04090244 (2) CITY OF CUPERTINO' '* � ♦�r^x. 9�i /'� " _ -BUILDING DIVISION PERMIT C'ONTRACTOR,`INF.,URMATIQ �.. .
- ' BUILDINGADDRESS: ECONOMY ROOFING PERMIT"04090244
OWNER'S NAME: PERMUT UEDATE
KEVIN122,12924
ONE:
SANITARY IN CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=ao LICENSED CONTRACTOR'SDECLARATION Job Descriptio
dC I hereby affirm Ihm 1 am littnud under provisions of Chapter 9(commencing
w with cdon]IXlo) (Division 3 of NC Busincs�Professions CMk.and my lig ns,is
_m„ inmBf and BmI. o ' jj$1 REROOF W/COMP . n
�= License
D^ea e CO 0 OCT 1 7
0 Date TSD 2004
rj' CHITECTS DECLARA ION
5y a ' dcrs my plans shag sd a lthlic rccnrds (� {�
;;c V�I�®�Il V�
a G Li
Professional
OWNER-BUILDER DECLARATION
aIhereby affirm Nal 1 am exempt from the Commnors Liecnu Law for the
a O fe reason.(Section 7031.5,Business and Professions Code:Any city nr county
a pendit sea construct,alter,improve,demolish,or repair any structure
'n N poor to its issuance.also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant o the provisions of the COntraclOfs Liecnu lsw(Chapter 9 Sq.Ft. Floor Area _ Valuation
FFG (commencing with Section 7000)of Division 3 of the Business and Proressions Code)or
to
that he is exempt therefrom and t,basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of 3 G�Pd lgulitbe10 0 Occupancy Type
not mom than fico hundred dollars(SSW).
1,as Owner of the pmpeay,Or my employees with wages es their sole mmpcnsation,
will do the work and Ne structure is not intended or.mc¢d fors.].(Sec.7 4.Business
and Professions Code:The Contactor.License Law dies not apply to an owner or - Required Inspections
property who holds orimp rms thereon,and who comssuch work himselror through his
wn employers,provided Nal such improvements are not intended cremated forale.IL
however,Ne building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he did not build or improve for purpose of
ale.).
❑1,as owner of the property,am exclusively contracting wild licensed contractors m
construct Ne project(Sec.7044.Business and Professions Cade:)The Contrecmr's Li-
came law docs not apply to an owner of property who Wilds or improve Ihemon.and
who contracts for such projects wild a matmemr(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under sec. .B R P C for this reason
Own Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
1 nave and will maintain aCenificate of Consent to self-insure for Worker's Comped
..tion,as provided for by Second 3700 of Re Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compeduadon Inaummce,u requited by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers�(Cn�tmtB1yP}f��m�atio Insurance carrier and Policy n/u�m�pe�r a7m:/� ,,.,,
artier.s r WV �Q^2 Policy luc 1. LOLL—am
CERTIFICATE OF FiMFI ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed irthe Permit is forone hundred dollars(SIM)
m less.)
1 certify that in the Performance of the work for which this permit is issued,I shall not
employ any person in any manner so as W become subject da the Werker'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you sbouW
become subject to the Worker's Compensation previsions of the Lahr Code,you must
.J O forthwith comply with such provisions or this Permit shall be deemed revoked. '
Z CONSTRUCTION LENDING AGENCY
[r.�.. I hereby affirm that there is a construction lending agency for the performance or
ai> Ne work for which this permit is issued(Sec.3097,Civ.C.)
WQ Lender's Name
5 Z Lenders Address
V C I certify that 1 have read this application and state that the above information is
W F correct.1 agree to comply wild all city and county Ordinances and scale laws misting to
0 building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupertino against
FN liabilities,judgments,costs and expenses which may in any way accrue against aid City _
U Z m consixtr ncc of thc SO.domg of hi,,c,mil.
APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NO -POINT Issued by: Date ry
SOU E REG LATION v
7 r�4y
Re-roofs
S- turc of APPiic V omncdu te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future building.,.pant srom or handle havardous material
defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
,nae.soy eeCS zss3z(ar+ �j Ne - All roofs shall be inspected prior to any roofing material being installed.
Will mea applicant or f\wrc buildin I pa e w ter devmes wmm� If a roof is installed without first obtaining an inspection,I agree to remove
np s ecgapam q Preen
mit hazardous air comaminanu as drdned by the Bay Arta Air Quality Management all new materials for inspection.
District? `` rr�
C]Yes u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califon
ma Health dr SafetyCode,Sections 25505,25P3 add 2534.1 undcrscamtl that if the building �Zlo f-�
docs not entremly have a unamt that it is y responsibility m nod fy IW m
me Part the /.
mquir nmwhiccarWm ri t aisormof.Cerdficauofacup `y' qSignofApplican Dat
All roof coverings to be Cl ss"B"orb Iter
Owjs6L,A.dOuizcda I Dau \ i
Community Development
10300 Torre Avenue
" Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: & PERMIT # _ , /
OWNER'S NAME: L PHONE # 1/— 2-9
GENERAL CONTRACTOR: Fcovo yy ` FAX # — 7 o S
419 - -76)
I am not using any subcontractors:
Si afore Date
Please check applicable subcontracors and complete the followin 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 >11
Septic Tank
Sheet Metal
Sheet Rock
Tile
e /Contractor Signature ate
Community Development Department
Building Division
? I City of Cupertino
10300 Torre Avenue
CITY�F Telephone: (408)777-3228
Fax: (408)777-3333
SUPEkTINO
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: K o V tqnI L ry ✓,,
Job Site Address: iA f',
Roofing Company Name: c o v o-m 11 riN r r✓ _
A plicant's Signature: - Date: ` d�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO a
I2EROOF
�CUPERTINO PERMIT APPLICATION FORM
APN # / , Z CJ o Date: 7/;>— 2y6
Building Address:
Owner's Name: Phone#:q / ale)VI
,v h/ 9 23 (r
Contractor: Phone #: License#:
G
2
y
Contact: Z9 G� Phone#: U7 /^ /2 Cupertino Business License#:
G U
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles "]i( Asphalt Shingles
_ ❑ Wood Shakes _ _ _ _ ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
`Y- To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:' - ---- -
rh
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed wit anning De if
there arerestrictions: /
Cost of Project: Type of Cons ct rt'
Qty. if
A lica e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
f BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
X37.