03100129 Y CITY OF CUPERTIN0
I BUILDING DIVISION PERMIT CONTRA T RANFORMATION
Bu 1LDINGADDRESS: PETERSEN-DEAN INC PERMIT NO.03100129
OWNER'S NAME: 7980 ENTERPRISE DR PERMITISSUEDATE
T.TNT TjqTN-T RT AT,
(510) 494-9982 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
HIMELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Desc
Mu C I hereby affirm thin 1 am heensed under um, ions of Chapter 9(comm.ncing ,rips ji jon
w with Section 7M))o(Divolon ofln Btsie. (.,.ionic liceneris ttNl1LED
��Zin foll and of e�ft. 3 � �QF
Eifel.Clad LF. r
n Date Com oar
ARCHITECTS DECLARATION JAN 2 9 2004
I understand my plans shall W used a public records
eoG
Licensed Pmressional BUILDING
s S Oat I am exempt
from
DECLARATION
:0 0 1 naso ,((Efm o nl 1 ore exempt from Nc Contractor's License Low county the
o O following reason.(Section]031.3.Business and improve,
de i demolish.
Code:Any city nr county
e$ which requires a e.cels re construct,ober,improve,h Permit t or repair any structure
that hor niucensed purmarcquithe theapplicantfor sucContractor's
file
enseLaw(Chned mmcm
PFO< that mencingwitpursumHotheofDivisio of CaneComsinss ndProflaw(Choptn9 Sq.FL Floor Area Valuation
Chat he is(commencing Section andaxi t f basis
3 of the alleged
exempt on.Any
Cook)or
Net he is exempt therefrom and the base for the altegcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollar.($500).
P Y YP
❑1,ex owner of the property,or my employees with wages as their sole compensation,
will do Ne work,and the structure is not intended or offered for sale(Sec.7014,Business
and Professions Code:The Cnntracmri License Law does not apply to an owner of Required Inspections
property who Wildsor improves thereon.and who dassuch work himself or through his
tun employees,provided that such improvements ire not intended or offered for sale.If.
however,the building or improvement is sold within one you of completion.the owner-
builder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
(:)1,as owner of the property,am exclusively contracting with licensed contractors to
consume(the project(Sec.7044,Business and Professions Code:)The Contractor's Li. .
cense Law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with o eontnctor(s)licensed pursuant to Ne Contractor.
License Law.
O l am exempt under Seo. B&PC for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affiant under penally of perjury oro of the(allowing declarations:
1 have and will maintain a Certificate of Consent to selGimum ror Workers Camped.
sation,a provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
]00 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Polity number me:
eerier.g'i Q�.'nA^- Policy No.:O3 94 213 6 0 0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the Permit is foronc hundred dnilan($11111)
or less.)
I candy Nm in the performance of the work for which this permit is issued.I shall at
employ any person in any manner an as to become subject to tM Workeri Compeaatlon
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:Ir.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
D O forthwith comply with such provisions or this Permit W deemed revoked.
h CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there is a convection lending agency for the performance of
Y� the work fur which this permit is issued(Sec.3W7,Civ.C.)
1 A Lender.Name
5 Z Landers Address
Q I certify Nat 1 have read this application and scale that the shove information is
y F coned.I agree to comply with W city and county ordinances and some laws misting m
�U Wilding comwction,and hereby..Chari.mpresenutives of Nis city to enter tined the
W above-mentioned properly for Inspection ptrpaYb.
(Wc)agree to save,Indemnity and keep hareleaa the City of Cupertino against 1
�(a/] liabilities,judgments.costs and expenses which may In anyway seem against said City
J rF,l incousequenecof Negrant fthispermit.
APPLICANT UNDERS oS PND PLY W AL;NON.P NT Issued by:942zDate
SOURCEREGU 1
�/I- V Re-roofs
Signature of ApplicartiContrxmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building=open,store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(.)?
❑1a �"a All roofs shall be inspected to any roofing material being installed.
Wi It the applicant or future building oceupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i
t,Wvardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
snict7t]Ycx �Nu ��ZIhavemad Nehavardnusmaterialsrequimme 55underdusear thatifthe Calding s neth&rentlyCodc .edam 8505.2553 d25534.1undcrsmntlNatifthe huilding i6 Qs not cumcntly h mnapt th i pomthili t n.til' lbe acupwt of Ncmmcnks art sea ore r eoolUpe/ / Signature of Applicant Date
or amonaed agent rime All roof coverings to be Class "B"or better
Community Development Department
f Building Division
'=1 City of Cupertino
C•{LL��� 10300 Torre Avenue
, I CITY OF
Telephone: (408)777-3228
V P E T I N O Fax: (408) 777-3333
"t.
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. O
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:
Job Site Address: .Z 2 9 6 5J�—�-
Roofing Company Name: d�GP�LLd..���� - �o'"
Apee
licant'sSignature: Date:
Greg tl
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF r'
CUPERTINO PERMIT APPLICATION FORM
APN# `�, Dr C D Date:
j �
Building Address:
2 Z 76 5 w,Yv Gam_
Owner's .Name- n / Phone#: 7 3 IF
-.1`l , � `y
Contract . Phone#: License#:
�� _ a�t C_ S/o q9�- 9q �Z 4G & 117
Contact: Phone#:� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _�e Asphalt Shingles
j8: 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 D scriptio • op
T o a.�I ee. -
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if.
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
l� coo . oz
Qty. if
Applicable 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
2 3S?' `f
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