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CITY OF CUPERTINO771-7771
�CONTRAC�"TORANFORMATION:.'
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
JNSJ ROOFING INC
PERMIT N904060190
20401 STEVENS CREEK
OWNER'S NAME:
PERMIT ISSUE DATE
DE ANZA PROPERTIES
691 W SAN CARLOS S
2004
ONE:
SANITARY NO, CONTROL NO.
4082796171
ARCHITECDENGINEER::�e�,pp��
BUILDING PERMIT INFO
ua ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
lob Description O
I creby affirm Ihal 1 am licensed under provisions of Chapter 9 (commencing
with5 I
Di'u a�nd�P ,.axions Cedc, andmy1flema,isimml t--5`I`b
REROOF �/
taLte,untraE
�icenxe
i'dK�,*'Courome
1 un M uactl pubic runrds
Licensed
OutNE. BUILDER DECLARATION
1 hereby alarm Law for the
1 am exempt from Ne Cssions Any
�l
mann. on o : c
Tat Lr Business and Professions Code: Any city
mcounty
which s a permit re altea improve, do
which re ermitt are pair any awcmm$22750
uireuum,
permit t
prior m s licensed CC, also n t to the pro axion o far suchCon parlor' 'aim a slga(6 hapten l
ita ism
that of theContractor'sLimns,Law
Sq. Ft. Floor Area
Valuation
Section]000) of Divisions a(the onC Code) or
mencingpuntion7 )ofDivisio
(commencing
vi Col,)or
Nat ha V exempt Nucfrom and the buss for are alleged exemption. Any violation of
pt eged exaandon.An
a
Occupancy e
p yTyp
Sections 7031.5 by a" applicant far a peamh tubjew the applicant to a civil penally of
not mole NEg500
an ve hundred dollars(),
❑ I, uawnuof Ne property, ormycmploycetwiN waguu Nair sole wmpenlotion,
Required Inspections
will do the work and the structure 13 not intended oraRcred fortale (Sec. 7044. Business
and Profeasiou Code: The Conuacmr3 License Law data not apply in an owner of
property who builds or improve thereon, end who douauch wok areal(or Uuough his
own employees, provided that such improvements am not intended cro(fered ferule. If,
however, the building or improvement Is said within one year of completion, the owner.
builder will have the burden of proving that he did not Wild or improve for p.m.. of
ark.).
1, as owner of the property, am exclusively contracting with licensed Contractee to
construct the project (Sec. 70/4, Business and Profusions Cade:) The Contractor's U.
ccolo Law dean not apply to an owner of property who Wilds or improves tamon. and,
who contracts for such projects with a eonamarme(s) liaised Pursum to the CantrumYs
Lk law.
I aasmpt under Sec. , B k P C(a, this mason
m
wam Dam
WORKER'S COMPENSATION DECLARATION
I hereby of ars under penalty of perjury am of the following decimations:
for Worker's Comp
1 have and will maintain a CCNEcate orCanunl to self -insure cm
aa'lon, u provided far by Section 7700 of the labor Code, for Ne pcnormana of Ne
wort for which this Permit is issued.
1 have and will maintain Workers Compensation Insurance, u required by Section
37 War LOW, Code, for Ne performance of Ne wort ter which this permit is issued.
My Warkees Compensation Insurance carrier and Policy number art:
Carrie,. Policy Nq:
KERS'
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the Permit is foram, hundred dollars ($10(a
nr In .)
1 artily Nut in the Pc o ce ( the oh for which also Moaned, I mall not
1t.h''
cmpla anyperson' yman C "Auld NC WorkClt COmpCaadon
I"wao ifomi 1
Applicant
NOT CE APPLI NT: If. .(set king this C li0cas, of Exemption, you should
me ubj to arkcr's Com tion pro 'ions of Nc Labor Cndc, you ..at
hwithc�mply vel mit Shall W dccmcd revoked.
CONSTRUCTION LENDING AGENCY
I bunchy anion that Nem is a comotctinn landing agency for la Performance of
dm work for which this permit is Issued (Sec 3M, Civ. C.)
Lenders Name
Landes
Address
I codify that 1 have rend this application and state Nn she above infamnNun is
V
correct. I agree N comply with all city and county aNinances and sum laws relating to
Wilding convection, and hereby suNo ize mpruentuisv of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree m love, indemnify and keep harmless Lha City of Cupertino against
liabilitim,judgmenu, costs and expenses which may in any way accrue against aid City
et2--
consequence of Ne granting of this permitTANDS
AND WILL COMPLY WITH ALL NON -POINT
Issued by;
S Y
Re -roofs
Type of Roof
LZ
_
V onlur
gna a rHRD RIALS DISCLOSURE Da
.turn Wilding aeupant at.. or avalc harudou material
u de0n by the Cupertino Municipal Code. Chapter 9.17, and the Health and Safety
a&. Section 75532(a)7
❑ Yu �
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
-cmlt a'rardnas air contaminants u d,frmed by the Bay Arm Air Quality Management
all new materials for inspection.
Disuin7 `/
❑Yu a<
1 have read the huardou materials re,anor cnu under Chapter 6.95 of the Calif.,
/t
nk HetlN Codc,Satiom75505.M577 and 25534, 1 understood that if the Wilding
(C^i
Doer ant Nat it u my res, auihility m nod ry use ant cupaof the
mmcnsawhich uvW tinortaiacmrtecaraccrdEcaar c.WCyo1
tui fApplicant Date
\ b
roof coverings to be Class "B" or better
trwar
seat 'e
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aCITY0
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
v�-O� 0 � 70
APN #
®70
BUILDING
Date: 6 22
Building A dress:
BUILDING
Owner's Name:
Seismic Fee Res
BUILDING
Phone #:
e Pw QL
BUILDING
BPLANCHK
(Zo4 GO- 73
Contractor:s
JN J ef;
Phone #:
�,�.
s 279-617(
License #:
73 Q Q S 0
Contact:
�•vtk
Phone #:
'�
Cupertino Business License #:
Type of Roof Covering:
ExistinP
Proposed:
/Built -Up Roof
M -/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: I�
1 ^..- u)
p
Vbco i j %iii11d
"A,j tw%.vO turAQ4 w-*cV ped b. ...
Residential ❑
Commercial
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:
Type of ruc on: ccupancy group:
750
I
q
DDlreable Fee TD Far Tlvcrrintinn
L-.-,
Foe f_.
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