04080217 (2) CITY OF CUPERTINO "`�' % s»aa <
BUILDING DIVISION PERMIT €CONTRACTOR�INFORMATION ;
BUILDING ADDRESS: MILLENNIUM CONSTRUCTION PERMIT NO 04080217
OWNER'S NAME: YERMIT ISSUE DATE
ONE:
SANITARY WO. CONTROL NO,
ARCHITECI'/ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0z LICENSED CONTRACT'OR'S DECLARATION
C w 1 hercny affirm the.1 am IiStoud un provisions ofsCode. 9(commencing lob Descriptio�NAL E
U
iN cern iIXkf of Division]of Nc�asaMProfessiof Code.and 9(co license is
epi in y `t Lke.x Y3 REROOF-REMOVE EXISTING & REPLACE
o Dam ' d canvamarfhu�nl�s•Ss WITH 30 YR ELK COMP.
ARCHTIECrS DEQL RP 1QN 1T.�(� L
<' tun t d my plans shall he used a pu.car& DEC �OoT
JyU
yLL� Lice d 5 orad ppp n /�
to m 3 met I am BUILDER DECLARATION DD ���®�'SkV 11// �
1 hereby atErm met I am ucmp.from the Conummr's License Law for the 'til\\VIf I\I\`r--/J•J
0 O following reason.(Section 703 1.5.Business and Professions Code:Any city or county
K (Li which mquirm a Permit ff)conswct,alter,improve,demolish,or repair MY smuctum
pronin is issuance,also requires the applicantorsuch permit to file asigned statement
that he is licensed pursuant m the provisions of the Contractor's License law(Chapter 9 Sq.Ft. Floor Area - Valuat70$oo0
mom$ (commencing with Section 7000)of Division 3of me Business and Profcssinns Cmle)ur 4
y _ Nat he u eumpt aluminum and tM basis for the dlcged exemption.Any=of
Section 7031.5 by any applicant for a permit subjects the appfcanuo a civil penally of APN Number Occupancy Type
not mom Nan five hundred dollar(5500).
❑I,as Owner of the proeny,in my employees with wages as Heir sole compensation, 3691.8032 . 00
will do to work,and the swctum is not immnded or offered hostile(Sec.JW ,Business
and Professions Code:The Conuacm's License law does not apply to an owner of Required Inspections
property who builds.,improves.he emi,and whodoca such workhimulf or through his
own employees,provided Nat such untrawmenu are not intended oronmmil fm sale.If.
however,the Wilding or improvement is sola within am year of wmpletion.an,owner.
builder will have the mmm of proving that he did Out Wild at improve for propose of
salt.).
❑1,as owner of Ne propcny,am ermimivcly emorm.ing with licensed ec nommrs to
construct me project(Sec.7064,Business and Professions Code)The Contractor's Li-
cerise Taw does not apply in an owner of propm.Y who Wilds or improves.W mon,and
who contracts for such pmjecu wit a coefficients)licensed pursuant m Nc Cantramorx
L'erase law.
1 am cal"under Sec. .B h P C for Nis mason
weer Date
WORKER'S COMPENSATION DECLARATION
40 1 hereby aDtna under penalty of perjury arc of tom fallowing declaratians: -
I haw and will maintain a Cenifica sof Consent to sel6iasum for WortetsCompen-
smion,as provided for by Section 3700 of the Tatar Code,for to pam ormanu a(in,
work for which Nis permit is issued.
❑I have and will maintain Workeri Compcnssam"ins u a,as required by Section
3700 of the ratan Code.for tW peRormmee of me work far hich Nis pemril is issued.
