06030032 (2)�w
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CITY OFCUPERTINO
OTRACT.'° RINF.ORMATIOi: ':
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
MBROWN CONSTRUCTION, INC
PERM'TND'06030032
10031 CARMONA COURT
` ER'S NAME:
PERMIT ISSUE DATE
CARTER, NANCY
702 S. DANIEL WAY
03/07/2006
P NE:
SANITARY NO, CONTROL NO. '
(408)260-1260
ARCHITEC iENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
I hereby affirm that l am lice n wd under provision, of Chapter 9 (commencing
p
with Section7")ofDivislon3afdu Bualn,,dProf mC de, lieemo le
InmRto= and effecl. �$
REMOVE EXISTING COMPOSITION AND EPLACE WITH CL
License Cl '
A COMPOSITION
Dau CentraMr
ARCHITECT'S DECLARATION
T'SD
FfNALE[�
FINALE
1 understood my plans Shell he used M public rccnrds
2OD6
Licensed Preform onal
OW NEmBUILDER DECLARATION
1 hereby .(Sure that I , Lew for the
exempt from the Conions
MAR
C
1 afer. Nd PNICAon-li (.'a11C:Any Cm arepanly
maeaa.(BCC6a1 RDIS, : My c
which re l construct. mse, or my moccudwar m
w61ah
iss a ri
rm
01
Mob
e a sir
re quires;thealter,
e. alll
I h parinit u
priorms issuer palsmmui the tMaision; nfar such perm'u01e eL1ov Raumcm
its
pureuant to Ota of the Camncmf'and
Sq. Ft. Floor Area teat
(thiatic commo,liccmsed
of Division Preeiaw(Chapur9
Code)of
(commencingwith SccOon7000) of O asisOI3ofthe Businessendon.
Any
that he c exempt therefrom and the basis for the alleged "emptier. Any violNon of
�N7 1b,
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penally of
not mom than five hundred dolWs($500).
1pc�Ypp,7N�y
11b U1
3J/a.•`•EN 00
❑I, as awn" of the property. a my employees with wages as their onto compensation,
Required Inspections
will de, the work and the structure Is not intended or offered fOvale(Sec.70W,Bualnesa
and Profession$ Code: The Contractor's License taw dome not apply on an owner of
q p
property who build, or improve, Demon. and who doessuch work himself ar through his
own employees. provided that such improwmenu me not Intended crartemd forme. 11.
however. the building or improvement is sold within one year of compietion. the owner.
builder will have the burden of proving that he did not Wild or improw for purpose of
tele.).
❑ 1. u Owner of the propeny, am exclusively contracting with licensed contrawmas in
construct the project (Sec. 704, Bminem and Philosophers Code:) The Coauacme, LF
came Law does at apply in m Owner of factory who bullar or improve thereon. and
who contracts for such projects with a cotnracter(s) licensed pursuant in the Cornerstones
License taw,
❑ 1 em exempt under Sao. . B At P C fer this reason
her Dau
WORKER'S COMPENSATIONDECLARATION
1 hereby LMm1 under penally of perjury oro of the following d"lantion$:
❑ 1 ham end will malnuin •CeNficeu efCan$ent m ulFinaum for WorteY,Compen-
sath n, ar provided for by Section 3700 of the Labor Code, fm the Performance of the
work for which this permit is issued.
have and will maintain Workels Compensation W urea, M required by Schon
of the taker Code. for the performance of the work for which this permit is listed.
yWarke m ado�ansuran�`e cesi" and Policy number am:
Cartier. r `�`� Policy No.: I t �- 1? t
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This smion heed nothecampked if dm permit is f"anchundmddollsn (SIM)
o coal
1 certify Nat in we performance of the work for which this permit Is Issued. I shall at
employ any person in any manner an u m become subject to the Workers' Compematlon
Laws of California. Date
Applicant
NOTICE TO APPLICANT-. If, after making this continents of Exemption, you should
become subject to the Worker's Compensation provisions of the Lahor Code, you must
Forthwith comply with such provisions "this permit shall he doomed m orkcd.
