04080258 (2) CITY OF CUPERTINO w pt ^,
BUILDING DIVISION PERMIT RCONTIUCTM INFORMr1.TION �
e ..,.:'.:a4,. , . ,#'i"a"" y..asp .. ,:: 13
BUILDING ADDRESS: WOODS ROOFING PER""04080258
1131 QFRRYqT4TRP. ng
OWNER'S NAME: PERMIT LARIE DATE
Ig 1h DIANA CLAYTON
ONE: SANITARY NO. CONTROL NO.
(831) 637-5576
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACIUR•S DECLARATION Job Descri tion
Y+� 1 hereby affirm that I am licensed under provisions of Chapter 9(rnmmca cin@ p
<� with ScCdon7Do0)ofDivlaidn3oftWBuainasand rofessloru Code,m ylicemc is
^ Infu Oil fare.andn
ClflE Llc
REROOF
Da
'
ARC
CHrrECr ECLARATION
�i 1 undenun l my plans shall he used as public records
3 5 aid Lkcmetl Pmfcuiond
OWNER-BUILDER DECLARATION
q I hereby,(firm(Section n I n. eaempt from Ne es kats Co License 4w for Ne
p o which m mnoaermitsRB Lr Business and Proow,dem li Cade:Any City or county
$f2i pow in
its issuance.
also
soconstruct.be alar,improve,deermit t.orrepaira sigany struumment
H S° the,W Iuissumce,yuan Wthe PoViSl of Of for such amiter torile@ncilalatemcm
�< Nnhaenikcnsed pursuant aOta of Dkiom of tite in Buanessan¢veluw(Cheptcr9 Sq.Ft. Floor Area Valuanon
€g
(commencing ptthendfromon ndda, lvisidfr of Neeged ca end..leasAnyom Wlim or P! n
3 Net K V aeempt mertfrom and me bels for Ne aik{W ucmptian.Any Waluidn of r 1
Steel 7031.5 by airyapplicenl fore permit subjecu W applkam a•civil penalty of ` 3�N4'ULL�drO Occupancy Type
not mart Nan Ow hundred dollars WOOL
01,as owner of Ute property or my employees with wages as theirsele eompemadon,
will do the work,and Neslmcture innotimended orofrarWforak(She.70a,Bunieas
and eny who
Professions Cade:The Ganllemon.ed's Lo.ndwint law dace nn apply ff an dwmr of
is
papentywyces.provided
that
muchimpro mems daesauchwded or onforNmugh his
awn employes,provided Nvt ouch tmprowmentasm ndl yew
otc aro@red tfor he Ow.lr.
however,Ne avehbuilding or Improvement k cold within one yen of cemple for the owner
builder aB have the burden of proven@ Nn ha dltl out build m Improve for purpose of
"In.).
❑Les owner of the Sec.70prosody,,am Business reclusively couvamin{with:)Th ed amnvamore N
com,La d canon pec.7014,wnerofandrty,whai Wi Cade:)Themtheman.and chose Lew dos not apply b an with
a of property,who huller or Mprow Contra,and
who contracts for such projects with a couussmr0)licensed pursuant a the Conuectoh
Liceme Law.
❑Ian exempt under See .BkPCfor this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penally of perjury one of Ne following declarations:
1 haw mod will maintain aCerdfiamo(Consent Ioalf-imum forWuraces Comport.
-mon,u provided for by Section 3700 of she Labor Code.for the performance of the
work for which this permh Is dased.
ve Ntl will maintain Workers Compensation Imuruice.u required by Scedon
Ooaf Ne labra Code,for the performance crime work for which this .I,wended. '
1110,
y Wd aces Com tion hisu�artier and Policy number mon.
Cartier: RT 191— Polity FROM
O K S �a!��
CE IFlC OMPE SATION7I NFROM WORKERS'
COMPENSATION INSURANCE
(fhb section need trot hecomple ed if me permit is faroxhundred 011.(SIM)
less.)
I century that In the performance of the work For which this permit la issued.I shall not
employ any person in any manner a as in became abject to the Workers'Compemation
Laws Of California.Dale
Applicant
NOTICE TO APPLICANT.IL afar making this Certificate of Escmptian,you should
become subject in the Worker's Compensation pmvisiom of the labor Cmk%you must
O foMwith comply with such proviaimu m this Minot Mmm
Mall be deeedwked.
Z"' CONSrRUCrION LENDING AGENCY
[—�.N., I hereby affirm NU Nem k a combustion lending a@enq for due performance of
CC
the work for which Nu permit is issued(Sec.3097.Civ.C.)
QIandcm Nona
7 z lender's Address
U O 1 antify Nal 1 haw sad Nis rep AICIRdon and num Nu use abdw information B
Lp comet,I agree to comply with all city and county omimnsa and nam laws misting in
0 building convection,and hamby summon repmaenmiws of Nin City In enter upon the
43I abov>mentiuned property for Wpecdon Purporea
LL (We)egme a taw.Indemnify and keep harmless the City of Cupertino against
co) lizinities,judgmenu.com and expenses;which may In any way accrue agaiml said City
U Z in consequence of Ne @ranting of this permit. §�
APPLICA V w�'�'e`L"Y/°"'' ALLAN.WITH / INTIssued by: - &0 Date
SOURCE R '[ION
Re-roofs
Signuu of Applian,Conuac ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future building oceupamsare in hatbk huamom mauri)
ss defmod by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
ale.cYu 15533()? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil haraNnus air contaminants as de0ncd by the Bay Ass Air Quality Management all new materials for inspection.
District?
❑yes �U
I haw rest Um hvardtans 253.255 uianew underChapur6.93 dome Califon Q
nu HmIN85afetYCode.SaUau 25305.25577 aM25531.1uMcmaM Nnif the Wilding s( Q
dna not earth ly haw a mnanL N 't h my ms omiNliry m Iwtify Nc ars sot f Nc
myvimmen mhmuu to law faCciylkateafQce y.//p Signature of Applicant Date
�m f//p
Owner or eulhorvuds@em � ❑/ate All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
aC10F
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRE PERMIT#
/13 8O 2 S
/
OWNER'S NAME: PHONE# --L 5 S -,cP/63
GENERAL CONTRACTOR: l,J WVZU FAX #
I am not using any subcontractors: 3C a P
67 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
L)rrj, % &� ell 10
�Owner/Corlizact4 Signature Date
Community Development Department
Building Division
Qt City of Cupertino
f� 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E T I NO
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:
Job Site Address: 1131 n ,
Roofing Company Name: 0f9i9� �r
A "cants Signature: Date: Awa�
eGreg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO c� g
REROOF a Z 530CUPEIIiTINO PERMIT APPLICATION FORM
APN# 36 2- (� Date:
Building Address: D
//3 /
Owner's N Phone#:
2ss -ft/ 63
Contractor: Phone#: License#:
l )trvcP 's 6L/0-o703 32513 !
Contact: Phone# Cupertino Business License#:
et-hAA- a-' Zvi"/O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles /'4!C 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: T/ (2 - 0t L/0 yn E4U 414.� ,z_i 9
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with PI ing Det. if
there are any re 'ctions: LJ
Cost of Project: oo Type of s do Occupancy. up:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Idg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
fit 2