05080087 CITY OF CUPERTINO "'
BUILDING DIVISION PERMIT 3CONTRACTOR INA RMATllots'`-
BUILDING ADDRESS: T D ROOFING PERMIT N005080067
22593 WOODRIDGE CT
OW NER'S NAME: PERMIT ISSUE DATE
RICHARD ESPARZA 3540 MARGATE AVE 08/11/2005
ONE: SANITARY NO. CONTROL NO.
(406) 892-8872
ARCHOECUENGINEER: BUILDING PERMIT INFO
BLDG
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app
—LICENSED CONTRACTORS DECce;of CON Job Description
t 1 hereby sffnm Nn 1,3 Ilaved under pmvitlona of Chapter 9(rommermis P .
t wN3ecdon]OfU)of DivWon]af dx BuurctaaM Profeetlow Code,and mYliceveis
+'1 infullfaraadeff p REROOF-T O WOOD SHAKES/INSTALL PRESIDENTIAL. 50
?Y�IZ Lic /
`5
Data
A HIlELTS DECLARA Ps
C IuMorwnJ my plow dWl be usodas public rtcorN Ajt
5 Licensed Professiarral 'tli y+,k IA
OWNER-BUILDER DECLARATION "*�fi
I hereby affirm Nal I am exempt from the Conummrs License taw for the 4 y\
is o o following won.(Section 703 1.3,flood.and Profwslow Cadc:My city or county 'i �V n
5 3 ff which requires a m
a permit eunnct,alter,Improve.demolish.or repair any suunure $9500
prior in as issuance.also acquires the applicant for such permit w file a sigrcd statement
�< that he is licensed forwent to the prevision of the Common's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commandos wim Section 7000)of Division 3 of the Buxinwaand Prof.ioru Code)our
thou he is eserapt therefrom and the basis fa the alleged exemption.My vIoladan of Ruh I
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of '"' tl q 11,Occupancy Type
Out mom than five hundred ddW(5500).
❑
1,as owner of the property,Or my employee with wages as their sole compensation,
win do the work and the swcmn§mmimmeded Or offered for ask(Sm.7044.Bud»•• Required Inspections
and Profesdam Cade:The Commxmrs License law dress act apply man owner of q P
propcny who builds or improves theme,and who doessuch workhimx3forthrough his
awn employms.provided that such Impraemenu are not intended reoffered for ream.If,
however,the building or impmmmem is sold within are year of completion.the owner.
Wilder
will have the burden of proving ties M did rot Wild or improve far purpom of
asle.).
❑1,as Owner of the property sac exclusively contracting with licensed onnmsctora to
convect am project(Sec.7044.Business and Profession Code:)The Communes Lt.
ccne law dors not apply an an owner of properly who buiMa or improve thereon.and,
who comm.for such projects with a mnuscmr(O licensed paravam an the Contractors
License law.
0 1 am exempt under Sec. .B A P C for this won
Do. Dam
WORKERS COMPENSATION DECLARATION
I hereby intro under pewlly of perjury Orc of the following dcelwtiortx
1 ham end will maintain aCW Ocam of Consunua self4mima for Worker's Comport.
.a..as provided for by Section 3700 of the labra Cade.far tie Not....of the
were,for which this Permit is Waned.
Lhave and will maintain Workers Compensation Irnwana,as acquired at
by Seon
of the labor Code,far the pedremarse of the work far which this permit is Issued.
My Workers Co pens a'on insunna�o��rtJ.5t end Polity number are:
Carrier. (IF ME TION Na.: t`4�7 [ 5 fc
CERTIFICATECPE%PPFll1...11ONI NFROM WORKERS'
COMPENSATION INSURANCE
(This adicen reed notMcomplowd fifth permit is format hundred dollars($1013)
our ma.)
1 certify that in the perfmrmartro of tion work for which this permit is issued.I shall not
employ any person in any manner an u m become subject the Worker'&PewNon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Continuum of Exemption,you should
become subject to are Workers Compensation provisions of can labor Cade,you man
OQ forthwith comply with such provislon Or this permluhall In deemed revoked.
CONSTRUCTION LENDING AGENCY
[—a I hereby arm Nat dere iso mnnraction lending agency der the performance of
CYi i de were,fat which this permit is Wood(Sec.3097,Civ.C.)
fy Q
Lenders Name
=Z Undoes Add.
U0 1 certify Nat I have rad this application and .in that that above tnfotmadun it
Is, caned.l agree m comply with all city sad county ordiwmes and sate mw rdsdnt to
0 building construction,and hereby mmoda representatives of this city to came upon me
{e,7 ehovamendoned Property for inspection purpwes.
(We3 ago to ave,indemnify and keep harmless die City of Cupertino against
W Iiabillmajudgmems,ensu and expenses which mayin arrywaywcrue agdntaid City
V 7 in comvegwwe of the Swans of this permit.
i7 APPLICANT U DE NDS AND WILL COMPLY WITH ALL NON DINT Issued by: Date
SOURCE REGU�A / 8'
D 0 Re-roofs
Signature ofA eanVConuscter Dam
HAZARDOUS MATERIOS DISCLOSURE Type of Roof
Will the applicant or future building occupant same Or MMM hayardow material
as defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
ad.Section 25532(.)? II All roofs shall be inspected prior to any roofing material being installed.
❑Y3) fR o
WIII me applicant or fu,,w``rc building accupam saw equipment er devices which If a roof IS Installed without first obtaining an inspection,I agree to remove
It hannion air contaminants as da'acd by the Bay Arca Air Quality Management' all new materials for Inspection.
District?
❑Yes )jlo
I ham mad the hvardonmamdals requirements under Chap ard.95of the Celifor.
3)i.Healon&Safely CeM,Sections 35505,25533 and 25534.lundemmedthatifthe building �I d b
data not currently Mm a Bron that it Is my responsibility b notify me OmuPM1 of the
requiamems which man be ren Psi m once ars Ccnireae of Occupancy. ignature of Applicant Date
91 OanCfar. aalla.'a on( Dam
n 5� 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
IUPEkTINO
Building De artment
JOB ADDRESS:
Wao� tr� � PERBE
OWNER'S NAME: V- S nv~2Z, 1 PHONE # ;L-:5 5 - �( o
GENERAL CONTRACTOR p 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
Til
Owner/Contractor gnature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U^l���'�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: fx V C� ((
Job Site Address: 21 Sq 3 W0 Od kr ; J G C
Roofing Company Name: T f C
Applicant's Signature: JAI _. Date: O S/
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
alOf
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 4 Z 154 O(o '7 Date:
$ IIS dos
Building Address:
S, . s 3 woad
Owner's Name: Phone#:
1z� c ct v C� q 0 8 a 5 S - y qz>Li
Contractor: Phone#: License#:
b 7-L vt 'Zh c 89 b- &ST 4 SScI I
Cont t: Phone #: Cupertino Business License#:
_JDc.v.tCl �409D GqG 83S
Type of Roof 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 I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Ak I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: '0 ��; Cy-%At_A
hemoJe wood S� (a,i e ire � acsi W', Ttn
Residential .Commercial. ❑ ..
Fire Zone: Yes ❑ NoConfirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
clSoo 71-v- - � 0
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
3 °
72,;-6
70 ,