06010123 CITY OF CUPERTINO - a 'r '`'''
BUILDING DIVISION PERMIT CONTRACTOW NFORMATION
BUILDING ADDRESS: LOS GATOS ROOFING PERMITNO.06010123
- 7535 WATERFORD DR
OWNER'S NAME: PERMIT ISSUE DATE
JOHN LUCAS 888 FAULSTICH CT 01/23/2006
NE: SANITARY NO, CONTROL NO.
(408) 298-9399
ARCHITECryENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�Op LENSEDCONTRACTOR'S DECON Job Description
uC 1 hereby affirmmNat 1 am licensed under provisions
ons of o(CChapter 9(commencing P
W with Section 7000)of Diviaion3afdxc Steincssand Professions Code.and my license is
imm�romeander t w REROOF-T O SHINGLES, INSTALL 7/
16 "OSB";�? License Clues Lic.« 3 Q O
sec Dalc__t=LX Q�_Coslr,norl�� 7t`s� ROOFERS SELECT FELT. INSTALL PRESID. SHINGLES
RiR� CHITECTDECLARATION
1 understand my plans shall W used az public ecords rkpNP77I,' ''Pp{3I
C m Licensed Professional
OW NEm exempt
DECLARATION
COO Wrchy affirm o n 1 am pxcmpl from W eaxom Coale:
e:Any
Law for lW
iCOO followingmason. ertion 783stru t,altCazand ve,deinosCWc:Any city scounty
m which requires a Pcnnil to construct,alcor.impmm,dcmolisA m repair any srmdum 1 A nl _ 700
N
c prior m im issuance,also requires We applicant for Such permit to file a Signed sralernnm _. .-,
< at he is licensed pursuant to We pmvisimus of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area `WIuati 1873
'H� (commencing with Section 7[11Q)of Division 3 or the Business and Professions Code)or
i Nal be is exempt therefrom and the,basis for We alleged exemption.Any violation of I I �f !f}1 LId1 t sg
not
Want five
any applicant for a pertnh subjects We applicant m a civil Penalty of APN Number P hs y/pr L q 06c6paii6y Type
oat mom Nan fico nandma donna sena 36617023 . 00 �/❑ L✓ u u V
do We work,
Ne proPeny,mmyemployc"withwagraas NeiSce.cd14.Box.
will Prllework.and Inc he C.munotintended Lea,does
re, ($cc.7044,Business
and Professions Code:The Convacsors License taw docs bol apply or an owner of Required Inspections
property who builds or ed Oat suthereon,and who are
work or offered
ed for Wn his
own employees,provided Nat such imprommw t are ne intended of m o@red for sale.It.
builder .We building orimpmmmenliscold withinone year of completion,Weowner.
of
builder will haus We burden of proving that he did nm Wild or improve Ire purpose of
rakJ.
1,as owner of the Propeny,am"elusively contracting with licensed emaracors to
construct We pmjecl(Sec.7044,Business and Professions Cade)The Conuacmr's Li
ecrese taw does not apply b an owner of property who Wilds or improves Nemon,and
who contracts for such projects with acontracwr(s)licensed Pursuant in We Canuactor's
License taw.
❑l am exempt under Sec. B A,P C for Nis rcawn
wner Data
WORKER'S COMPENSATION DECLARATION
1 amity affirm under penalty of perjury one of de following declarations:
1 have and will maintain a Ceturicam ofConunt m self-insune for Worker's Comport.
.arm.m provided for by Session 3700 of W tabor Code,for flue,Performance of de
work for which this permit is issued,
❑I have and will maintain Wurkees Compensation Insurance,as required by Section
3700 of We labor Cade.for the performance of We work for,which this Permit is issued.
My Worker's Com load Insurance eanierand Polity number am:
Cartier. S Policy No.:'Z7 -2a�`
CERTIFICATE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed not W completed lithe permit is for one humd cddollars(SIM)
or loss.)
I ccnify Nat in We performance of We work for which this Permit is issued.l shall not
employ any person in any mannerso az to become subject to lW Workers Comp"vden
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
become subject m Ne Worker',Compmundon provisions of the labor Code,you muse
.JO roMwim comply with such proviaiou or this permit shall W deemed cooked. -
zy CONSTRUCTION LENDING AGENCY
[-+ Ihembyaffirm
the worNat Nem isaeat¢vuclinn lcntling agency fm the performarmc of
C4 A k for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name
4s lender:Address
�;) 2
U O 1 certify Inn 1 have mad this applicadon and sone that We above innernadun is
D,t-' CWICCL I agrte b comply with all city and county ordinances and sone laws reining to
OO Wilding cowrvuetion,and hereby authorize representatives or this city to enter upon the
H 4 above-mentioned property for inspection purposes.
(we)agree to um.indemnify and keep hasmleas the City of Cupenino against
f/1 liabilities.judgments.costs and expenvs which may in any way accme agairut said City
U Z in eonuquence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ,•r
SOU�REGVT19�
Signature of Applma
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Date L
Type of Roof
Will We applicant or rulum W:tiling aecupml nom or handle hazardous mammal
az defined by Ne Cupertino Municipal Code.Chapter 9.17,and the Health and Safety
c,SC yes 25532(a)? All roofs shall be inspected prior to an roofing material beim
❑res 6lNa � P P Y g g installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building occupant tau equipment or dosis"which g agree to remove P
it hazardous air camsminants as defined by We Bay Area Air Quality Management all new materials for inspection.
ovist?
❑Yes S40
1 have mad We hvardmtsmvenals"I irements under Chapter 6.95 of the Califon
ma Health&Softly Code,Sooders$N15,25533 and 25534.1 understand Institute Wilding
docs not currently ham a tenant,Nal it o my responedolily o nodec
(y We pup rt or We
coq . ntswmm usWmet pnmmissuanceonCerdfic,moracapancy.
Signature ofApplicant Date
Owner ar,uthorixodagent D,m — All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
-%' Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: 7J 31` U/g 0 PERMIT#
464/`/23
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR 4 f 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
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY O-g-Fe Telephone: (408) 777-3278
CUP[k1 5 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 sip 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 dozen 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 policyon re-roofing.
Homeowner's Name: J�7D�k,r) /L't,t c- a-,s
0o k-
_ --
_Roofin Com an Name ` — •a'
A plicant's Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO / 2
. &CITY of EROOF O �' `� l �, 2-
CUPEkTINO PERMIT APPLICATION FORM
FAPN#lding Address:
ner's Name: Phone#:
Vh. Lam« s a 70� ziiG
Contractor: C &Phone#: 4-0-T License#:
�00 Jo
Contact: �— Phone#: Cupertino Business Licen e#:
Ile aSairr��
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles -/E� Asphalt Shingles
Wood Shakes - - ❑ Wood Shakes
Wood Shingles O Wood Shingles
❑ Other(Specify) Other(Specify) G S 3
Number of existing coverings ❑ Provide LC.B.O.Rep ,
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 7 With Cu ertino's Tear Off Policy:
rResidp-nti
cription: �L 7 o s r
T�
Commerciale: Yes ❑ Na Confirmed with Planning De t.
there are any restrictions:
rg4ect: Type o Constructi Occupancy group:
732 , o
Qty. if
A licable Fee ID
Fee Description Fee Grou
" BPERMFEE Bldo Permit Fees
BUII DING
BENERGY
En= BUILDING
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BPI ANCHK__.--•-•-„---_.__._. __.Plan Check Fee —
BUSLICBUILDING
Business License BUILDING