06020144CITY OF CUPERTINO
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CONTRACTQRINNORMAII0N
BUILDING DIVISION PERMIT
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.'J!'_DING ADDRESS:
PERMIT NO.
06020144
q.�•�� WHEATON DR
OW Nin S NAME:
PERMIT ISSUE DATE
THOMAS ROSSI
02/23/2006
NE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMrf INFO
BLDG ELECT PLUMB MECH
D D O O
LICENSED COMRACTOR'S DECLARATION
o
Jb Description
of Chapter 9 (co encing
1 thereby from that I am Heenecd under provisionsmm
with S,cuo0 ]8011 of Division Sof the Business and mt Simon Codc, endm license is
terse I to
REROOF--T/O SHAKES,.INSTALL LIT WEIGHT
uansc Clu Lk."'
Date Cunvac r
SLATE FIRE FREE TILE
As
EW LTS DECLARATION
CONTRACTOR: IMPERIAL ROOFING (#01000014126)
shall
I undersunJ my plain shall used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby Orion that I am exempt from the Contractor's License Law for IW
fallowing mason. (Section 703 L3, Business and profession Code: Any city or county
which acquires; a Permit to mnsomn, afte% improve, demolish, on repair any someone
! prioe t. its issuance. alw neither the applicant for such permit o file a signed statement
he is licensed Ne Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant o the pnvisimts of
(commencing with Section ]()00) of Division 3 of Use Business and Profexsinrs, Coe) or
$18000that
he is exempt therefrom and Ne basis for dm alleged exemption. Any violation of
APN Number
Occupancy Type
Semon 7031.5 by a" applicant for a Permit subjects the applicant to acivil penhy of
not moe than five hundred dollars (M)_
I I. u menu of an, imperty, or my employees with wager as their sole compensation,
will do to work. and the structure is not intended or offered for salt(Sm. 70,14, Business
Required Inspections
and Profession Code: Tim C.O.Wfl Li. Law den not apply to am owner of
q p
property who Wilds orimproves thereon, and who doessuchwork himulforthrough his
Own employees, provided Not such improvements are, not intended,roffered foredo. If.
however, the building or improvement is sold within one year of completion. the owner-
builder will have Nc burden of proving that W did not Wild or improve for purpose of
.It.)
1. u of Imparts, rts, am exclusively convening with livened commrs�oto
1ownerohm
■ �k�
consomct
tr project (Sec. ]044, easiness and Code:) The vesmncela
d who or improver thereon, and
cense law coca not apply m ts owner of property=whn sed red
property
P■M'gjt
such projects with a eontraetor(s) licensed pursuant m IW Contractor's
p
whocontractsLa
.for
License law.
MAY `
rl 1 em exempt under Sec. . B d: P C for Nis euan
— ?®06
owrcDem
LAr
WORKER'S COMPENSATIONDECRATION
herebyu(LJ■�
1herebyml hereby eRunder perW ty of perjury arc of the, following culoatinn:
I haw and will meinten aCe tificae of Consent to elf-insum for WortetsComp.n-
uolon, u provided for by Section 7]00 of dm Labor Codc. for Ne Performancea( the
wok for which this permit is issued
I 1 have and will maintain Workanu
er's Compensation Insurance,, required by Section
3]00 of the labor Code, for the performance of Ne wok for which this permit is issued.
My WO e42mtpenutiom Inmumxe wrierW Polity numWrare:
Cartier. Policy No.:
ERTI CA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he compleed if tW permit u foram, hundred dollars (Sloe)
or less)
'Certify the performs— of N. work for w ich Nis pc I is issued. I shell net
cmplo ny pc onm ten uutq¢ nor �'c IW a 'Cumpensauon
laws (Calif 'a. au
Applic
NOTICE APP 1 , eMr maltyy u cnifiea of Exemption, youshould
becomest b e Woheh Compemduon provision f drc IaWr CM., you must
fOMwi mpl" with such provisfon or Nis permit shall he deemed rtvmkcd.
CONS UCTIO'LENDING AGENCY
1 W a I..
that Vert is womm�minn k, ageney for Nc perfmmantt of
r whahem
the work for which this pcnnit is issued (Sec. 304], Co.Civ. C.1
� Lender's Nam.
Lancer's Address
1 certify Nat 1 have mad this application and sten that the above information is
COMM I agrm to comply with all city and county ordinances and sum laws elating to
Wilding couwction, and hereby authorie eprommeiuxs of this city to enter upon the
cfion purposes
abovets fond
(We) agree to save. indemnify and keep humlw the City of Cupertino against
jusin.dpropmny
C.
fi,enmCACOC 0 and ex Which may inanyWay attmcegamnsaid Cie
in eor¢equcne. a c gun ing o 'perm'
APPLICANT NOER N D L COMPLY WITH ALL NON -POINT
— 2�-�
Issued by: Date
50 RE ULATID
Re -roofs n
Signaoue Of Appl' o r Dam
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will plicae ter ruwe building occupar"tom or handle hr�uus material
u &flood Cupertino Municipal C Chapter 9.13. aad the Health and Safety
am.Se .15532(1)?
I Yes I No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fumm Wilding=upon, use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
It havardous air contaminants ss def ed by N. Bay Area Air Quality Management
all new materials for inspection.
Disvict?
I Yes No ,
1 have reW Ne hamrdous materiels requirements under Chapter6.95 of dm Califor-
atiate505,25533 and 25534.1 understood that
nreiaqlsW'�yc az ifNbuilding
Ja NlitamymanptsofYNttuantofNc
ee foccupaney.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owno N ,.d.gem dam
i am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information_
Date
Owner/ Contractor Signature
Date
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
oofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date
Community Development Department
!, Building Division
City of Cupertino
10300 Torre Avenue
11 Cill OF Telephone: (408) 777-3228
��' � O 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.
7. NOTE: If you.call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
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
Roofing Company Na
Applicant's Signature: Date: b
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
,
CITY OF
CUPERTINO
in
1
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM /
APN # (/ 2w -
6
Bld Permit Fees
Date: Date:
Building Address:
/ �, 9/ (� Y�F�4 aN
v�
Owner's Name:Phone
0 26 SSI
BSEISMICRE
#:
Z5z /9
Contractor: � Pho �e #:
�
License M.
Contact: Phone #:
BPLANCHK
Cupertino Business License #:
Type of Roof Covering:
Existing:
Cl Roof
Proposed: 6zJ/
13 Built �� h
BUILDING
-Up roof
❑ Asphalt Shingles
Wood Shakes
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report # L
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy: ❑
ob Description: b F &zkg)
/) o
HCl
Residential �J/ Comme.cial
Fire Zone: Yesq�No ❑
Confirmed with Planning Dept. if
E5
there are any restrictions:
Cost of Project:. (/ Type of Construction: Occupan go
I
Qty. if
Avnlicable
FPr m
BPERMFEE
Bld 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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