05090016 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACORNF)ORMATION
BUILDING ADDRESS: SEASTMAN CONTRACTING, INC PERm"NO05090016
OW NER'S NAME: PERMIT ISSUE OATH
ANCY5NOTO
141 R DOUGLAS ST 09/02/200
ONE: SANITARY NO, CONTROL NO.
(408) 971-9000
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELELT PLUMB MECH
(� 0 (�
�00 LICENSED CONTRACTOR'S DECLARATION lob Descri tl n9
1 barony affnm that I am licensed under pmvisiou of Chapter 9(Commencing P I [�
Uh Scetbn 70(XBof DivWOn3ofthellmonwand Pnfesalan Code.aodmy license Is ,L t fl h"T,,
7 Lic.
is fall fORt Nde LICasz�J REROOF-T/O SHAKE, INSTALL 4 ' " MEDT E
Deb COmracmr CLASS Bit
O ARCHITECTS DECLA ATION
? OCT 1 understand my plans Mall M used u public records 206
i c� Licensed Professional
OWNER-BUILDER DECLARATION ����su_r,� —_
j�x I hereby grim that i am exempt from IM Contractors License Law for the YLLJ�'I^F1yNrj, jj�iry`t+�'�1'
iOO fallowing resign.(Section]onstruBulan. and Ro.dermi Code:Mycity or county
9 tx+ which Ryuires a permit re cores the char,impress,deermit t ri e A siany manucac
pnormits iuuubuaborequires pervisto ant for such Permit to cessigned atsbmcm
Riothat Im(comms ctt withSectanOoalm 00)ofDaionoftheCoOuecw'sUcenselaw(Chapler9 Sq. Ft. Floor Area VBIU$tIb8539
(commencing with Section)OW)of Division Sof Ne Guiness and Profwiom Caulk)Or
.- Nat he is aempt MCRfrom and the hub far Ih alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the appliam tO•Civil penalty of APN Number Occupancy e
net mom Nan Bw hundred dollars(5300). P y `1)P
❑i,As owner of the property,or my emplaycu with wags u theirsole compensation, 35709043 . 00
willdo the wmKaod mesvucture isnot imendedaroffarted fants(Sec.7044.Business Rwired Ins
ane Pronasion code:The Contractors does an,License Law doan,apply b e eCU0n5 an Owner or q P
property who buildsorimprows thereon.and whodessucltwork himseifor through his
own employes,provided Nal such improsemauaR naimm�dod or offered(rook.If.
however.Me building or Improvement is old within me year of completion.the owner
Wilder will haw the burden of proving that he did ant build or improve fes purpose of
Ago.).
❑1,As owner of tie Property am exclusively contracting with licensed cmusema in
contract the project(Sec.70".Business and Profession Cade:)The Causcmrs U.
ecus Law duce not apply in an owner of property auto builds or impmws Berton,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. .B&P C for this Radon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury aro of the following declare oar:
I haw and will maintain a cmdruam of Covent to self-luum for workers Compen.
1037.'00
on.u provided for by Section 3700 of the Labor Cada,fa the performance of me
rk for which this permit is Issued.
1 haw and will maintain Worker's Compensadon Insurance,u acquired by Section
of the Labor Code,for the perfannanee of the wart far which this permit is lued,
y Workers Cnmpeuetion Inwnntt artier end Policy nyy��bcr artrtier. �n•J Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thbxcdm mood nothecomplebd if the permit is fmomhundRd dollars(5100)
or kgs)
1 Conry that in me perfam ace Of the work for which this permit as issued,I shall mm
employ any person in any maruRrm As m became subject to the Workers'CompenNm
Laws of Celifomia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Canincab of Exemption,you should
become subject to me Worker's Compensation provisions of me Labor Code.you must '
.J 0 roMwith comply with such provision or this permit shall he deemed rooked.
Z� CONSTRUCTION LENDING AGENCY
[r I hemby airan Out them b a construction lending agency for the performance of
e4> the work res which this permit is issued(sec.3097.Civ.C.)
tiCa Landers Name
Z)Z Undoes Address
f)Q 1 caNfy mu I haw Red this application and sou that the show information is
Iy F cones.I agree to comply with all city and county oNlnarc s and state laws relating to
QU
building construction,
toand whartbyautha d keep
of this ofCala Calamine
Agast Open the
W show-mentioned property far inspection Purposes.
(We)agree b cows indemnify and keep may
in m me City offe ag.nino agalml
r.ty in Coastal. men0.catsind expenses which may in any way sane sgelnn said City
t)7 A PLICANT of ma RST i N of this D WILL G7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-C -0 ;r
SO
_;:rULATIONS.
/ ea 6 AA.GLa 90?zof Re-roofs
SignWIR o(AppllcantlCOnnCla! Dale
HAZARDOUS(ATERIAIS DISCLOSURE Type of Roof
Will the"pit=,or(atom building Occupam arae orhaodle haardaa m,tc isl
u deBad by the Cupertino Municipal Code.Chapter 9.13,and tis Healon an Safety
sales.ScedOa 25532 ),1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ZrI
Will the applicant or future building aecupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove '
It 14h Cardona sir cmmminants As tkMed by the Bay Area Air Quality Management all new materials for inspection.
I
uicl7
p Yes No
than Rad me huaNmsmucrlalsrequiRmenu underchapterb.95ofthe Califon �S
Realm&s,utyCede,seciatassws,ss5»and 25534.lundimundmulfinebuildbg
es not currently haw a ICnN4 mod it I my Responsibility b Aalfi,the aeupNt of the
IRmcnu which muss be met prior m issuance of a Ccnincau of
nvwU M Q �J, Signature of Applicant Date
Owner car wthmind agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMTT#
2-2Og3 Sf-OCLIW ier (!,-I- , 1 . 0,5-
OWNER'S NAME: PHONE# 6?7 1 - C7000
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
Si a Date
Please check applicable subcontractors and com 1 t the foll g information
60 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
Tile
Owner/Contractor Signature Date
aClOF'
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
UPEkTINO 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 rnanufacfurers 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.
7• NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
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:
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINOO
REROOF l
ICUPEkTINO PERMIT APPLICATION FORM
APN # � O d Date:
BY1�7 Add3 _
2
Owner's Name: Phone#:
J D Z/M .02 ss�3a
Contracto Phone#: License#:
AJ ,?zq/7& Sa SZ7S/
Contact: Phone#: Cupertino Business License#:
V6_eC> LCA c
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
ar Wood Shakes e 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.
AdL
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
I&I OPE OOE LULL OF InCh, S,11AyC_ n M
Residential R' Commercial ❑ 13
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
I q 53�r
Qty. if
Applicable 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
37 �
27 � , s'