MyW.Mint Compensation lnsuranca canner and Policy a Wr am:
cr. o r
CERTIFICATE OF EXEMPTION OM WORKERS'
COMPENSATION INSURANCE
(This section need not W camplemd if.le permit Is for arc hundred dollars(SIM)
or less)
1 notify that in Ne perform�ampe ro�fame.Wwork for which Nis permit u issued,1 shall not
employ f nany
pJc'S OssaF became subject to the Workers'Coni'ma.an
wso Calto
PPlic U�
ETD L ANT:IL after making this vimins of of Exemption.you should
ome sub' . c Worker's Comperualian provisions of Nc labor Codc,you moa
.J Z Ed
ahwith co ply with Men provisions or this pe rrai mall be ammcd revakcd.
Z O
CONSTRUCTION LENDING AGENCY
[r 1himhyafltrm Nat Nem iso consffuctinn lendingagcncy far me,perriarom.of
!Yi dte work fur which.his permit is iaaucd(Sec.3097.Civ.C.)
Ik1 Q Lenders Name
�• Lendm'a Address
7 Z
U Q 1 sonify the 1 base mad Nis application and sum Nat tic&bassi information it
corm 1 agree to comply with all city and county oNinanus and sum laws relating in /
p V building construction,and hereby suborim represenutivm of this city to enter upon me
fJ.l above-mentioned property for inspection purposes.
gy (We)agree to saw,indemnify and keep Wanton the City of Cupertino against
FN liabilities,judgmens,costs and expenses which may in any way acerae against said City —O
U in conmquencc of to Saudi ng of not permit.
PL ANT UNDERSTANDS AND WILL COMPLY WlTkt AS{..N()N-POINT Issued by: Date
UR RE LATIONS. J�J
Re-roofs
Signator o pp canVConmaor Dam
I HAZARDOUS MATERIALS DISCLOSURE Type of Roof
❑1 to applicant or future Wilding meupa d store or handle hazardous material
as ele cd by tW Cupeniou Municipal Code,Chapmr 9.13,and me Health and Safety
w1c.Section 35532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yet
win the appncanl or m re building oceapant ora equipment or devmea wmm� If a roof is installed without first obtaining an inspection,I agree to remove
" emit hazardous air commouri n m defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
In& mad Nc hvaMoums 25505, 553raqu3 anenuundcrdeamor6.m if the Celifor. •�.� �U�''�
ria He a muiently Cade Sudorsnat itimy and$534.1 to
mai/de Wilding
Jac o curtcndy haw tenant,Not it is my rcaponsi M1ililym entity to.xcupml of the -
re, ichmust like met poor missuance ofaCertificate of0 ane'. SlgnatU Of pplicant J Date
=2
Ownero mi &agent m All roof coverings to be Class"B" or better
Community Development
• 10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADD�� S• CG��I Cay r�- IT #
OWNER'S NAME: L BUDNE # 4o� •2Sb- Ao-do
GENERAL CONTRACTOR: , l'a FAX # 4o& -I'Z s en-
I am not using any subcontractors: p 2$ t7Y
ignature Date
Please check applicable subcontractors/ d 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
e
r/Contractor Signature �^ Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E TIN 0 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.
IMPORTANT:
1. Flat roofs must have a minimum of I/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: lAlri� ��
Job Site Address a31 th 1v�f wuo� CWo_
Roofing Company Name: Yn 11 t rtv,k,*�, l n6-&,
A plicant, Signature: Fi i Date: � d
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROO F
�CUPEI�TINO PERMIT APPLICATION FORM
APN # ?/ Date: 290
Building Address:
b' Il 'CUA \e"AA 06 Cod-'—
Owner's Name: G -%7 s!j'11 �e#:
Ulm l 'F �
Contractor: Phone #: License#:
tllesnium 0i__ Sl1'JI�,
Cont t Phone#: Cupertino Bysinesice se#:
g` 2's'' 4e �eSC�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings i ❑ 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?`,)
Vt WIDU�_ RVI n ILCxrr tr�
Residential Commerci ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Pla t. if
there are any riction .
Cost /j ype of Con o Occupa grou
Qty
Apj4icAole 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
2 `
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