05070033 (2) CITY OF CUPERTINO - �s -
BUILDING DIVISION PERMIT CONTRACTOR x INFORMATIOW
BU ILDING ADDRESS: CONRAD ROOFING SERVICE P11ITND05070033
038S N RT.ANRV AV
OwNER'S NAME: PERMIT ISSUE DATE
RITA SALIVA
ONE: SANITARY NO. CONTROL NO.
(408) 294-7615
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIELT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
tilFF 1 hereby affirm that 1 am licensed under provisions of Diaper 9(commencing Job Description
Ziy with Section70(anfDivision 3 of the Business and Professions Code.and my license is
n in full tone andeffect.
STH Lieenxea•• t--39 Lie-1
LiIOS'L REROOF W/SHIGLES
[F p Dam 7-6—4r Conused pts
E'9 tor ;Icb�
ARCHITECTS DECLARATION
a< I undersandW used
my plans shall u public records
u G Licensed I'miesiore"icnal
mos OWNER-BUILDER DECLARATION
Count DN D
E a 0 I moo .(firm on 1 1. exempt from Nc Conions Co License Law for the �a
p o following mason.(Section)D,L5,Business and w.do Toru Code:Any city or county V
;r$�i which iquiresa ,also re cores,the aloeimprove,demnnit t carepsig my signed
dtatement
prior e inor censed pursuant to
theapplicantfor uenractor to file a,Lacdnammcm
,Zn (co mencittnwitpurstion7 N)ofDiviouofof Contractor Sq.Ft. Floor Area Valuation
x� (cot he
(commencingwith Section7")of Division,oftheog.d.ss pinal.Aniom Code)of
y�$
that he u exempt dmrcfrom and the buffs far the alleged exemption.Any v[.]all on of
Section)031.5 by any applicant for a permit subjects the applicanno a civil penalty of 3 MIST3xB ffiberO 0 Occupancy Type
not mom than fine hundred dollars(s500). Pane Y YP
I,u owner of the pmpm y.m my employers with wages u Ndv sole eomNnuaon.
will do Me work,and the structure is not intended or onroul forsale(Sec.)OW,Business
and Profcasons Code:The Coneacmes License Law dols not apply W in owner of Required Inspections
pmpeny who builds or improves themon,and who doossuch workhimulf or through his
own employees.provided that such improvemenu arc not intended oroRemd formic.If.
bOwewt,Ne building or improvement is sold within one you of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
El 1,as owner of Ne property,am exclusively contracting with licensed contractors W
construct Me pmjem(Sec.7044,Business and Professions Code:)The Conuactur's U-
cense Law does not apply to an owner of propcny who Wilds or improves thereon,and
who contracts for such projects with a contractor(&)licensed pursuant W Me Conuaclofs
License Law.
❑1 am exempt under Sec. .B&P C for this moron
Owner Date
7a311WORKERS COMPENSATION DECLARATION
1 hereby uffirm under penalty,of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insum for Workcr'sCompcn-
W
on,az provided for by Section 3)IXI of Ne Vhur Code,for Nc perfonnana of the
rk for which this permit is issued.
'Thave and will maintain Workc/s Compensation Itssuranu,u required by Section
of Ne labor Cade.for Ne performance of the work for which this permit is issued.
Worker's CompensationInsurance carrier and Policy number am:
rtier: fftw F�..a Policy No.:Zeg-ODOIIYS-OS"
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W cmnplemd Rine permit is fmonc hundred dollars(5100)
carless.)
L certify that in the performance of the work for which Mia permit is issued,I shall nus
employ any person in any mannerm our become subject to the Workers Compensation
Laws ofc.lifornia.Date
Applicant
NOTICE TO APPLICANT:If.afar making Mis Ccnificam of Exemption,you should
become subject W Ne Worker's Compcuation provisions of Ne Labor Coke,you most
Z, forthwith comply with such provisions or Nis permit shall W dimmed rewl cd.
Z'O CONSTRUCTION LENDING AGENCY
'rs Ihemby 4ffirm thus there is•consimeinn lending agency for dm perfnoutom of
C Me work fur which this permit u issued(Sec.3097,Civ.CA
C1.
Leadc's Name
= Z Lender's Address
U Q 1 certify that I have read this application and sure that Me above informniun Is
I➢ P correct.1 agree to comply with all city and county ordinances and sum laws Noting to
0 building construction,and herebyaullono,mpresenutives of this city W enter upon dm
above-mentioned property for inspection purposer.
Fa (We)e,me Ip save,indemnify and keep harmless Me City of Cupeninp against
to liabilities,judgments.costs and expenses which may in any way we=against mid City
of Me gnomic,of
U Z s pComit.
APPL CANTcUNDERSTANDS AtND WILL COMPLY WITH ALL NON-POINT Issued by: e
Date 7-1 f
SOURCEiSILAT10rY5. 7- /—off
C 'Re-roofs f /�
Signature dT ApplieaDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof '
Will tW applicant or(Wort building occupant uorc or hnndk hvallous material
az defined by Me Cupertino Munici al Code.Chapter 9.1 i.and the Healon and Safety
Dam,Section 355J2(a)'! All roofs shall be inspected prior to any roofing material being installed.
E]Ycs ;;No
Will the. li.ant`or future building If a roof is installed without first obtaining an inspection,I agree to remove
rap g occupant use equipment or devices which g
it but/amour air conuminanu sed ncd by the Bay Area Air Quality Management all new materials for inspection.
Wic"
❑Yes
I have mW Ne halaodrats materials requiremenu under Chapmr6.95 of Mc Calif.,
nia HoilM&SafetyCode,sections 25X)5.35533 and 25534,1undcrsund that lithe Wilding
does not currently hast a mount,that it is my responsibility W nnWy tM occupant of Ne /✓
mquimmcny%S�wJ�¢hT,nsthe molpiorWissummofa Cer ricamofacupucy. Signature of Applicant Date
f'—)
owner car aamnrivmd agent mm All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
lslamlv Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: �p 3 6 s ff /jj �s� PERMIT #
S--0 -706?2
OWNER'S NAME: Iii 6% PHONE # X94=-74 ir
GENERAL CONTRACTOR: FAX # 2-14-574L
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
Tile
i
Owner/Contractor Signature Date
Community Development Department
Building Division
��r✓\`�„ City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N® 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,
willrequire 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 1.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: _ I fA Sal�,I cy_".
Job Site Address: I 3 s A , 13 kw * A-4 c,
Roofing Company Name:
ApphcantsSignature: [��—' Date:
Greg Casteel
Building Official
Revised 11/2/04
' Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
8CLIVEIZ11NO PERMIT APPLICATION FORM
APN# _31L33 () 03 Dat ?,
zo�S
Building Address:
- 10 3 0 S At
Owner's Name: Phone#:
t� S 4,tisa Zs3-
R-1 96s7
- Contractor: Phone#: License #:
6z 40o —0 Y is 2.-11 b s
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: _.__ .- Proposed:
❑ Built-Up Roof _ ❑ Built-Up roof
RAsphalt Shingles 191' Asphalt Shingles
.. Qrr Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
To be Removed- - ❑ Provide Mfgr: Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: -q;st+il -7//j."
otr� J4.rr • > or
Z.3 jtecy 0. 1y. _a--v� jtn44n1( C< ttab. . a 111( 1. 1. 2e`G
Residential Commercial Fj_ j-_- .-
Fire Zone: - Yes ❑ . No ❑- - _ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: - 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