05090051 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION -
BUILDING ADDRESS: SIMON SAYS ROOFING PERMITNO05090051
OWNER'S NAME: PERMIT LSSUE DATE
Ah MARY KAWAGUCHI 3866 REXW00 09/08/2005
.ONE: SANITARY NO. CONTROL NO.
(408) 531-9700
ARCHITECrIENGINEFR: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
D O O O
uOp .LICENSED CONIRd under
DECLARATION Job Description
w❑ I hereby affirm that 1 am licensed under provisions of Chapter Y(commencing P
<W mfulif tion rude o(Divizimnlof Ne Bu Qpr�c}jinns Cole and myliccnsc is - n
^� inranrarc aderr 3y / Y f •REROOF-T/O SHINGLES, INSTAID COMP S�HaINGLES
j�z Liaaa.c ase fr+ d� �J / , �f,
�1-o Dam O fl 1/—Q L�-,
ARCHDE C RATION
Jm I understand my plans shall he used at public mcmN
U
n0 H Licensed Professorial
2005
3 OWNER-BUILDER DECLARATION
E a 0 1 hereby arRrm that 1 1. exempt from tPr Contractors License Law for the pQ$171921
///area
po (allowing n]onstr Business and Professions Code:Any oily Or County �t{l 1,1 D 16� V
,I m which requires a Permit m construct,altar,improv,demolish,or repair any ulrwmR If�II II'I " j' tl`\�" 11 9 2 1
prior m its batione..also mquims Neapplieam potlatch permirm flea signed suscroma a� u
that he is licensed punumn,to the provisions of the Component's License Law(Charter 9 Sq.Ft. Floor Area u�i sew Valuatibn
K1- (camommiag with Section 7")of Division 3 of N.Businessland Profesliaas Codd or
Nat he is exempt Ncmfrom and the basis for Use alleged exemption.Any violation of
Section 703 1.5 by any applicant for a permit subjects be applicanuo a civil penalty of oC araC QGGU
not more Nan fin hundred dollars(s500). Occupancy Type
❑L as owner of the property,army employees with wages u their salt compensation,
will do be work and be mountain at not intended oroffcnd for sal.(Sec.71364,Business
and Professions Code:The Conuacmrs License Law docs not apply to in owner of Required Inspections
property who builds or improve b ureon,and who does such work himselfor through his
own=play=.provided that such improvements are not intended Or offered for sale.If,
however.be building or improvement is sold within one year of completion,be owner-
builder will have the burden or proving Nat he did tat Wild or improve for purpose of
sale I
❑1,as owner of be progeny,am exclusively contracting with licensed contractors to
construct the project(Sec.71364.Business and Professions Code:)The Contractor's U.
cram law docs not apply m an owner of property who builds ar improves themon,and.
who contracts for such projects with a ewtvcmr(s)liaised pursuant o dm Contractors
License La .
❑I am exempt under Sec. .B A P C for Nis mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under proalry of perjury arc of be following declaration:
ammI haw provided
ro will maintain Section
37W of Cansem r Code.for far Performance
of tax
f u pro h phi for by Section 1]00 0(be,labor Code.for Nc pcnformamx of tM
work for which this permit is issued.
Mw and will maintain Workets Compensation Insurance,as mqumed by Section
37W or be tabor Code,for be performance of be work for which Nis peropi,is issued.
My Worker's Compensation Insurance cannot and Policy number are:
Cartier. Policy _
CERTIFICATE OP EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE ,
Thus section wed not beeampleted RNe permit is forone hundred dollars(SIM)
or less.)
1 cmOfv Nat in the perf....of be weak par which this permit 0 issued.l shall wt
employ anyperson in any manwr as as In bacome subject to be Worlmos Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL arm,making N6 Car irmate of Exemption.you should
become subject in the Worker's Compensation provisions of be Labor Com.you masa
.J O forthwith comply with such pmvisiou or this peinch mall bme
Ito deed ranked.
Z'" CONSTRUCTION LENDING AGENCY
[-.N+ Ihereby arfrm Nat drove is a construction lending agency for the,performance or
W 7 be work fur which this permit is issued(Sec.7097,Civ,C.)
fA Q Leader's Namc
=,z Undce.Add.
J 0 1 certify that 1 have read this application and sum that be about information is ,
canes.I agree to comply with all city and county ordinances and sole laws relating to
DU building construction,and hereby authorise«presentatives of this city to enter upon be
N W about-mentioned property for inspection pummes.
(We)agree to save,indemnify and kelt harmles the City of Cupertino against
pFy Iimilities,)udgatents,costs and expenses which may is any way see=against said City '
U Z in conmqusenec of the grammil a 's permit.
^ APPLICA UNDERS N ND WI OMP1Y_WITH ALL VON-,RgINT Issued by: Date J—
SOURC GU S q / //
//'f'Y//�5 Re-roofs
Signlrure of Applicamam
or D
HAZAR
HAZARDOUS MATERIALS pSLOM or URE Type of Roof
Will be due Cupertino
fume:Municipal
CgOccupant startor handle Heallousmaterial
as defined by Nc Cupertino Municipal Code.Chapter 9.12.and be Health and Safety
Calc,Sec tion 23512(x)? All roofs shall be inspected prior to an roofing material beim
❑Yea �g� P P Y g g installed.
Will the applicant or future building occupant use equipment Or device.which If a roof is installed without first obtaining an inspection,I agree to remove
nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
iaria1
❑Yes Idsvo
I have mal the hvardeuem 5505. 533 indents under Chapter6.95that lithe
the Glifoo-
.I.Health
not marmot
haw
355(15,2351)and 25514.1undCrslaldn am.scbuilding
dos not cuncndy haw a mnan4 Nati my repo hility m noufy the wcupant of On
mgmrcmcnts muatx�at itcaaance �cerdr amorotsugG S Signature of Applicant Date
I 6/ All roof coverings to be Class"B"or better
Owner` auNam<d aFcm g Dam
am Community Development
CuTorre Avenue
peOrtino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Buildin Department
JOB ADDRESS: y S ,� n� C)L, PERMIT#0 ,5 U S 00 5
OWNER'S NAME: �'{I I PHONE# LI V 6 -2 7/
GENERAL CONTRACTOR ' o FAX#
n
I am not using any subcontractors: 2^vo - 05
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
Owner/Contractor§ignature Date
Community Development Department
' Building Division
z City of Cupertino
.: ' 10300 Torre Avenue
CITY
l l Y OF Fax:
(408)777-3228
. Fax: (408) 777-3333
L U P E IST I N O
Building Department
Subject: Re-roofing policy for the City of Cupertino
-1- Prior to permit issuance;you must agree to comply with 1997 UBGStandards- -
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 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.
C
Homeowner's Name: /�
Job Site Address: �p—
Roofing Company Name: 7
Applicant's Signature: - �+ Dater OS
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO DSS
atr�%Ibow!, REROOF I
SCUPEkTINO PERMIT APPLICATION FORM
FAPN # Date:lding Address:
4fIner's Nam *siness
Contractor, -- - -- Phone#:
— - .-31--57-00Contact: Phone #: License#:
L _ 2— 305-7>
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ 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.
• I Have Read,Understand and Will Com 1 With Cupertino's Tear Off Policy:
Job Description: T��' y/� � "d (: � f (�
Residential Commercial ❑
Fire Zone: Yes ❑ No F-1
Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Pro ect: Type of Construction: Occupancy group:
ji 2z�
Qty. if Fee Description Fee Grou
A licable Fee ID
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener y BUILDING
f BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
(