05110030ip CdC
lto
�
'ta,,
>q
aa'4
i
gat
N_
�pC
3$e
Ya•e
4
O2
z
V
tri
R. G
U C
UC
OF
Fo
U2
CITY OF CUPERTINO
PERMITCL1NTRt1CTQR
INI+'ORMATION
BUILDING DIVISION
BUILDING ADDRESS:
JNSJ ROOFING INC
PERMIT NO. 05110030
OWNER'S NAME:
PERMIT ISSUE DATE
DE ANZA PROPERTIES
NE:
SANITARY NO. CONTROL NO.
4082796171
A0.CHrtECT/ENGINEFA:
BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
IOb Description
r 9 (comenng
nder Provisions Chapemci
bcmbY affirm that 1 am liceemd uions o
with Section 700) of Division 3 of the Business as Prorussiov Cone, W my licence u
�i«ll�nC1naeHeCL C3 % bD
REROOF-REMOVE CAP SHEET, INSTALL
g
Dam con
4 PLY CEP BUR SYSTEM
ARCHf1E(.TS CLARAT
1 understand my plans shall he used u 'c rmnNa
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contmctors License Law for Ne
i following moon. (Section 703 1.5, Bandanas and Profassev Cock: Any city or county
which mquires a Permit to commuct, almr, improve, demolish. or mpwr any suunum
prior in its issuance. also soquirca the applicant forsuch permit to rile a signed summenl
Nat he is licensee Oe the Conuacmr'n License Law (Chap. 9
Sq. Ft. Floor Area
Valu#gig O O0
pursuance previsimucif
I monsmencing with Section 70007 of Division Sof Ote BuvKesand Professions Cae)or
Nat M It exempt tlemfrom and the basis fee the alleged eaampdm. Any violation of
APN Number
Occu ane T e
P y YP
Section 7031.5 by any applicant per a permit subjects the applicant to a civil penalty of
not more than Bwhundred do]].(0011).
36902027.00
❑ I, u ownerarOe pmpwy, or my wploym with wgu u thevmlc campewuon,
Required Inspections
Tortola(Sec. 7044,
ands:
came, o•
Law data net apply 1f rt came, or
he CombtmtNuaed, Law On
sena nae: Th
and Professions
wsOurem, nMenu
ertywhions
wan aensmnwork nimxlrar through his
owpm employees. Providedhimnaa
own employes,provides Natovenimprosoldwi are not inuaedaroRna
Oat such
yearof mprove M.for Ne owe
0. owner. bawewame
or snldwdid
wan of
builder will Nve ale burden of proving Nat rte did ms build m improve for purpose of
illnow the bud. of proving
rygys,
tab.). -
pTW 4Al
❑ 1. u owner of the propenY• am eaclobvcly cmuaming nth based mnuanon m
.y
fU//[s�"s@}Tj`'
RNA
commun the project (Sec. 7044. Bnsismss as Professions Cade:) The Cmua um`3 U.
Moose Law docs out apply to an owms of prope tywh, builds or improwes Racoon, and
who contracts for such promo with a comnsun(t) reeved pursuant to the Contrscmrs
License Law.
/w
FEB 9 7nnlj
Iamcmp amer Sec. as
a ,BAPCforthismun
Owner Dau
{t ��rjjj t( j}•�.� b +`, a4',
� jj l� tl N T }. N f��
WORKER'S COMPENSATION DECLARATION
I hereby aRum under penalty of perjury one of On following declarations:
t'r�a.+fj')1lll )jL`�DL✓p 1Y(!f
I haw and win maintain aeereificamof Covent N self-ivum for WorkersCompen-
satim, as Provided fee by Section TIM of the Labor Coe. for On Performance or the
worst for which this permit is issues.
