04070053 BUIL DING DIVISION PERMIT ® )CNFORMA�TTON
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BUILDING ADDRESS: JNSaJ ROOFING INC FERMITNO04070053
OW NEWS NAME: PERMIT ISSUE DATE
ONE: SANITARY 0. �ftOL NO.
ARCHITECT/ENGINEER: BUILDING PERMIINFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACROWS DECLARATION lob Description
sc.',
1 hereby a0lnn.thal I am licensed under provisions of Chapter 9(commencing
with Scnion 7000)of OiWslon3of the BusiOcuanO Profcsnom Code,and mylicense 8
Lg> DSI ; `°"1 no 3 con{ REROOF W/CAP SHEET
�� A0.CNREC7'S LAR ON
'� 1 untleruanJ my plana Nall be used u p N
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hp Licensed Prof wionat
OWNER-BUILDER DECLARATION
1 hereby.(lien that 11. exempt from the Cushors o Lkao Law for to /
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following mason.(section]101.5.Brei^^••ad Profession Code:My eilY or counlY
$ which requires a permit m conusucL&here Improw.demolish,w Minor any stnectum V
FL S°
prior t"III Oasuce.also numoug the applicem for such permit to rile a signed auemces
gg Lyy���G that he is licensed purnent to the previsions of due Commons Limnc Law(Chaper9 Sq.Ft.Floor Area Valu non
gC$ (oammcin{with Mellon 7000)af Divifion3aftM Businwand Poefcssfana Codc)w
3 dal hecnis mem pt Wemfmm and the basis for One alleged evmpdun.My violation of
Semon 7031.5 by any appikao for a permit subjects the applicant In a Civil Penalty of 310ft H' i"Q10 0 Occupancy Type
not mom Nan Rw hundred dollen(5500).
❑1,u Owner of unto property,or my employees with wages as their sole compensation,
will do the work and themuerum isnmimended"ofered formic(Sec.9044,Butner Required Inspections
and Professions Code:The Conhomh Liam Law don at apply in owner of q P
property who bui ms or im prows tusmn,and who does such work himself or duoush his
own employee,provided thalsuch impmwmwuam notineMnd onffeMd fofasle.U,
however.the building Or improvement is old within am:leer of completh n,the Omen-
builder will Mw the burden of proving that he did at build or Improve for purpose of
sale.).
❑1,as mactr of the pmpeny,an exclusively connoting with licensed conuasrors be
construct the project(Sec.9044,Document and Prefessitms Code:)The Conuacmr's Li-
mass,Law does not apply to Ott owner of property be builds or improves thereon.and,
who canuacu for such pmjects with a conuaclor(s)licensed pursuant to ttc Conuoloes
Lice"Law.
❑I sena exempt under Sec. .B k P C for this rtaron
1031.00
Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deC asationa:
1 haw and will mainino a Cerdfioam of Cont ro off-inure for Wmkcei Compact.
on,as provided for by Section 3700 of she Labor Cade.fee de performame of the
k for which this permit Is issued.
1 hew ad will maintain Worker's Compensation Insurance,as required by Section
of the Labor COM,for the performance of nae work fn which this permit Is mood.
y Wanda Coma"tan Issuance tinier od Policy nmber am:
ner. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This session wood not le compleed If the room,is Iwowo huMreddollan(SILO)
at loss)
1 certify that in the performance of the work for which this permit is issued.I small net
employ any permonecaa be o jecl la the Worken'Compe"tion
Laws of Celifor a. i �]
Applleent
NOTICETO PLP NT`.IL afar ma ing this CCNRca of Exemption.you should
become suhjas the Winner's Compo ton provision the Labor Code you man
O
forthwith
comply wt hauch N' Pe. be dcemnd mucked.
y CONSTRUCTION LENDING AGENCY
(.r I hereby affirm that them is a Conuuctnn lending agency for Ne performance of
�i the wan for which this permit is Issued(See 309'1,Civ.C.)
W Q Lender's Name
1L IeMer.Addteu
V Q 1 ceniry that I have mad this application and sate that IM show Informetun Is
W!', correct I agree to comply with all city ad county remittances and sou laws missing Ire
building consuucuon,and hereby authmice representatives of this city to color upon the
W above-mcntonM property for leauss on purposes.
a (We)agree to saw,Indemnify and kap Itumlw the City of Cupertino against
y liabilities.judgments.costs and expense which may in any way accme against and City
V 2 into sequen (the Sharing ofthis pwmlL Issued by: Da[
F7 APP U ANDS AND WILL COMPLY WITH ALL NON-POINT
( V7��
SO CE REGULATIO
7 OQ Re-roofs
Signe eof AppicauCo voterDateH DOUS ATERIALS DISCLOSURE Type of Roof
titan In ilding Occupsutuwc Or handle ha'rardom mamrial
as defined by the Cupemno Munsapal Code,Leapter 9.12,and the Health card Safety
Oulu,Section 25532(a)?
❑Yat ON. All roofs shall be inspected prior to any roofing material being installe
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hamodaus air contaminants u dcflwd by the Bay Area Air Quality Management all newlmateri&for inspection.
District?
Dyes ON.
I have read the hssamousnuarials requirements under Chapler 6.95 o(te Califor. O
.is Health at Safc yCode,Sections 25505.25533 and 25534.1 understoodThu lithe building \
dues not currently haw a enan4 this h u my responsibility In redly the Occupant or the
mquirmenu which am W met prior les iuuence of a Certificate of Occupancy. Ignature fApplican Date
Owner sur authorived agent Dam All to ngs to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
#UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
2932S- 2M38 s G• k 314, 0 0700 5 3
OWNER'S NAME: 7�4- Ay.-.a b`>r yes PHONE # S
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors an c owing 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
T' e
? (�- ci
`J er/Con actor ignature ate
Community Development Department
e Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
Fax: (408)777-3333
UPEkTINO
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: �),e PM-3;k Frop&4. S'
2037-5
Job Site Address: 2a3gc7 f �S Cwlc UV4.
Roofing Company Name: J N S J °flh mac-
A
Apliclant's Signature: Date: �y
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
(� CUPERTINO PERMIT APPLICATION FORM
APN# 316 _ )-6 _ 0 QO Date: -7
Building Address: 2 o s
- Z d 3 87 S�e veil C, u k Ind.
Owner's Name: Phone#:
�e PvvtN �ro �v}t��S ` O a - 6381
Contractor: Phone#: License#:
J NSJ (4A!4 qo8 27 , 6171 739980
Contact: Phone#: Cupertino Business License#:
j4ey,H ,t
Type of Roof Covering:
ExiPropose:
VBuilt-Up Roof 2 Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ 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: t
(2e*-w^ fel C Sb-t h•f (Krw nom, ca sl,. t ►4o�.C(-w 'A `
Residential ❑ Commercial 52--
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: 21,680.o Type of C4astraction: Occupancy grodp:
SL�
Qty,
A li a le Fee ID Fee Description Fee Group
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
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