03100041 CITY OF CUPERTINO *d
BUILDING DIVISION PER co
.. .•ate. ,'arzv3 .,. a t^ .
,BUILDING ADDRESS: LAPORTA MARY AND VINCENT A PTV'03100041
01 00 CTTTC!TTYr
OWNER'S NAME: PERMIT ISSUE GATE
NE: SANITARY CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
!OZp LICENSED CONTRACTOR'S DECLARATION lob Description
I Um I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
{< wW Seelma 70M)of Division 3ofthe Businnsand Professions Code,md my license is
in full force and effect.
Lfcenu Class Lk.M REROOF
3s„ Dnm Cuntracier
^� ARCHITECTS DECLARATION
i I understand my plans shall W used as puhlie records
�aU
-�� Licensed Poasmonel
3 OWNER BUILDER DECLARATION
40 0 1 masa ,(firm on I I. exempt from the Contractor's Cos :Any c Law for the
400 O following reason.(Section t 7(17 1.5, t,altar. and Improve,
de ons h.or:Any city s county
S$ which requires a permit m conswcL eller.improve,Jemnliah,or repair any structure
-ZT poor m its issuance,also requires the applicant for such Permit file a signed statement
ss�o that he is licensed pursuant to the provision of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Val uauon
'R (commencing with Section 7000)of Division 3 of the B usincas and Profession Code7or
Nat he is exempt therefrom and the basis for me alleged exemption.Any violation of 'Arc)2RO09 00
Section 7031.5 by any applicant for a permit subjects the applicanuo a Civil PCm1lty of APN Number Occupancy Type
not more man firo handled dollars($500).
❑1,as owner of the property,or my employees with wages as mels sale compensation,
will do the wok end lhes=,Sart is not intended oroRered for sele(Sec.7004,Business 305 RAMS
and Professions Code:The Conmctors Lianas Law does not apply m an owner of }�a�v,. Re uired Inspections _
property who builds or improves themon,and who doesmch work himselfdr though his 30 / — II N
own employms,provided that such improvemenm are not intended or offered for ale.If, f
however,the building or improvement is sold within one year of completion,the owner- 601 R a TEAR' /(y('�({}y�� AT
builder will have me burden of proving that he did not Wild or improve for purpose of 6 RO- 77�h��,,'77L���77Ym!!W,
❑1,a owner of the property,am exclusively contracting with licensed contractors to 6 f TE S
construct use pmjcet(Sec.7014.Business and Professions Code:)The Contractors Li. 6 N—P QJ I
Christ,law does not apply to an owner of property who Wilds or improves Ihemon,and l/Jl/r
who contracts for such projects with a contractor(s)licensed pursuant to the Contactors �a
License law. j
nn ne�m�'Iunder Sec. ,B A P C for leis reason /
er CJ ^ Date�/�
WORKER-SC MPENSATION DECLAR I
I hereby aRrm under penalty of perjury ore of me fo owing declarations:
I Ices and will mulatto a Cenifcate of Conant to self-insum for WorsecesCompcn-
sat
ion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as neyuired by Section
3700 of the labor Code,for me performance of the work for which this permit is issued.
My Workers C�mation l sunny c end policy number am:
Ca a � �ry No.: _
CERTIFICATE FEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not le completed time permit Is for one hundred dollars(SIM)
or less.)
1 cattily that in the perfomance of be work for which this permit is issued.I shall not
employ any permit in any mannerso as m become subject to be Workers Colopenution
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making Rats Certificate of Exemption,you should
become abject to be W(id eft Compemadma provisions of the Labor Came,you mum
�z forthwith comply with such provisions or this Permitahall be deemed revnked.
zO CONSTRUCTION LENDING AGENCY
1 hm ren
ereby affirm mole its Ra
comauninn lending Macy for e periu mance of
ythe work for which his permit is issued(Sec.3,97.Civ.C.)
Ya Lenders Name
1 z Ua&,iAddle•.
Q I ttnee that 1 have read Rajs city
and county
and cute Net the above iw miming to
y F Wilding
I agree c comply with all city and county ominanas and sun Iowa r Wing to
7 V Wmee-mconswnion.md hereby aumorimrposes tions of this to enter upon me
4 above-mentioned agree
to
for demnify an keep ea
(We)agree to ass.indemnify and keep harmless the City of Cupenit against
Z in
nunce of
cosuand expensasmit. may inanywyaccme against mid City
;)'z, in consequence of me gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
.+
SO EGULA S.
Re-roofs
5 u of Applicam/Coametoala
HAZARDOUS MATERIALS DISCLO Type of Roof
Will the applicant or future Wilding occupant snore oill2dihamundous onwards]
as defined by Ibe Cupertino Municipal Code.Chapter 9.13,and Ne Health ad Safety
Code.0Yes 25512(x)? "Na All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future building occupant use equipment or dcvicn which If a roof is installed without first obtaining an inspection,I agree to remove
is ha'raNnus air conumimmu as dcfnod by drc Bay Area Air Quality Management all new materials for inspection.
tinct?
0Ycs Nu
I have mal the hvamsms materialsrequimmenu under Chap¢r6.95 o(Jm Glifor-
niaHealthkSafmyCadeSecvoas25505,25533mdn53d.lundema ifthe Wilding
Jen not corsemly have a Hosts,does it u my mspommitity m notify IW oceupul of f
mquimmc which mustbematpriorso facenifeateofOccupancy,V61 /0 1% Signature of Applicant Date
o n r�d agent .�/ D;re — All roof coverings to be Class "B"or better
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. All the work authorized by this permit
B. A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
be ��vauacd
3. — I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: �w 2c� Date: lee, �6,
Job Address: .2012-Y Syi SuNr Permit# a�
I
Any changes to the information provided on this form shall be submitted to the City of Cupertino uld
• Department.
City of Cupertino Building Department
CITY OF 10300 Torre Avenu
CU PEI�TINO Phone: (408)777-3
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Recycled Paper
_� Community Development Department
Building Division
jCity of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U P E IST I N 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? / V/�yce 7-4
Job Site Address: gZO / 2 S S u1w Svc D/2,
Roofing Company N L�p& G F-
A plicant's Signa tt C/i.^� �� � DISW l o aoolo
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
J CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
i
Building Address
2 0 Z
Owner's Name: Phone#:
V111f C 1!7- A.1 7LL o2 9 -2 L—
Contractor: License#:
✓/IGc �� �o4L-T�
Contac : �7 Cupertino Business License #:
V AX Lt Yv2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Buih-Up roof
❑ Asphalt Shingles NR/ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O. Report#
�( To be Removed ❑ Provide Mfgr. Installation Specs.
• 1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
onn /
/2ENXuvirK9 cpopF/"rrLwVrJcn P;S
Residential 9Commercial ❑
TivsToLL
Fire Zone: Yes ❑ No '9K Confirmed with P a t. if
there are any res tons:
Cost of Proj Type of Constructio Occupancy gr t:
PzC—s' — AL
Qt-yjf
A lic b 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
• 0.3 ��-
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