04050002 CITY OF CUPERTINO /-s 'p{' � �j 7�'
BUILDING DIVISION PERMIT VQNT� 0RJI.4 �RMATT�L\ '
eta ILDING ADDRESS: MBROWN CONSTRUCTION, INC PERMIT NOO4O50002
OWNER'S NAME: PERMITLSSUSDATE
JERRY
ONE: SANITARY NO. CONTROL NO.
408 26 -
I
CHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
LICENSEDCONTRACIOR'SDECLARATIONIobDescri tion
1 hereby affirm Nm I am licensed under Provisions of Chapter 9(commencing PhSection,jWI�1 of DivisionJof Ne Buainus Pmfca'ns CNk y en.'am�maafee Ip$"'L' REROOOF
nn Z Li emu CI /'' Lic.p
:1 Dalc C,mrw o
QQ ARCHITECTS DE RATION /
3 1Polesund my plana shall he usetl pe public ocnNs
Pmfcr
G: Licensed ional
S OWNER-BUILDER DECLARATION !
1 hereby'mere that 11. exempt from Jw Contractors License Law forthe
O O fallowing reran.(Sectiun 711313,Businrs and Improve,
de ions Code:Any city m county
which in issu a permit re requires
altee improv,demolish,or rtpnig any structure
Fiprior in issuance.also requires the applicant forauch permilm RleaaigneJ statement
s< thmmenciingwi Scctinttnthepmvialonsofthe Conuacmrind NocsionC.de)or Sq.Ft.Floor Area Valuation
tt$ that W is exempt
therefrom
sed basis for of the B ed exemption.
M vi Cade)per
y 3 that he is exempt thertlrom and the aper far the alleged exempnt 10 Any l Penalty
of
Section to. by any applicant fora permit subjects drt applicant m a civil penally of 3 7P &*crO 0 Occupancy Type
not mom Nen five hundred dollen(SSW).
❑I,as owner ofthe pmpnrty,or my employees wire wages as their sold compensation,
will do the work,and thesuucture isnot intended aro@red forsake(Sm.7644,Business
and Professions Code:The ConuacWrt Lica•on Law dors most apply b an ower of Required Inspections
property who builds or i mproves theroon.and who does a uch work himself or through his
man employcns,provided Nal such improvements am not intended oroRued female.If. _
however.the building or improvement Is sold within one year of complexion.the owner-
builder will have the burden of proving thm he did not build or improve for purpose of
sale.).
❑1.as Owner of the property,am exclusively contracting with licensed ennaaabrs l9
construct the project(Sec.7614.Business and Professions Cade:)The Convectors U.
cense law dors not apply to an owner of property who builds at improves thenen,and
who contracts for such projects with a eonuactoms)licensed pension,to the Con mictoh
Licun cmmn.La
I
❑ pl under Sec. ,B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby airmen under penalty of perjury one of the following declarations:
I have and will maintain a Cenifinte of Consent to wif-umme for Worker's Compere
7037"�D)
non,as provided for by Section 3700 of the labor Code,for the performance of the
rk for which this permit is issued. �
1 have and will maintain Worker's Compensation Ia urana,as required by Section
of the labor Code,for the performance of the work for which this permit is hawed.
yWorkersCom ea0 InsuranceeerierandPolicynumberam:
,��� EXEM/ CERTIFIC COMPENSATION
OSURAM WORKERS'
COMPENSATION INSURANCE
(Thr section need not he completed Elba permh Is farane hundmddollan($]W)
or hos)
1 wo fy that in the performance of the work for which this permit is issued I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceniftcate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
.J O farNwith comply with such provisions or this Permit&hall M doomed mvokcd.
ti
CONSTRUCTION LENDING AGENCY
'ken 14i l hereby affirm that there is a construction lending agency for the Performance of
!Yi 7 da,work for which his permit is issued(Sec.309'(,Cih,C.)
QLenders Name
r7 z Lenders Address
J Q I cerdfy that 1 have read this application and soon Wa the above information is
D. P correct.l agree to comply with all city and county ordinances and sou laws retailing in
OU building construction,and hereby authorise mprexmasives of this city to enter upon the
above-mentioned Property for inspection purposes.
(we)agree to ssw,indemnify and keep harmless the City of Cupertino against `
can' liabilities,judgment.costs and expenape which may in any way acemc against mid City (J
(„)'Z in consequence of the granting of this Permit.
^ APPLICANT UN ERSTANDS AND WILL COMPLY WITHAL NQgNN-POINT Issued by: Date
SOUKCE REGU A S. YL/p(/
/ •J Re-roofs
u'a of IinnVContrector Date
HAZARDOUS M ERIALS DISCL RE Type of Roof
Will the applicant per
if
building occupant store or handle havardous material
as defined by the Cupertino M p&I Code.Chapter 9.11.and the Health and Safety
Code,section zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yr
win nn appncenl or mmm building attapam use equipment or acetate which If a roof is installed without first obtaining an inspection,I agree to remove
mb nanNnaa air aonteminana fi
❑Yea Noned by the Bay Aro Air Quality Manegcmcnl all new materials for inspection.
District
Ihave mad the hau amaterials requirements under Chapter 6.95 of the Califor.
nis Health 6 SafctyCodc,Scca ns 25505,15533.,1255U.l undermod lhatifthc building
does not currently w a tecta Nm it is my resparibility w nudly the wcupam of the / \
requ' mcnuwhi ust t 'orwissuanccofaccoiftelco opener. Sig atureofApplicant Date
u7ma
Owner per aul orized agent Data All roof coverings to be Class"B"or better
Community Development
*00F
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS,/ ^ �-/ 4U hyo HERMIT #
()yo5-
00-2-�
OWNER'S NAIL: c It K PHO #
GENERAL CONTRACTOR: C611 b FAX # a Z G
G,
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 �✓ c
Septic Tank
Sheet Metal
Sheet Rock
Tile `
aVZContra or Signature -DAte
t
Community Development Department
Building Division
- r 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.
A 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: �eX 1�f��
Job Site Address: S 01:51 y 46) &Y—Ic– 06"J p
Roofing Company Name: ✓� C V C (fW "–
A plicanfs Signature: Date: f=
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
l
1 CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# S C?> 9
Dater O
Building Address I
v O G2,
Owner's Name: `� �� Phone #c 253. 5
Contr c rc3w� s 4— UPh ne#: G Licg 1 0 z,
Contact: _ P e Cupertino Bu ness License#:
its 2i�o--12_o0 10
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
J Wood Shakes ❑ Wood Shakes
❑ W�od Shingles ❑ Wood Shingles
Ja—Other(Specify) /_rz� ❑ Other(Specify)
Number of existing coverings 21 ❑ 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: _ �� " _.
Yl nE ¢� E D s D X51 + • 41
Residential I ICommercial ❑
Fire Zone. Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Pr i e tf a Type f Constru 'on: Occupancy group:
t0
Qty. .
A c 'ble Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING