04090075 CITY OF CUPERTINO
suaolNc DIVISION PERMIT CUNftiM OR INF
Utt
MATIU�:
I MT
BUILDING ADDRESS: - PERMIT NO„4 9(](]7 5
OWNER'S NAME: PHRMRISSUE DATE
ONE: SANITARY O. C NTROL NO.
ARCHITECf(ENGINEER: BUILDING PERMIT INFO
ELECT PLUMB MECH
0 0
LOp LICENSEDCONTRACnOR'SDECLARATION Chap lob Description e®
1 hereby affirm
LICENSED
ONTRAunderprovisionsof Chapmr9(commencing c
with Sbd.o7W0)af Division 3ofthcH cv mxl4Pmfcssiom Cotic.end myliccnsc is
'oma ' G.39 ;(oz&3 REROOF O
S � Lken LI.H
Dam comrucl '}ga� CONTRACTOR: BEST ROOFING�� T i�_ 100y
\ RCNITECTS DEC 0
undenandm planxahallbeuuJup I' corN CITY JOBS NO FEES ,L
Diu
3G Licensed Pmfcuianal /�A
'� OWNER-BUILDER DECLARATION
gm 1 hereby off ma that 1 am....I from the Comments'.Lice...Law for the
4 O o following maser.(Section 7031.5,Business and Professions Code:Any city or county
$� which requires a permit to construct,altar,improve,demolish,or repair any stmctum
prior m its issuance,also mquims the applicant for such permit to rile a Signed statement
��a that he is licensed pursuant to the provisions of the Connector's License law(Chapmr 9 Sq.Ft.Floor Area Valuation
rc $ (commencing with Section 7000)of Division 3 of the Business and Proressions Code)or
.- Nat he is exempt thcmfrom and the besis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant nt a civil penalty of APN Number Occupancy Type
not more Nan R.hundred dollars($500).
1,u owner of the property,mmy employees with wages as their sole compensation,
will do the work and the stmctum is not intended or offered foreale(Sec.7041,Business (]
and Professions Cods:The Conancmrs Licerue Law does trot apply to an owner of Required Inspections
propertywho build,or improves thereon,and whode a suchwork himselfor through his
own employers,provided dual such improvements are colonnaded ororfercd(.rule.If,
ha nnono.site building or improvement is sold within one year of completion,the owncr-
builder will have the burden of proving that In,did not build or improve for purpose of
ala.).
❑1,as owner of the property,am emlusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The ConOecmrs Ll.
came raw time not apply in an owner of property who builds or improves themon,and
who contracts for sack projects with a oom essor(s)licensed pursuant in the Contractor,
License Law.
❑Ismexemplurner Sec ,B&PCforthismmem
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alTmm under penally of perjury one of the following decimations:
1 have and will maintain aCeniftca e of Consent in self-insure for WorkersCompen-
.tion,a provided for by Section 37W of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of 0Labor Code.for the performance of the work far which this permit is issued.
My �s,Cani P matin�'sllmum.ecarrim and Policy 6,afm.�ba,.ra
Ct
CEN FlCATE OFEXEMPTIONFROM WORKERS
COMPENSATION INSURANCE
(This sectiw recd not he completed if the Permit is for one hundred dollars(SIM)
or lass.)
1 certify Not in the performance of the work far which this pernit is lamed,l shall eat
employ any person in any manner an as in become subject to the Workesa'Compensation
Laws of California.Dam
Applin.
NOTICE TO APPLICANT.If.after making this Certiricale of Exemption,you should
become subject in due Worker'a Compcnud^n previsions of the Lehr Code,you must
Z f xt with comply with Such provisions or this permit shall be deemed revoked.
„E,i O CONSTRUCTION LENDING AGENCY
[-� I hereby alRrm but there is a construction lending agency for NC Performance of
IY' the work for which this permit is issued(See.3097,Cih,C.)
WW A Under's Name
]Z Lender's Address
U Q 1 certify that 1 have read this application and shim that dm about information is
W F cmrecl.1 agree to comply with all city and county ordinances and sum laws relating to
O V building constmction,and hereby authorise reprrsentatives of this city to enter upon the
r W above-mentioned property for impaction purposes
(~G (We)agree In ave,ladcmnify and keep humlc s the City of Cupertino against /.
y liabilities,judgments.costs and expenses which may In any way acrotic against said City
V z in conuqucncc of the ERSTANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
gYPLi
SOUK ER G L I S.
9111!064 Re-roofs
Signet o(Appl VConuactar % ta
If
MATERIALS DISCLOSUR Type of Roof
Will the applicant ar future building occupant store or handle haankna material
adefined by the Cup a.
Municipal Code.Chapmr 9.12,and the Health and Safely -
odc.Section 25532(a)?
C]Y. All roofs shall be inspected prior to any roofing material being installed.
��Ho
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 hazardous air contaminants as Jcfined by the Bay Area Air Quality Management all new materials for inspection.
District? -
❑Yes RNo
I hove madden heardou"s�`mamdals requirements undm Chapmr 6.95 ofthe Caliroa 11-
nuHmlN&SaretyCodc,Sccdom25505,25533ud25534.1 undenrand0miflhc Willing - •V ( j,)
not curer ly have a mnan4 Net it is my msponsibility m ncany the occupant or the t
requ men ,h an ecce poor nt issuance of a CcnlRcam of c cr -lgnatUTe Of Applicant \ Date
gr
o orar:amoriaJagcnt Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR:' . eS 50 'h11,w FAX# S I —f)gfi f7a 22
n c.
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
Plumbing
Roofing �m W o.
Septic Tank
Sheet Metal
Sheet Rock
Tile
(f
Owner/Contractor Signature D to
Community Development Department
ABuilding 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 Nam ClT`� Or CL Prr -0
Job Site Address.V_ 0 -100 Se✓eh
Roofing Company Name"( Be-57-
A plic" SignatL e —: l Date:
tGreg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 6
CUPEkTINO PERMIT APPLICATION FORM
APN#
357 L
— oo-7 7PPhone
Building Address:
oci �2L)erh'5 Cre-e I\
Owner's Name: Cl f 1 #:
`/ Cv(� ? 77- 3221
Contractor: Q i Phone#: License #:l
L1�S ROOF,r, Sto-77k-8'x53 `% 3
Contact: /yo e( C�' (er Phone#: ��6 72�(d Cupertino Business License#:/
5l0 —
Type of Roof Covering:
Exis 'ng: Proposed:
Built-Up Roof /45i`Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
mber of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 1 Wit Cu ertino's Tear Off Policy: ❑
Job Description: /, cv�
Residential ❑ ` Comm rcial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
'— —1 there are anrestrictions:
,?�
o t^ a Type of Co t c ' n:/ Occupancy gro p.
Qt . if
hcab Fee ID Fee Description Fee Grou
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING