04070063 CITY OF CUPERTINO ` ''` '°''tz,.. ''•` "' '=
BUILDING DrvisioN. PERMIT �'T®RJNF I2D4ATTON °
BUILDING ADDRESS: (' & C ROOFING PERMIT NOb4O7OO63
OWNER'S NAME: PERMIT ISSUE DAZE
JOHN SU
ONE: SANITARY0. 114,12 C OL NO,
408
ARCHITECT/ENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
"rag LICENSED CONTRACTOR'S DECLARATION Job Description
-
G I hereby afRrm that I as llmmade
d under proomvislof Chapter,
9(commencing p
with Section 700111)of Division 3 of dm Buinw ural rmficasiom Code,and my license is
in full force andaffec , yQ Z� Z REROOF W/PLYWOOD CDX JUL
Llcenu Class Lim 1
z D.m 7i—ie._n e� eanaee F1 Od- 'P+ , 2004 .
P1 q �f —1TEC.TI DECLARATIOi 'F
eZ< I understand my plans stall W used u public recnNs
;WWWO Licensed Pm(essioatt S71O0■�®B�®�
OWNER-BUILDER DECLARATION y�
S I hereby alErm Nat I am exempt from the Con nctaYa License Law for the
p0
following mouton.Section 7211.5.Business and Profesium Cc&:Any city or county
$ which.qulru a permit to eon dam,shur,Improve,demolish,or.pair any lummu te
Fiyprior m its issuance.also smdom Ne applicant for such Permit to rile a signed statement
pp < that heislicensed pursuant mth.provisions oftoConmemor'sUcenuLaw(Chapter 9 Sq.Ft.Floor Area Valuation
d (commencing wit Section 70W)of Division 3 of Oc Business and Profeesinna Coca)Or
'� tete
Out he a exempt torefrom and the basis for the alleged esecapdon.Any violaton of nrr».ramra.e
Sxtion 7031.5 by my appliexnt for a permit subjects the applicant m a civil penalty of 3's'a'r1`[1Ys"erO O Occupancy Type
not mom than five hundred dollars($5D0).
r
I,as owner of Ne property,army employees wish wages as their sole compensation,
will do the work and theaduchim Is oat intended moffered fonalo(See.7041,But..
and Profs som Cade:The Condecmts License Law don not apply a an Owner or Required Inspections
p ropeny who builds or lmpmw thereon,and who does such work himse if or tuough his
own employes,provided Nat such improvements ase not intended oeoBered forsele.If.
however.Or building or improvement is sold within oro year of completion,the owner-
builder will have the burden of moving Nat be did not build or improve for Impose,of
sal.j.
❑I,as owner of the property,am exclusively conda0ng with licensed contractor to
construct Ne project(Sec.704,Business and Pmfmsions Code:)The Convector's LI-
come law door not apply b an owner of Pmperty who builds,or improves Merton.and
who camncu for such pmjaca wish a condamr(O licensed pursuant o the Conmemra
License Law.
❑I am exempt under Sec. .B At P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing dedanlions:
I have and will maintain a Cerdfieste of Consent ton self-insum for Worker's Com a- -
saion,as provided for by Section 37(10 of the Labor Cade,for the Performance of the
wart for which Nis permit is issued.
1 have and will maintain Weraces Compensation Imurace,u bm uimd by Sector,
3700 of the labor Cade,for the performance of Ne work for which this permit is issued.
My Workers Camp...flas Inumnce ostein and Policy number are:
'ser.S?—sC.4t cyNa.. OO .
CERTH' Pf10N RKERS'
COMPENSATION INSURA
((Lis section need not Wcomplead If the permit isforone hundred dollars(SIM)
,or Mss.)
I comfy Out in to performance of the work for which Nis permit is issued,l shell not
employ any parson in any manncru as to bceome subject to the Workma'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Carillon.of Exemption,you should
become subject to to Worker's Compenution provision of one labor Cod%you nun
Z forthwith comply with such provisions or Nis mcrmi,shall be do m.d revoked.
.Zi CONSTRUCTION LENDING AGENCY
fr Ih.rehy affnm Nat then is a convection lending agency for the performance of
ai,7 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Ladder's Nam.
7 Lender's Add.
U O 1 acidly Na I have read Nis sp mandn and nate Na Ne show information Is
W(–' correct.1 agree m comply wit LI city and county ordinances and state laws miming to
�U building conduction,and hereby amhoriwrepresentatives of this city to enter upon lite
W above-mcmioned property for impaction purposes.
(We)agree to uve,indemnify and keep harmless the City of Caperton against
liabilities.judgments,costs and expenses which may in any way amme against said City
U Z in consequence of Na granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da'9/("
SOUR REGULATIONS. ` 7_/', –a 9
iTif...l� l®.rtie� T ! Re-roofs
jigusance of Applkoun Codracmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle Weardous material
as dented by the Cupertino Muni' al Cade, ta
Chapter 9.12.and the Health d Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yon No
If a roof is installed without first obtaining an inspection,I agree to remove
Will rhe applicant orrmure building Occupant use equipment ordevices which
mit balum o o it Wmamimants efined by the Bay Area Air Quality Management all new materials for inspection.
Dinrict?
❑Yes Nn
1 have mad Or hauadouamatedals mqui.mcnu under Chapmrh.95 arthe Califor-
nuHmlthASafmyCade,Sam.25505.25533 and 25534.Tma onand thairthe building l/ ///7
does not currently have a tenant Nat it u my.rpt nibility m pa the occupied of to est" z::r
0
paquiturCWhich must the met poor m issuance or a Certificate or occupancy. �gnature Of Applicant Date
4r4�� n'' � All roof coverings to be Class"B"or better
Owncyr�mhadwd omn Dam
Community Development
10300 Tone Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERM
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR. FAX # 6 D
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 F Z Z
Septic Tank
Sheet Metal
Sheet Rock
Tile
Oy r/Contractor Signature trate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF, Fax: (408)777-3333
qUPEkTINO
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 above stated policy on re-roofing.
Homeowner's Name: w S U
Job Site Address: 226 9? 3 L.r��✓li� 2 1 Y)rr i
Roofing Company Name: /L L' IFn0 tGt KJ �-
A plicant's Signature: it�.n �a �/� Date:
\�1IP61/SD��
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO K3
REROOF OC 0 7
f� 0 0
CUPETINO PERMIT APPLICATION FORM
APN# 3// Z l / Date:
Building Address:
.226 3 woR1DGE er
Owner's Name: Phone#:
A
Contractor: Phone#: License#:
c oma, - 29f-i 6 z�2
Contact: Phone#: Cupertino Business License#:
�._ . 2�- -/�6� Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ^��❑ Built-Up roof
❑' Asphalt Shingles ! Asphalt Shingles
4 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. P Es,A�'UM 4 L
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 0
Job Description:
ResidentiM ACommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with t. if
dp-7 there are an re 'ons:
of rqjq ct: rk,, Type of Co Occupant roup:
�1U
Qty.
A 1' alsl 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