FORM
APN# 3 / '1 Q Date: Q a
Building Address:
!/a c-5, 7e6c,1XV6 lez . u-/0 9j o /
Owner's Name: � � Yde�'-Z�2_.
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed: 30 66
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >9C Asphalt Shingles .30 -14
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nurpber of existing coverings�� ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understan and Will Comply With Cu ertino's car Off Policy:
Job Description: yei , ✓ � G Q3$
3a e T � ,3C ` , e-- ;
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: 9 Type of Constru tion: Occupancy group-
Applita0le I Fee ID Fee Description Fee Group
13PERMFEE 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
�6� 3�
6.6