❑ 1 have and will maintain Worker's Compensation Insurance, aa rt coned by Section
37W of the Labor Cede, for Ne performance of Ne work for which this permit is iasml
My Workers Compensation rami canine and Policy number am:
Cartier. 9104- Policy No.:
C F1 OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuaccdnn need nothe completed if the Permit Is formic hundred dollars (5100)
m, )
1 Roby Nat in the performance of the work for which this Permit Is issued, 1 shall not
employ any person in any mmncr u b �mcs 'ectmtK Worie4' CompevaOon
'!
lows of Califamiu Dau 1a 0
Applicant
NOTICE TO APPLICANT: If, fict,nialcing, Ok Cci ificau f Exemption, you No d
benne auhject m Nc w0r ri C pcnsauan p visions ser Nc Labor Cade. you
• forthwith comply with sten provut or Nu permu Nall he deemed new
i CONSmisac ON
• 1herrwha1Drm Nato( issed(Secu30boding agency per Oe pertorman¢of
' tic woh for which this permit u issued (Sec. 3091, Civ. C.)
Lenders Name
Lenders Address
1 certify that 1 have mail this application and sum that the show information is
' Comm I agree m comply with all city as county oNinances as sum laws relating m
building construction, and hereby auNone, mpresenutives of this city to enter upon Ne
I
move-mcnudgm property for inspection puriowhich
(We) agree to save. Indemnify and keep h ornicas de City or Cupertino against
a
j may In any way mcroe agaivtsata City
incosome,uudgmenhemsuana ofPenscsmit.
A PLIC ueme of the granting of Nu permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale t/ -?-6
SOURCE REGULATIONS.
Re -roofs
SignatumafApplic_HAZADOUSMATERIALSDISCLOSURE
or Dau
Type of Roof
Will the applicant or future Wilding =upset some or hares a ha chn ons material
u dcfimd by the CupcNm Municipal Cade, Chapter SAL and the Health and Safety
cede. Sce,im 25s3z(a)?
❑Yes p.He
All roofs shall be inspected nor to an roofing material being
P P� Y g g installed.
Will On 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 havartlnns air commuranu u defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
Oyes GlAu"
IhawreseldehsasrEmsmaurials mquiromentsuocr Chapw,6.95ofOe Califar
'
palinal @Safe, CaM,Sttuons25505, 2S53J and 25534.1 unders�ndthatifthc building
docs
cot y are a anon m .,.in m noul'y the aeupant of Nc
roquim uwvh' 'prior no issuan Cwficate ofOcmpancy.Signa[
re of Applicant Date
%I oS
roof coverings to be Class "B" or better
owner gra ari>edagent Dau
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
16150 "nowt �.
PERMIT
� /�o 03 G
OWNER'S NAME: Tc. A�,u (n
PHONE # Y68)2 -7y-4/7/
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors: 1 t 7 ro j
gnature Date
Please check applicable subcontra ors and complete ollowing information:
•
Contract r Si a
1t�7�QS
Date
SUBCONTRACTOR
B INESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
I
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Contract r Si a
1t�7�QS
Date
�CITY OF
UPERTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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.
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: C K&tf "A CAr"ki
Job Site Address: 2 6 1 TO 'TorNe Av-0- ,
Roofing Company Name:
Applicant's Signature: Date: li o5
isGreg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Seam
CITY of
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
OP//003 0
APN#
Oo17 Date:
Building Address:
tdiso 'Fcvre. Ave,
Owner's Name:Phone #:
-1X ?" j 73 8 -'f"f
Contractor: Phone #: License #:
� tJSJ gea �c . (�o8j 27Y-617/ 739980
Contact: I / Phone #: „ Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
T Built -Up Roof Q- built -Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: G3-
Job Description: Nwv,�+- (e) cerSk-'t rakj /'�� » 4r`1 0 B Sjfiew.
Residential E�r' Commercial 0
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:/ Type of Construction: Occupancy group:
0 00(�r—
Qty. if
Avnlicable
Fee ID
FPP IiPcrrintinn
Foo Cl.
BPERMFEE
Bld Permit Fees
BENERGY
Energy
BSEISMICRE
Seismic Fee Res
=BUILDING
BSEISMICOM
Seismic Commercial
BPLANCHK
Plan Check Fee
BUSLIC
Business License
Qty. if
Avnlicable
Fee ID
FPP IiPcrrintinn
Foo Cl.
BPERMFEE
Bld Permit Fees
BENERGY
Energy
BSEISMICRE
Seismic Fee Res
=BUILDING
BSEISMICOM
Seismic Commercial
BPLANCHK
Plan Check Fee
BUSLIC
Business License
677.6/