05040092 CITY OF CUPERTINO s - :��'� _°�,
BUILDING DIVISION PERMIT RACTUR TN]�URMATTUN
`'n
BUILDING ADDRESS: ...... 5 0 4 0 0 9 2
OWNER'S NAME: PERMIT ISSUE DATE
WIANT JAMES E
ONE: SANITARY NO. CONTROL NO.
ARCHITECTrENGINEER: BUILDING PERMIT INFO
BLDG EIELT PLUMB MECH
2 O ij LICENSED CONTRACTOR'S DECLARATION O
fj I krtby.from Mat l am licensed under provision of Chapter 9(commencing Job Description
with Section]g10)I(Division 3 o ma Budneu and haf"vo"CpdO pd mylkewe is
^� infull force ands -i/•
g_ LD��nmc ca«acmr REPLACE ROOF-1/2" PLYWOOD PRESIDENTIAL
ARCHITECTS OECLARA oN CARL BECKS & SONS ROOF PD BL 4/18/05
'� 1 un ruanJ my plain Ma11 k wed u public mortar
Licensed Professional
L
FI E®
3
OWNER-BUILDER DECLARATION
gm I krehy.(Shin on I am"erupt from tic Conlnmofs License Law for the
i p o following r"ron.(Saito Roa tur Bualncss And Pmfee mu Code:MY city m county _
which I"Issas permit to cnnmMe alms+morose.demo1W,or rtpdr any a men J
k- y
priorahe iss iensedpabum in Me preisio of
sahpctor's commrile a Law(ned uumem
FFE5 z�Fp< Nn he is cceosed punwnt m Ors provision.of thehe Business
License law(Chapter 9 I. F100[AT Vall7,�t14p0 0 0
6 3$
(commencing pt therefron om
and theof basis n 3for of the B ed ens,inti Proon.Any
Code)of
IC 3 Nel he is exempt Ihertfrmn and the bub for the alleged esemptlan.Any vlola0on ofMon
Section 7031.5 by any Applicant for a permit subjects the applicant An a civil penalty of Occupancye
Out mom man five hundred dollen($300). Type
❑I'm own"ofthe property,or my employe"with wages u their ale compensation, 359140 0
will do Me work.and thermal..le nal in Wtdad maneRd forsale(Sm.7(l M,Bananas
and Prof"aio"Code:The Caaaacror's Line.Law does set apply m an Owner of Required Inspections
k
propany wWilds aimprowathenum.and whodocaauchw"k himselfar Waugh his
own employat.provided talmch improvements are not intended aroRend forsam.If.
however,the Wilding or improvement la mid within a"year orcompleWn.the owner.
Wilder will have the burden of proving mat he did tint Wild m improve for purpose of
"I.).
0 1,m ow"s of the Property.am"elusively contracting with licensed conaacmn In
construct the project(Sec.70",Bwln"a and Profess+ans Code:)The Commsoea LI-
ccnse law does not apply to an owner of property,who Wilds or improv"Merton,W.
who contracts for such projects with a contractor(s)licensed pursuant in ma Contractor's
Lice.Law.
❑lam"empt under See ,B&PC for this mason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby a fuse under penalty of perjury ane of the fallowing declarations:
I haw and will mainWn a Certificate of Consent Io self-insure f"WarkerACampos.
nation,as provided In,by station 7700 of the labor Code.for me performance Of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
7]00 of the labor Code;for the performance of me work far which this permit is its"d.
My Workers Co em a Insurancec 'cr and Policynu r
Grtler. Policy No:
CERTIFICATE PITON FROM WORKERS
COMPENSATION INSURANCE
(This secdm need Am campmusi iflk permit Is fmanehundred dollen(SIMI)
or lea)
1 sonify mot in the pmformerce of the work far which this permit is Immd.l Mall nm
employ any person in my mercer m as m became subject to the Work ss'CompeamdM
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Coziness,of EsempOon,you should
become subject in the Worker's Compensation proA dot of ma Labor Code.you mot
.,O forthwith comply with such provisions at this permit Nall k deemed revoked,
E[—MM CONSTRUCTION LENDING AGENCY
r.r I hereby affirm that then is a construction lending agency for the performance of
C? the work far which this permit b issued(Sec.7097,CN.C.)
te71<ndeYA Name
�Q
Z)Z Lenders Add=
U0 I certify that I haw mad this application and sum that the above inform W m is
O. correct,I agree to comply with all city and county ordinances ant state laws relating to
0 SV' building construction,and hereby authorize mpremnutives of this ity to came upon the
W .hove-mentioned property for Inspection purposes
(We)agree in saw,indemnify and kap armlets the City of Cupertino against
v.v Dal Imbidides.judgments,costs and expenses which may in my way aceme against mid City
O In consequence of the Orating of this permit.
APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCg•�� TIONS.
—( % � Re-roofs
Slgnuum of App—ti"MConumtor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum Wilding occupant atom or Mndlc hMnrdow material
u darned by the Cupmmo Municipal Cade.Chapter 9.12,and the Health and Safety
an.S Nes 25532(13,?
❑Y" PNt All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building aaupant use equipmcnl no&,I..which If a roof is installed without first obtaining an inspection,I agree to remove
soh harardnus air mouminerts as darned by the Bay Area Air Quality Management all new materials for inspection.
Osumi?
[3 Yes PN.
I hawrod the ha»rdmu,25M. 553req3 Wcntsunder L•haps,r due Irma Glding
dataI &Sally CadgsaVanf33303.23377 am1233N.l undcrumd due Irma Wilding
alma int currently low ans the t b my responsibility m notify ms,occupant of int
mgmmment,.wyegm p "wacaracerircatcofOccupancy. Signa ttire ofApplicant Date .
Owner or outharimd agent Data All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
oclo
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: ` ?)5 �S ) _ 'l� PERMIT# 0S-D J C) �.Z
OWNER'S NAME: -(—�/ PHONE# Z S 5-
/ S�
GENERAL CONTRALTO • 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
Com' - o
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
�UPE TING
Building Department
Subject: Re-roofing policy for the City of Cupertino
L-""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.
r. 4. To receive a final sign off from the-City,'the:follo' mg steps are
required:
t 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 plyw_ood.nail inspection is required;
j} 6 Any roofing which is,applied without first obtaining an inspection,
•'` — will'require the removal of all new inaterial down'to the sheathing,'
�.. ilii:+_'r• i.,I\ " roper City inpection'carbe perforiiedsoap
,7: NOTE:,-If you callfor a plywood_nail:inspection ani the job is not ready,
•you,will be charged are,inspection fee of$176.18. The re-inspection fee must ,
beyaid before"an"other inspection 8 be scheduled:
.� eu.n � � u Ml 1.1'..Ra.kn ., e.nr .4[. v.. • �.o L�u.._e .Y4 .-a { i. Y. •4„ ' .. .. ..
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: A lit I,,n—1
Job Site Address:
Roofing.Company Name: Cf �ti
Applicant's Signature: Dater
- Greg Casteel
Building Official
Revised 11/2/04 -
- Printed on Recycled Pepe, -
CITY OF CUPERTINO
Ink REROOF
ICURZT'INO PERMIT APPLICATION FORM
APN# Date: .
Building Address:
O � i;'s Name: (l(� Phone#3
�r
Contractor: — Pone#: License #: 2�9
y . _... /
Contact: Phone#: Cupertino Business License#:
Type of Roo Covering:
Existing: Proposed:
❑ Built-Up.Roof ❑ Built-Up roof
❑ Asphalt Shingles �r Asphalt Shingles -
� Wood Shakes ❑ Wood Shakes
" 'Wood Shingles '' ❑ Wood Shingles
❑ • Other(Specify)' ❑ Other(Specify)
Number of existing coverings / ❑ Provide LC.B.O.Report#
To be Removed . ❑ Provide Mfgr.Installation Specs.
I Have Read;:Understand and Will ComplyWith,Cu ertino's Tear Off Policy:
`ri •. _ ".Job-Description:. ^,n :gin-• •`��; ��, ;.� ^�(,> �r 1:`•ias, .
Residential,
_•_ ,Fire Zone: ".Yes p _No's .._. _ _ t a. Confirmed with Planning Dept.:if,
there are any restriction's:' .LJ
Cost of Project: Type of Construction: Occupancy group: Z .
Qty. if .
A licable 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