CONSTRUCTION LENDING AGENCY
L hereby affirm that them its construction lending agency for the performanm of
Ne work for which this permit is Issued (Sec. 3097, Civ. C.)
Lender's Name
'
Leader's Addition;
I certify that I haw read this application and sum, that the show information Is
Covent. I agree on comply with all city and county ordinances and suite laws mining to
building convection, and hereby autborme representatives of this city to enter upon tic
shave -mentioned property far Inspection Pugmses
(We) agree to sew, indemnify and keep harmless the City of Cupenine against
liabilities, judgmu and expense, which may In any way acce agaimuald City
cn. cam ry
in consequence of the granting of this permit.
APPLICANT NDERSTAND ND WILL COMPLY WITH ALL NON -POINT
l 6
Issued by: Date
SOURCER U ATIONS.
Re -roofs
Type of Roof
//��((,,JJ��'//'((����
�'Daw�
si,moura�pplicarntromor
- ' 114VARDOUS MATERIALS DISCLOSURE
Will The applicant or future building=uponumm orhendle harawou3 material
as defined by the Cupertino Municipal Cade. Chapter 9.13, and the Health and Safely
otle. Section 35532(e)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or f tum Wilding occupant use equipment or devices which
emit haulmoos air comumina B M defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yue
l have mad the W.Oh rmaterialsmquimmcnu under Chapur6.95 oflhe Califor.
h
nia HUI" Safcty CSM, Sections 35505,35533 and 25534.1 undcmuM Nu ifthe Wilding
docs not cu nil hewatear!Nmitsmyrespomihilityw.ofytk p.t.rfie
raquimuents chmuatemet toruusmnaaracmuecateof r 0
6
Signature o Appli t Date
All roof coverings to be Class "B" or better
Owner
or uIpfizod x,A pate
V
CITY OF
OUPEkTINO
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: CQyyy%pyjC,, C4-- PERMIT #
(ja 0 3 00':3�
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX # X24 6- C 1 O
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21
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
" 7
* i WT
• ., .
aG
ate
Community Development Department
Building Division
City of Cupertino
•
la
10300 Torre Avenue
Telephone' (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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.
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 I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will complywiththe above stated policy on re -roofing.
Homeowner's Name: / " VY_
1002))+1 �tz
C,4
Job Site Address: �n . `' ^
Roofing Company Na \ u �-'v , C Y U 1
Date:
Applicant's Signature:
•
Greg Casteel
Building Official
Revised 11/2/04 '
Printed on Recycled Paper
cm or
UPERTINO
CITY OF CUPERTINO
REROOF OW500 3a
PERMIT APPLICATION FORM
APN #
- -- ------ ----
Bldg Permit Fees
Energv
Date' O
Building Address:
Owner's Name:
BUILDING
BUILDING
Phope
v S 3-
C
BUILDING
BUSLIC
Contractor: nit 1n
BUILDING
ori �� l Z� -
License #:
Contact:-
Y_UW Vl
Phone #: Cupertino Business License #:
2 S t 0
Type of Roof Covering:
Existing:
❑ Built -Up Roof
Proposed:
❑ Built -Up roof
r. Asphalt Shingles
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
Li (Specify)
Number of existing coverings
❑ Other (Specify).
❑ , Provide I.C.B.O. Report #
(3 To be Removed _
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will ComPlY
With Cu ertino's Tear Off Polic :
Job Description: � Oce,
e) I .' l�.d„` cit
�-1�
Residential Commercial ❑ LOW e6S carte.
Fire Zone: .Yes ❑ No ❑
Confirmed with Planning Det. if
LJ
there are any restrictions:
Cost of Project: Type of nstructign: ; Occupant group:
14, v �Lc�� I
b0
11zz Qty. if
L`se Tlnen.i nfinn
Fee Grout)
Applicable rcu iL
BPERMFEE
BENERGY
- -- ------ ----
Bldg Permit Fees
Energv
BUILDING
BUILDING
BSEISMICRE
BSEISMICOM
Seismic Fee Res
Seismic Commercial
BUILDING
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING