04100082 (2) CITY OF CUFERTINO
BmT.mnc mvlslon PIiRMITCONTRACTOR INTORM MON ":
BUILDING ADDRESS: N TR TION INC PERMIT Nq.410
0933 CANYON VISTA DR
OWNER S NAME: PERMIT ISSUE DATE
al RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST 10/13/2004
HONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INPO
BLDGELECT PLUMB MECH
0 0 0 0
Lop LICENSED CONTRACTOR'S DECLARATION
w p I hereby affirm that I am licensed under provisions of Chapter 9(commencing dal%Description
<u with sect n] B of Division 3 order Bu.sinc and Promminnv Cnde.and my license is / � �� „s�, �m
in fml lhr cn _ O REROOF W DURA LAST Ca
EU
Off= License Lie P '
nFW Das Cumracm p��
j ARCHITECTS DEGIA ATION AOI) GV
w< Ivo Jm},n)5sra shall lv .. +e��ie eceords HIR Col 2005
JaU
U.11ffd Professional
i OWNER—BUILDER m the Contractor
BUI�l
<y I naso affirm that 1. exempt from the nmions C s Licensee Law for the rp'�^] If
p o following reason,(Section]6]L5,Business and Professions Crede:Any city or county
ou m which requires a permit ro eonmecl,alter,improve,demolish.or repair any structure
$10100
FZy prions its issuance.alm requires the applicant Fortner Permit o He a signeJ.vamment
that hei.Ecensedpursuanttothe provisions pnheContractorsLicenselaw(chaprm9 Sq. Ft. Floor Area Valuation
seFO (commencing with Section70ko of Division 3 of the Business and Promssit CnAe)nr
y 5
that he is exempt therefrom and tW basis for the alleged cacrodian.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of be Occupancy Type
not more than
five dollars($560). P Y YP
❑ I,as Owner of the property,or my employees with wages as teir.mlc compensation.
will do the work,and the souctum is not intended or offered for sale(Sec.]Odd,Business
and Profession.,node:The Contractor's License Law does nut apply to an owner of Required Inspections
pfaperty who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered formic.If,
however,the building or improvement is mid within one year of completion,the Owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale)
❑I,as owner of me property,am exclusively contracting with licensed contractors to
comma the projcn(Sec.70,14,Business and Professions Codc:)The Contractor's Li�
cease Law does not apply to an owner of properly who Wilds or improve Reopen,and
who contracts for such projects wire a conlraclorb)licensed pursuant to the Contractor's
Leine Law,
C] am exempt under Sec. .B&P C for this reason
owner
wn Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Cer ificac of Consent to elf-insure for Worker's Cnmper-
sation,as provided for by Section 3700 of the Labor Codc,for the performance of the
work for which this .it is issued.
❑1 have and will maintain Worker's Compensation Insurance.as squred by Senion
3700 or the Labor Codc,for the predominance of the work for which this permit is issued.
My Wmkcex Compensation Insure cc o ad Policy,nummNr am
�ryI S Policy
E OFCERTIFICA PnON FROM WORKERS'
COMPENSATION
Z(�
INSURANCE
(Thu ecaitm need not W completed if tic Permit is Tor one hundred dollars(5100)
r less.)
1 ccnify drat in the pe formaner,or the work for which this permit is issued,I shall not
employ anyperso anym tomo as it)hecumesubjectm the Workers''Compensaion
Laws of California!Datc
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Wcome subject to the Worker's Compensation provisions of the Ichor Code,you must
z forthwith comply with such provisions or this Permit shall he deemed revoked.
Z'O` CONSTRUCTION LENDING AGENCY
l^^ IMmby affirm that there is a consuuction lending agency forte performance of
5 me work fur which this permit is issued(Sec.3097,Civ.C.)
'.s] Q tenders Name
Lender's Addict
D
U 0 1 ccnify that 1 have mard this application and cute that the above information is
U. F correct.1 agree 10 comply with all city and county ordinances and state laws relating to
0 V building epnmvetlon,and hereby amrmi¢rephumaivex of this city to enter upon the
>^ C have mentioned property for ins,eum purposes.
(We)agree ro save,indemnify and keep harmless the city or Cupertino against i�� /
liabilities,judgments,1.costa and et,crimnify es and k eh may in anypress t way accmc ty.1Cu ertinoaag City /// (/
U Z. in consequence of the gmaing of this permit. 1
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E RE k�LAT ,S.
1 0-1 'OL Re-roofs
\ Gnamo fin' on
App actor Das
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle bvarJuus mamrial
az defined by the Cupertino Municipal nWc.Chapter 9.12,and the Health and Safety
colo,Section zss3z(a)+ � All roofs shall be inspected prior to any roofing material being installed.
❑t
Will in.applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new ma * 1 for inspection.
Chorin'
C]Yet tt(r+U
have mad the hror dour materials mquimmenv under Chapter 6.95 of the Califon
nia Hallh&SWct Codc,ScNonx 255115.25537 and 255Jd.1 unJcrsunJ that if the huildin 11lr` C.
tlrcs nm currentlyhowa tenant.that h is my respomihility m noir,the occupant _
e�(TOO L-.(stash t MCI primu.isaaanceoraCcrtinea'�aeupancy,� J SignatureofApplicant Date
��� —I
own raalm� hmi'edaFenl s Date All roof coverings to be Class "B"or better
NCupertino
Community Development
10300 Torre Avenue
CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOBYADDRESS �\ P IT # O (f0 0
l M Y�
OWNER'S NAME:
ti G PHONE #
GENERAL CONTRACTOR: ` FAX #
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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
�UPEf�TINO 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 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 mply with the above stated policy on re-roofing.
Homeowner's Name: ,uc�sr, K)e e Q 0L�S- AA a
Job Site Address: r
Roofing Company Name:< P., �O �S`�
A plicant s Signature: ��1`n r u q. A\c\e, Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
RFROOF
� Y OF
CUPEkTINO PERMIT APPLICATION FORM
APN # ir,,7 3Sy CJ Date:
j - sS T
Building Address:
I 3 � t r
Owner's Name: Phone#:
Cl,
Contractor: Phone#: License#:
r e_e� ^4- q 7,5-. I , en
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
EX, ng: Proposed:
ITiBuilt-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 Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
In 7 LC N^ ,-- rae,
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
A 1 a`lee) 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