04040202 BUILDING DIVISION PERMIT ,uaR X�iFOtMA'T.'xU�.
BUILDING ADDRESS: PERMIT 1304.040202
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO, CONTROL NO.
ARCHITECNENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
uop LICENSED CONTRACTOR'S DECLARATION
y�+F 1 homey affirm that 1 am licensed m . .d Prooas of Chapter 9(commencing Job Description—
I NAL E D
with Section o thatIa the Bueinder pr Professions oeypdcommenci is F
^ 0 in full fame and effort. (l REROOF
j$Z Lien nsC Class LIC.p
Z; Data cu newt CONTRACTOR: J W ROOFING
qq ARCHITECTS DEC AT
I understand my lens shall he used as puhli mcoNs NOV vg 2004
01!U
I' Lieenmd Professional
S OWNER-BUILDER DECLARATION BUILDING
u I L D I N
<� I hereby affirm that I am exempt from the Contractor's License Law for the
Co following massa.(Secuun IDnstr Business and rm(deioli Co de:Any city or County
$ which myuires a permil m cnnavuct,altar,improve,demolish,or repair any swcwrc
1to: prior to its issuance,oleo requires the applicant for such permit to file a signed Mnmmn
pNat he is licensedpursuantmtheprovisionsortheContractor'sUcenmLaw(Chapter9 Sq.Ft.Floor Area Valuat"800
(commencing with Secron 7000)of Division of the Business and Pmfcuinrm Code)or
3$ that he u exempt dmmfmm and Ne basis fes 0e alleged ammptlon.Any=of
Section 7031.5 by say applicant far a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not mem than five hundred dollen(S50(1). 36914007 . 00
❑I,as owner Orrin property.in my employees with wages a their sale compensation,
willdo the work end theswclum is notimended oroffemd forsale(Sec.7044,Bueinns
and Professions Cade:The Conhmmr's License Law doe;not apply he an owner of Required Inspections
property who Wildsorimprows thereon,and who doessuchworthimselfor Waugh his
awn employees,provided Nat such improvements art not intended oroRend for sale.If.
howevea Ne building or improvement is sold within one year of completion,the owner.
builder will have Ne burden of proving that he did not build or improve for purpose of
orale.).
❑1,as owner of Ne pmpmy,am exclusively containing with licenaed contractors to
construct the project(gee.7044,Butinrss and Professions Cade:)The Contractor's Li-
cave Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)liceved pursuant mute Convectors
Lice.Lew.
❑I am exempt under Sea ,B&P C for this mason
1371M
wner Date
WORKER'S COMPENSATION DECLARATION
1 hereby efhm under penalty of perjury one of the following declarations:
I have and will meimen;n a Cenifcmc of C...at to self-amm for Wmkdts Compton.
dan.ss provided for by Section 37110 of On labor Code,for the performance of the
rk for which this pemiit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
of the Labor Code,far the performance of Ne work far which this permit is issued.
yWorker'sCompensation Insurance esrtur and Policy u be am:G1�c FUf `
rtier. Policy No.
A CETIFCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not hd completed if the I amtit Is portion hundred dollars(SIM)
nr In..)
1 certify that in Ne 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 Iheworken'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:It,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of thd labor Code.you must
.JO faMwith comply with such provisions or this pcnnilshell M deemed mwoked.
.Z.t 55CONSTRUCTION LENDING AGENCY
[+ I hereby affirm that there iso cmvwction lending agency for Ne performance of -
!�r7 Ne work for which utia Permit is issued(Sec.309'1,Civ.C.)
6Wi Q Lender's Name
z Lender's Address
U Q 1 certify es that 1 have read this application and sun that and
above informationting is
t" bonding I agree to comply with all city and county ordinances end sou laws calming to
U movengconswetion,and hereby anthodaerposemnutives of this Illy in cater upon the
Loa shave-menuondd property for inspection purposes.
g1, (We) me to rave,inddmnify end kelp harmless the City of Cupertino again+( is
n„y II ilitiea'u menta,costs an which may in anyway accrue against said City
(„)'z in nae a of the granting of this permil.
^" AP I UNDERSTANDS AND WILL COMPLY WITH ALL NON-P01 Issued by: Date
R GULATIONS.
Re-roofs
Si tomo ApPlicanUConOr em
HAZARDRD OUS MATERIALS DISCLOSURE Type of Roof
Will use applicant rm future building occupant scam or handle Beside and
lDishh,0
ed by the Cupertino Mdnicipal Codd,Chapter 9.12.and the Health and Safety
d coon 25532(¢)? y All roofs shall be inspected prior to any roofing material being installed.
C3 Y., Nu
Will the applicant or fuwrc building acupent vu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air canuminnu as defined by the Bay Area Air Quality Management all Be ¢rials for inspection.
❑Yds u
ave mad Ne hara nus manrelsmyuirements under Chapter 6.95 of tin Cilifor.afcty Code,Sa:uons 25505,25533 and 25534.I unctatsnd thm iliac building
not buy ham a¢nano Net It u my rcserommility to nnuly the axupant of Nal q
u0 which mustWMet P60TWhonoree OfACertifcatc iumyy. ,S nature of Applicant Date
O/J
ow or mo x asbm Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
.i% Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�•UPEkTINO
Building Depqjlnent
JOB ADDR p J PERMIT # D 0
`/ O
Q V C h (
OWNER'S NAME: PHO
GENERAL CONTRACTOR: 3AA FAX #
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
Septic Tank
Sheet Metal
Sheet Rock
T41e
r/Contractor Signature Date
Community Development Department
Building Division
Yurs'"� ' City of Cupertino
: 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
4UPEkTINO
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.
C I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: cl AVE C'L�V
Job Site Address:
Roofing Company Nam )AJ& 1(�
A plicant's Signature: Date: y�OLr
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO0
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: aye,
Building Addres : • 113
Owner's Name: 1 1 (� 4 / Phone
Contractor: �7�JT n I /o `t J Phone#: License#:
Contact: ,U Phone#: 14M ]q Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
^LT Asphalt Shingles A Asphalt Shingles
O 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: ❑
Job Descriptidnpefflue
kd-
Residential ❑ ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
6picue
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
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