03100177 CI•TY OF CUPERTINO ��` u'
BUILDING mVISION PERMIT CONTA CT
ROR.*INFORM�TIgN
BUILDING ADDRESS: PERMIT NOQ 3 10 0 17 7
10605 N WOLFE RD
OWNER'S NAME: PERMITLSSUEDATE
hi COURTYARD BY MARRIOTT 10 23 2003
IFNE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
sz t� 0
j00 LICENSED CONTRACTOR'S DECLARATION
wn afirm.that I am licensed ander Provisions of Chapter 9 d ng
Job Description 'with Section 70IXlafDiviion3ofe Business drofesoCndmyTic
infulfROOF �gLED
ia
orated Gla�a � see
Dar ARCHITE SDECLARATION CONTRACTOR: BIGHAM TAYLOR ROOFINGIAR 19 2004
1a� l understand my plans shall M used as public records 1-1316 31
tEU
e01 LiccnudProfcssionel BUILDING
OWNER-BUILDER DECLARATION
a S I hereby affirm than 1 am exempt from the Contractor's License Law for the
OO following reason.(Section 703 1.5,Business and Professions Code:Any city or county
<2� which requires a permit to construct,alter,improve,demolish,or repair any structure
'jzy prior a)its issuance,also requires the applicant for such permit to file a signed statement
e � that he is licensed pursuant to the previsions of the Contractor's License Law Cruiser 9 Sq.Ft. Floor Area Valul15000.
u $ (commencing with Section 7000)of Division 3 of the Business and Professions Coi or
t, Net he is ommpt therefrom and tM basis far the alleged esempdon.Any violation of
Section 7031.5 by any applicant for a pennit subjects Ne applicant to a civil penalty of
man Type
t more man Eve hundred dollars(SSW). '
❑ Lagsowner ofilm property,or my employees with wages as their sole compmearded.
will do the work,and the nrvnure is not intended orofferetl forsde(Sec.7004,Business
and Professions Cade:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself or lhmugh his
own employees,provided had such improvements art not intended oroRered for sale.If,
however,fee building or improvement is sold within one year of completion,me owner-
builder will have the burden of Proving Nat he did not build or improve for purpose of
and..).
❑I.as owner of the properly,am exclusively contacting with licensed contractors to
construct the Impact(Sec.]004,Business and Professions Code:)The Contractors Li.
mile Law does not appy to an owner of property who builds or int prows menton,and
who contracts for such projects with a contractor(s)licensed pursuant to me Contractors
License Law.
❑1 am exempt under Sec. B&P C for this reason
17CW
ner oats -
WORKER'S COMPENSATION DECLARATION
I hereby affine under penalty of a jury one of the fallowing declaration:
1 have and will maintain a Cer ifieate of Consent to andr-h sure for Worlon sCumpen-
on,as provided for by Section 3]00 of the labor Code.for the performance of the
rk for which mss permit is issued.
I have and will maintain Worker's Compensuion Insurance,as requited by Section
of the Labor Code,for the refterencc of the work far which this pemrit is issued.
Worker's Cnmpens tion Insu nm carticr endPolicy nu bere�f�rtier: L Poliry No.: 'Ess
CER IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seed-d need not lmcompletcd if me permit is forone hundred dollen(91(0)
of lem.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any pans.in any manner an as to become subject o the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the lahnr Code,you mut
Z forthwith comply with such provisions or this Permit shall he deemed revoked.
ti O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a connotation lending agency for the performance of
li > me work fur which this permit is issued(Sec.3097,Co,C.)
y Q Lender's Name
Y
z 'lender's Address
�
Q 1 cordly that 1 have read this application and dins Net the above Information relating is -
U building 1 agree to c comply wire all city and county ordinances and state laws relating e
U athowngeonaned pea,and hereby impaction
nprposescntatiws of msscity menter upon the
above-(We)
properly for inspection duteous.
ti On (WJu egme to save,indemnify and keep harmless the Ci ay accrue
Cupertino against
On liabilities.judgment,costs and expenses which may in any way accrve against said City /
J 7 in cmeant, ION
ncc of th grantingathispefaryL 7
t� APPLICANT
'e
RSTANDq�ANfJ WILL CO ^ Y WITH ALL NO Issued by: Date �J
SOURCEREG ATS /\ �.ivq,i
Re-roofs
Stgnewre of ApplicaHAZA TDO ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future buildinge.Chapter
tstore ,handle Health and
az do,Sed io the Cupertino Municipal Code,Chaemr 9.1],and the Health and Safety
J0.section 25533(e)?
'
-1 Yes No All roofs shall be inspected prior to any roofing material being installed.
Wel 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
it hazardous air contaminant as defined by the Bay Area Air Quality Management all new materials for inspection.
levier?
❑Yes No
I have mad the havaNnusmetorials requirement under Chapter 6.95 mon,Califon-
diac.noth&Safctyhaw.such.25505.25533 if,25533and 25534.1 Irmadlit". crsmmlthat,occuprtfthe of mg
docs not currently hew tenant,Net it u my pdmibility m nodly the taccupant of Ne V
reyuircmcnt whicc met pd nor Get of a Cc ate of Occupancy.
Es ° � d�7j Signature ofAppli nt Date
2 m
Owner ser aulhonrcd open) „a All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
one: (408) 777-3228
CITY OF TelephFax: (408)777-3333
CUPEkTINO
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 abov/e� stated policy on re-roofing.
Homeowner's Name:
Job Site Address: law L)LQS p fL4.) tc.° CL
Roofing Company Name:
A plicant'sSignature: Date: �0
reg teel
` G
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF v 3l 7�2
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: iG ,;,
Building Address,
'16'6'a,5
�4 .
Owner's e: Phone#:
a.� /I 1 Q/VL X41
Contrac r: Phone#: License#:
Sro -0 9
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
r( Built-Up Roof �K Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
A. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job D scrip *on:
To b •rl 2 . QaPd /3 _ u • K . cv e
Residential ❑ Commercial Ig
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
2-5,
060 . Sp
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
v3 J-r