05060066CITY OF CUPERTINO
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CONTRACTUR�INFURMATION:
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
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RESPONSIBLE ROOFING INC
PERMITNO05060066
OWNER'S NAME:
PERMIT ISSUE DATE
NE:
SANITARY O. CONTROL NO.
ARCHITEMENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
9
Job DeSCrI eon
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1 hereby affirm Wt I am licensed under provisions of Chapter (Commencing
wish Stedon 7M)of Division 3 of due Business W Pnefesaions Code. and my license
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REROOF W/FOAM ROOF ✓+U t U
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Deten_CanuS
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RCHTIELTS DECLARAT N
1 understood my plans shall he used as public mcoNs
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Licensed Professional
OWNER -BUILDER DECLARATION
1 bemhy .(Bete she 1 Lkens Law for the
exempt from Ilw Cssions
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following mason. (Section 7(01.3, Business and Rofessiuhs Cale: Any city or aunty
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which requiw a permit be cnnseun, alter, improve, amoleh, of repair any structure
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prior ¢ its issuance, also requires the applicant fonuch permit to file a signed comment
that he is licensed pursuant to we prevision of shc Commend Lions Law(Cltopwr 9
Sq. Ft. Floor Area
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`Valuation
(commencing with Section 7000) of Division 3 of Ne Business and Profession. Crawl or
that he is exempt therefrom and the bub for she alleged exempla. Any violadon of
3 i�i�1Q`fl1�117Q0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than Ove hundmd dollar (23001.
1, u ow"s orris preputy."my employees wee wages u dwe sale compensidon,
Required Inspections
willdo the work, and Neswctum is mein¢Med"offered krsale(Sm. 7044, Business
and ProfessiCoronariesCode: The Coronaries License Law reine law t apply an owner of
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pmpeny who builds Cor im prow thereon. ,W who does swh work himself or threugb he
own employees, pmvided Nat such imprevemad are rot Imendrd"offered for We. if.
however, the huili log or Improvement is sold within one you of completion, the owner.
builder will have the burden of proving Nu he did not build "improve for purpose of
.1. 1.
❑ 1, as owner of tis property. am ex.l.huly contracting with licensed Conuut"s to
ansn"t the pmject (Sec. 7044. Business and Profnsiow Code:) The Conuanoes U.
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Co. law dues not apply in an owner of property who Wilds or improve demon, and.
who contescu for such projects with a contra¢ r(s) licensed pursuant m the Commemes
Lkens Law.
❑ I am exempt under Sec. . B k P C for this moon
_
Owner Dow
WORKERS COMPENSATION DECLARATION
1 hemby affirm under penally of pidery ane of the following declaration:
1 haw and will maintain aCeelfiaw of Consent in wl6insum f" WorkersCompen-
urian, u provMed f" by Section 3]00 of the Labor Code. f" the performance of the
work for which this Fresh is issued.
❑ I have and will maintain W"kees Compensation Insurance, u required by Section
7700 of the tabor Code, for the performance of she work far which this permit is Issued.
My Workers C.ompewado Insunn Corder and Policy number aro:
Carriers -roto �/ Policy No.: � r
CERTIFICATE OF EXEMPTION FROM WO
COMPENSATION INSURANCE
mile; section need net becomplcted flow permit Isforanc funded dollua(SIm)
nr leu.)
1 cenify that in the performance of the work for which this permit Is issued, I shall not
employ any pence in any mawra as in become subject to due Worken'Compeuation
Lew. of California. Dow
Applicant
NOTICE TO APPLICANT: If. after making this Ondfle a of Exemption, you should
became subject in the Workers Gampmesown pmYlalOw of the Latins Code you motor
'
fothwith comply with such Provisions w this Permit shall W deemed revoked.
..
CONSTRUCTION LENDING AGENCY
I hereby afflrm that them Is construction lending agency for she performance of
the work for which this pcone is issued (Sec. 3M, Civ, C.)
'
Under's Name
,
Lcnder't Address
I ai ily that I Mw read this application and waw that the above Informst)w is
cortacL I agree to comply with all city and county ordinances and naw laws mis ing in
Wilding construction. and hereby authorize mpresentodw of this city to enter upon the
shorc-mentione i prepeny, for inspection purposes.
(We) agree to tow. Indemnify and keep harmless the City of Cupertino against
liabilities, )udgmen s. costs and expenses which may In any way accrue against said City
in consequence or the gmming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGUyTIONS
Re -roofs
Type of Roof
�Z, ` 4'^/O'
Signorine of AppltandCon tar Dow
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant seem arhandle McArdovs materia
ss defined by the Cupertino Municipal Code, Chapter 9.12, and the Hcalth and Safety
Cade, odd 255320)?
All roofs shall be inspected prior to any roofing material being installed.
a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of future Wilding acup.nt use equipment or devices whichIf
it huardnw air crams eluents u defined by we Bay AMC Air Quality Mawgemenr
all new materials for inspection.
Twin?
❑Yes ❑N�.
Ihave &Safe Cow. .it=2305, requirements and 3534,1 rdermad.95 if the Califon.
rah HmlIh&Smm the Im edous 25505,23quiand rats un1 rChapter duet if the building
6
does not currently haw a .nam, that It a my responsibility in notify the axtupant of the
roquimments Which Chun be metptjyr to wuanaa, Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
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Ow wautha' a cm Dow
I
CITY OF
�UPEkTINO
17
JOB ADDRESS:
GENERAL CONTRACTOR:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building De artment
PERMIT #
OS'o 600 CC
OWQ PHONE # q Zc
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
- - I"/
Owner/Contractor Qnature
s/24/as
Date
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
Q25
az1 �j
Septic Tank
Sheet Metal
Sheet Rock
Tile
- - I"/
Owner/Contractor Qnature
s/24/as
Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Telephone: (408) 777-3228
Fax: (408) 777-3333
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,
r 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 n -d imum 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: �Qwe
Job Site Address:
Roofing Company Name: Kespmsae 9USI-neA
A plicanfsSignature:
Greg eel
Building Official
_ Date:
\�llr61J�1DCX1
Revised 1/30/03
Printed on Recycled Paper
CUPERTINO
CITY OF CUPERTINO �.�6���
REROOF US
PERMIT APPLICATION FORM
APN #
bib- 24-OZ5
Bldg Permit Fees
Date:
Building Address:
Energy
k(),2-60
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
Seismic Commercial
BUILDING
2-51 --1 4
Contractor:
Phone #:
License #:
P-eSoonsibl e
Tt-C. [ &rte fL
51X
Contact:Phone
#:
Cupertino Business License #:
�cl Pe —na
(Lo,x6) s� -S,51
Type of Roof Covering:
Existing:
Proposed:
M,'Built-Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles �l
❑ Other (Specify)
t" Other (Specify)-i1D0(�
Number of existing coverings 1 ❑ 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 Polic
Job Description: Sweee okf
9ycA\.t. . IrS}Gt0 A 5PravV m race . .
Residential [, _
Commercial : ❑ " n?
Fire Zone: Yes ❑ No ❑
Confirmed with Planning D if
there are any restrictions: Eept.
Cost of project:
Type of Cy truction: Occu anc group:
g
It) (0,-1450.°°
�2.-ro(S F .'F. (Z .
Qty, if
Annlicable
fid- 17
Fee Description
Fee Grout)
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
37- g6