04100054 CTTY OF-FIC $�cotvrRa rax 7 oR .�0 .
BUILDING DIVISION PERMIT
BUILDING ADDRESS: _ _ CASTO ROOFING PERMIT N004100054
NER'S NAME: PERMITL'SUBDATE
OW
TAKAO AKA
QA
NE:
SANITARY N0. CONTROL N0.
(650) 961 -R922.
ARCHITE
50 961-
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
a00 LICENSED CONTRACTOR'S DECLARATION
aVZF I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
n< with Section 70DBIofDivision 3 of the Busmen end Professions Code.and my license is
in mu censecfarce anecf REROOF W/SHAKES FINALED
j Y1? LiLlo.a
�:pi, Dale - ammnar, e
ARCHITECTS DECLARATION
�i I undersand my phos shall be used As public mentis
zi
5t; Licensed Pm@.tonal T /� U�4
3 OWNER-BUILDER DECLARATION L
2 1 bunchy of".'hot 1 am exempt form the ornament License Lew far the OC 2
i
00 following mason.(Seed..7031.5,Business and Profanation Code:Any city or county
K$ which requires a permit to construct,aher,improve,demolish,or repair any structure
to w
Her m its issuance,Alan requires the Applicant for such pcamiva file.signed sutenhan
that he is licensed pumuant in the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area LUI I JWVAtion
a I-$ (commencing with Section 70001 of Division 3 of the Business and Professions Coda)or
that W h ert
exempt thfmm and the bash for des alleged exemption.Any violadon of
Section 7D31.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 W4T7 hb*er0 0 Occupancy Type
Out roam Wan five hundred dollars(M).
❑I.as owner ofthe property,or my employees with wages as their sale compensation,
will do thework,end theswnum is not invented.,.(fared lots*(Sec.7044,Business
end Profeseions Code:The CanuactorS License Law does not apply to in owner of Required Inspections
property who builds or improves titanium,and who does such work himself or Wmugh his
own employees,provided that such improvements art not mended oruftered fursalt.IL
hawevea,the building or improvement is sold within one year of compiedon,the owner-
builder will hive IIIc burden of proving that he did not build or improve for purpose of
.AI.J.
❑1,as owner of the property,am exclusively contracting with licensed convectors to
construct the pmject(Sec.7044,Business and Professions Code:)The Conweter'a Li-
cense law dors not apply to an owner of property who Wilds or Improves dtewon,and
who co mensfor such pmjecuwith ac.ntnetor(s)licensed pursuant to the Contractors
License Law.
❑1 ren exempt under Sec. .B R P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain aCenificam of Consent o eelf-insum for Workers Compen-
author.m provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maimain Worker's Compensation Insurance,As required by Section
of the Labor Code,for the performance of has work for which this permit is issued.
My Wo eCampen'Aldo�n lns�unnm Gamier and Polity number am'
j,�''J
Camier� Policy No.: �
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need nmbocampated if the permit is furan hundred dollars(SIM)
or less.)
1 ecnify that in the purfmmance of the work for which this permit is issued,l shell not
employ any Noon in any marmerm As w become subject o the Worked'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.If,after making this Cenifieste of Exemption,you should
became subject to We Worker's Compensation previsions of the Labor Code,you mum
.J O forthwith comply with such pmvisi.ns m this Permit shelf W deemed revoked.
Z rye+ CONSTRUCTION LENDING AGENCY
(~ I hereby amrm that On.lAa emmarctinn]coling agcnry l'.,the peffurmencc of
6i> the work fur which thin permit is armed(See.3097,Civ.C.)
D.1 Q Leader's Name
z Lcnderi Address
U Q 1 cenify that I have=it this application and slow that the above intormadun is
LU F came,.I agree to comply wit all city and county ardinances and mm hwa misting to
O V building construction,and hereby authorix mpncaenudives of this city to cnterupnn the
G above-mentioned property for inspection purposes
(We)agree to rove,indemnify and keep harmless the City of Cupertino agamot
wFa N liebililiu,judgmcnu.colo ande.'ems which may in any way c."am,said City a
U'Z, in consequi nce of the granting of this permit. U
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NT Issued by: Date
SOURCE ULATIONS. fY
_�� I " , � Re-roofs
Signmu of ApplicamiConuacmrate
HAZARDOUS MATERIALS DISCLOSURE tD Type of Roof
Will the applicant or future building occupant atom or handle haxardous material
so delimit by the Cupertino Municipal Code,Chapter 9.12,and the Health And Safety
CoJc,Section 15531(.)?
❑Yes 1f/FAll roofs shall be inspected prior to any roofing material being installed.
(Nu
Will the applicant or future building occupant sex equipment or devices whleh 'If a roof is installed without first obtaining an inspection,I agree to remove
call hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
Ihave mail ones dnuamatedahrean ofthc Califon
iianyCocc,Se1515.25533And]5534,1 seamthatifthc Willing
Jars not currently have a tease.that it ismy responsibility mnotify the
occupant of he w
myuimmenu which must be met partite issuance ofa Certificate of Occupan SignatU c Of Applicant Date
Owner ser eommized ages Dau, 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
�UPEI�TINO
Building Department
JOB ADDRESS: -1PERMIT#
ir� �80 s7vips.4v-k� 6 S�ioo�s�f
OWNER'S NAME: T U Q PHONE # SD q&
GENERAL CONTRACTOR;___ 0 12r Z r//
I am not using any subcontractors: c� lb G CL
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
'U
Owner/Contractor Signature IV Date
Community Development Department
Building Division
al(
City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408) 777-3228
4UPEkTINO 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 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: r Ap�4l &o Q./,v/_
Job Site Address: 10386) 6/ /��- t s iT� `—
Roofing Company Name: GIU
A plicant's Signature: ate:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF v �
CUPEI�TINO PERMIT APPLICATION FORM
APN# 2(0 411 V/�I Date: 9/� G
Building Address:
/080 5 To,�es
Owner's Name: :L&-t A"o / ��071� Phone#:casto ��� _ ^�O
ContractoK38 Ciid Middlefield Way Phone#: License#: 39 7D�q3
Mountain (SSD
CA 94041-9501 -
Contact: Phone#: Cupertino$us rmss License#:
oL
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes LR' Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing covering— 0 Provide I.C.B.O.Report#
A To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Cc VK -,/707/!� CAUIt,/ "B"&f-cls
Residential -P Cominercha ❑
Fire Zone: Yes ❑ No O \ Confirmed with Planning D t. if
\ there are any restrictions:
Cost of Project: Type of nst cti : Occ pancy group: r
/0 SSU
JQ : if
A icab e 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
C