04040165 CITY OF CUPEWfINO °� �•h =
BUILDING DIVISION PERMIT p CON TRACTOR INPORMATION:
BUILDING ADDRESS: JIM KRAUSE ROOFING PERMIT NOO4O4O165
01 WATERFOR� DR
OW NER'S NAME: PERMIT ISSUB DATE
RAYMOND TANG 2310 DIANA AVE 04/2r,/2004
ONE: SANITARY NO. CONTROL N0,
408 779-0704
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
it O p LICENSED CONTRACTOR'S DECLARATION ,
I hereby affirm that I am licensed under Poviaiof Chapter 9(commencing Job Description
Z� with Section IIxxp of Divixion3 of do Busi `I and Pmf mme
cssinnsC nntl an
sc
^mow LD full(nrec and eel. as
yz uccn.o Cla:a �% Q a REROOF
n tFq p Dam ARCIIITECTS DECLARATION .55
kv a u I understand my plans shall W used as Public records
D y Licensed Professional `Z^•I/'
g OWNER-BUILDER DECLARATION
E a I hereby nf0rm That 1 nm exempt from the Contractor's Limnac Law for the .
IS o following reason.permit
]onstr,Business and Professions Code:Any my eternity
K m which its acquires a permit tri cures th. elle!,improve,demolih permit
care Pair anyomerru2
thatheor its tensed pursuant
nt tot ethovisio som husuch Law
statement
g <
Rcrn
rnme licensed Section 7000)ofmannannnecnmmemrsuanaesswsCodm9 Sq.FL Floor Area Valuation
y rcFo (co meriting Section and of Division 3nf doeged ssmtlns.f nyvisCMc)or -
i
that he is exempt therefrom and Ne basis for de alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penally of 3 Fi+6147tahBerO 0 OccupancyT e
not more than five hundred dollars P1500).
YP
❑I,as owner of the pmpcny,or my employees with wages as their,sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply o an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the awner-
builder will have the burden of roving that he did am,Wild or improve for propose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct 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 improvas transom and
who contracts for such projects with a contracloohd licensed pursue ad to the Com actors
License Law. -
❑ l am exempt under Sea ,B&P C for this reason
Own Date
73101WORKER'S COMPENSATION DECLARATION
1 hereby af0rm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Current to self-insure for Worker's Compen-
M
ion,u provided for by Section 3700 of the labor Code,for de performance of the
rk for which this permit is issued.
T have and will maintain Worker's Compensation Insurance,ns required by Section
of he labor Code,for the performance of the work for which this Permit is issued.
Workeri C(m uon Insurance carrier and Policy number art:
rriee ✓ Policy No.: 2-ft —0q-! �I
CERTIFICATE OF EXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the Permit is fmone hundred dollars(Sloe)
car I.,)
1 cenify that in the performance of do work for which this permit is issued.I shall not
employ any person in any mannerso as to become subject to the W_ orkera Compensation
Laws of California.Date
Applicant .
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,JO forthwith comply with such provisions or this permit shall the deemed evoked.
ztZ8 CONSTRUCTION LENDING AGENCY
[—t I hereby affirm that dare is construction lending agency for the Performance of
!Yi c7 de work for which this permit is issued(Sec.3W7,Civ.C.)
W Q Lender's Name
Z Lender's Address
U p 1 cenify that I have mad this application and sum that theabove lot. tied is
W(~ comed.]agree to comply with all city and county ordinances and slam laws relating in
pU building construction,and hereby authorize representatives of his city to enter upon the
W L} above-mentioned property for inspection purposes.Ty DA)agree to save,indemnify and keep harmless the City Of Cupertino against
fy lin liabilities,judgment.costs and expenses which may in any way accrue against said City
in conuyucncc oft cgranting of this iI.
APPLICANT U RSTAN ILL C LY NYfHSOURC ANT❑ RSTAN ILL C LY ALO 1� Issued by: Date
SOURCE RE ATIO
° Re-roofs
Signature of ApplicanpC.ntucmr Detc
HAZARDOUS MATERIALS UISCLOSU RE Type of Roof
Will the epplicem.r fumrc building occupant sort or ha le harardous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Codc,Scenes 25532(a)7 All roofs shall be inspected prior to an roofing material being❑tion �j.� P P Y g g installed.
Will the 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 hazardous air contaminants as deftncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑tics C� II
(havc mad the hazardous materials rcyvimmenu under Chapter 6.95 close Califnr f
nit Hcalth&Safety Codc,Sections 15505,25533 and 15534.3 understood datifd,building ,G C a
docs not currently havc a tenant,that it is my respmsihility m nntily tW oeeu ant of the T
rcyuiremcnu whi muslbedompdor suanccof crdficamofoemi Signature Of pllcant Date Signature of plicant Date
•, °
Owner. g Dale - All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
�k y Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Suildin De artment
JOB ADDRESS: PERMIT#
OWNER'S NAME: k PHONE # •qO o(-' 7 79-070 'FGENERAL CONTRACT FAX #
)C I am not using any subcontractors: ZG °
Signature ate
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESSNAME 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
O�rn
er/Contractor Signature Date
10/28/03 L i
I ,
m �
s
� Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4CITY OF Telephone: (408)777-3228
UPEkTINO 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.
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: -'/ 'L,
Job Site Address: 7 6 0 1 LJ q_�,� �
Roofing Company Name: ci
A plicant's Signature: (`-� Date: 16 0'f
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTiNO PERMIT APPLICATION FORM
--XP—N# 3 C. C9 .� l � — � -'J' D
Building Address:
6 0 l tAD
Owner's Name-^ Phone #:
7 -7
Contrac r. _ hone#: 719-0 7 o License#:
y
Contact: y/ Phone#: Cupertino Business License#:
3J517
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesA1C Asphalt Shingles
Wood Shakes b Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
^YN mber 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:
J Job D sc 'pt' n:
o - o s >s. a�� 3 w Sd
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: u
Cost of Project:o, Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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