05090086 CITY OF CUPERTINO s >t' ^ t°"" ^r""•
BUILDING DIVISION PERMIT Co 1TR,iGTnR�1VI`C?�MAT.IQ1V
BDILONGADDRESS: DAN ELLIOTT' S ROOFING CO PERMITNo.05090086
0792 WILKINSON AV
OWNER'S NAME: PERMIT ISSUE DAM
SAMUEL PICKARD 2669 COIT D 2005
NE: SANITARY NO. CONTROL NO.
(408) 559-7327
ARCHrrECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
0 I bombY affirm wait
am IkcvA under pmvWons of CMpmr 9(commenting
Ith to
on7M0)o(D'Msian 3 ofdse Busineuand ProfeWuns Cale,aM my license 4
iafullfoesanda, -ac /� REROOF--T O CEMWOOD, INSTALL ##30 FELT,
Lkenm AR Lk.N6/ 3>( pRESIDENTIAL 50 YR. FIBS I AS�n
K Dau: Canuacar r�--��--�� �1�1�`jj�j !I
9 ARCHfrE tato LARATION tt II��
�i l undersand my plans"I W used u public record, }t f/
3 c7 ❑❑❑ ff�ra"
Licensed Professional
3 OWNER-BUILDER DECLARATION
CormaON
u�a S 1 hereby wate.ffirmSect Net 1 erns except from the C Professions
au License Law for On .SEP-2 q
0 0 (allowing mason.(section 7(n13,Business and Profesaiuns Cak;Any dry or county I L 005
$K which require a permit to construct,altar.improve,demolish,or repair my t=turn
F- Sr, primo its issuance.also requires tW applicant(Or such Permit o file a signed statement
3< Ihu M ls licensed pursuant to the provisions of the Cormcmra License Law(Ch.(Chapter S Ft.Floor Area Valuate 19617
F c P P P q s ,
y
that
(commencingwith Sectionfrows orad of Division sitfar of ft al Business and Professions Code)or / 7y
$ dot k ls asempt IMJefrom atW the buss(.the alleged excmptlam MY Notation of h 'Au 01,
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number — "Ocbu 'and
oat mare than Rve hundred dollen(5500). 3 5 613 04 0 . 0 0 P Y Type
❑1,u owner of the property,m my employee wW wags u their miceompenodon,
will do the work and tita structure is not intended aaQered basso(See.7044,Business
and Profatuo a Cade:The Camacarn License Law dose not apply u an owner or Required Inspections
property who Wlldsorimproves Merton,endwho doessuch work transfer through his
own employes,provided Nat such Improvements sit not intended aronored for We.If,
however,the building or improvement is mid within am year of campleom.the owmo
Wilder will haw the burden of proving that be did no,board or ImProw fm pamose of
ark.).
❑1.a owner of the property,am exclusively contracting with licensed comments a
convect the project(Sec.704,1,Business and Profeasions Cade:)The Communities Li.
cense law dam not apply W an owner of property who Wilda or Improves thereon.and
who contracts for such projects wird amntratartO licensed puwuant W the Communes
License Law.
❑[am exempt undersea. .B k P C for thismoon
137�00
ner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby&Man under penalty of perjury one of the following dedantians:
I have and will maintain a Certificate alcommum W self-Wum for Worker's Compen.
on.u provided fns by Section 37M of the Labor Code,for the performance of ow
rk for which this permit is wood.
I have and will maintain Worker's Compensation Insurance,u required by Section
of the labor Cade,for the performance of the work far which this pemtit In blued.
Wer sCompensation W� ainpa�carrier and Policy number am:
nn, I "[,( Policy Na21!�2.L
CERTIFICATE JP EJB PIONFROMWORKERS'
COMPENSATION INSURANCE
(ntk seedme nerd not uncompleted Hine permit is froom hundred dints us(SIM)
or lute)
I certify Nat in the performance of the work for which this permit is issued,I shall not
employ any power,in any manncrm as W Immmasubjeeuo the Workers'Compensation
Laws m California.Data
Appl sent
NOTICE TO APPLICANT:If,after muting this Certificate of Exception,you Should
become subject W the Worker's Compensation provisions of the labor CMe,you most
.J 0 forthwith comply with such provisions o this permem
it shall be deed revoked.
.z.t 5; CONSTRUCTION LENDING AGENCY
[-t I Wraby4frrm that then iso ronsuuction lending agent'for the performance of
ai +✓ the work for which this permit in issued(Sm.3097,Civ.C.)
WM Q Lenders Name
:D z lenders Address
U O 1 certify that I haw read this application W mm that the above informal.is
Iyr;'". coma I agrm W comply with all city sad county ordinances and stag lawn mating W
O building convection,and hereby anthodm representutves of this city in enter upon the
Lf7 above-mentioned rearsay f.Inspection purposes
C (Wt)agree a save.indemnify attd keep harmtasa the City of Cupertino against
,s ty) liabilities judgments,costs and expenses which may in my myaccrue against old City
U 7 in consequence of the Smaller,of this permit
Fi A PL ANT UNDERSTANDS AND WILL CO Y WITH ALL NON-POINT Issued by:3 Date q�')✓3 6
S U E REGULATIONS. �O 9 /��r
M.-4 i�� Re-roofs igna art of pplicanVCanRD Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII tiro a Cispent or reformni building Co mcupant r 9.1 ter Mitt t e hawdam maurial
u @Med by dse CupeNno Municipal Cade.Chapter 9.13,and 0m Health and Safety
ala.Seat,.22553:4)? All roofs shall be inspected nor to an roofing material bean installed.
❑Ye, �Nu P P Y g g
Will the applicant or future Wilding occupant use equipment in dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
6-9 It hammus airconuminsnts a claimed by the Bay Ams Air Quality Management all'new materials for inspection.
i"ict7
[3 Yes /0
0
I haw mad the hanrSnw materials requircmenu under Chapter 6.95 of the Califor.
nla Health B SafelyCa@,Scctiau25505,25533 and 23534.l understand dot if the Wilding
not currently havea unm,that it i y responsibility m notify the occupant of the
to n set met Pdtossurance,afaCertlncawofOccupancy. Signature of Applicant Date
Owner a authorized agent Dam
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building,Deartment
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # (pao--961— 3ol �{
GENT=R*L CONTRACTOR a n a i o FAX#
I am not using any subcontractors: N,
Signatutle Date
Please check applicable subcontractors and complete a followin information:
60 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
r
Q� 12-o✓
er/Contracto S' ature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
*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.
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: Wy C1Ca1-4
Job Site Address: iG lCt l`�1Nrah f ,((V11Q.NV,0_ �,u�40
Roofing Company Name:
Applicant's Signature:. Date: R-11-0 S
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO q b
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
/ ( � D�0 —tZ—ID 5
Building Address:
�O`l X12.
Owner's Name: Phone#:
r c r teSo— ab - 301
Contractor: Phone#: License#:
'Sr ,o 55�'t=132'1 (01\72 $
Contact:
0 .qt-O Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ! Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes Tve S A-STVV\
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) C-2 wood ❑ Other(Specify) t 4 it t,
Number of existing coverings go h Q 13 Provide I.C.B.O.Report# O
q To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: lek �t2Sic1Ph1•�0.1 �30 .}rclf
\aSS edl Aew
Residential ® Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Wt. if
there are anrestrictions: IJ
Cost of Projec , Type of Construction: Occupancy group:
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
70 , S'