05100018 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT()WINFORMATIONi a
BUILDING ADDRESS: - PERMIT N0.05100018
6190/92 DISNEY IN
OWNER'S NAME: PERMITLSSUEDATE
MC AULIFFE GEORGE F AND HA EL 2005
ONE: SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
moo LICENSED CONTRACTOR'S DECLARATION O O O
d G 1 barely affirm Nat I am licensed under provisions of Chapter 9(commencing Job Description
.am with Section 7M)) fD1,kanSof the Business and Professions Cnde,and my had.is
n« inrnromeandoffect , Q 6 3637 REROOF-T/O SHAKE, INSTALL SHINGLES
22Z License CI a ^ Lic.p ,
Convaetn�W Luk CONTRACTOR: WRR ROOFING
ARCHITECTS DECLARATION
ey¢< 1 underaanJ my plans shall be used az public records
au
g o G Licensed Professional
` 3 OWNER-BUILDER DECLARATION `tleW
E I h .(Erre al NI on eacmpt frommIBC Conoth
saots License Law for e
io O following maxo mason.urra ft a)1171.5,Business and Pm,de oli Code:Any city at fumy
m� which acquires;a petmir m cnnswcr,almq improve,demolish.or repair any strmwrt ` e_
g= that
tr m its issmni,rment to the provisions,
of for such pertor's aos,Law
(Cha mem
xF< (commencingwJpursuan7")ofviviomnfNcCOmsiness ndProfLnw(Chapmr9 Sq. FL Floor Area J Q�fValu i�d000
0 (commencing is ttempth Section Division Use
theegedcsamd Profeuinvi Cnde)of
Nal he u exempt therefrom and the baso for Ne alleged Gumption.Any violation of - Ms
Section 7031.5 by any applicant for a permit subjects Ne applutdo so a civil penally of
ANumber 4/ ra
OFc
cyType
not mom tanfive hundred dollars($500). 37541017 . 00 11 , r A
❑I,as owner ofthe property,or my employees with wages compensation. 1V'.
n+v'h
will do the work,and the structure is notimended or offered for sale(See.7W.Business Required Inspections W
and Professions Code:The ComracmYs License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himul(or through his
awn employees,provided that such improvcmenu are not intended or offered for ale.If.
however.the building tar improsemem is sold within am year of completion.Ne owner-
builder will have Ne burden of proving that he did not build or improve for purpose of
ale.).
❑1.as owner of the property,am exclusively concocting wits licensed controurn to
consumer the pmjea(Sec.7(x i.Business and Professions Cade:)The Conomm/s Li.
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such prijecu wit a eonoaetor(s)licensed pursuant o the Contractors
License Law.
❑1 am exempt under Sec. .B&P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
,411 I hereby air.under penally of perjury one of Ne following declarations:
1 have and will maintain a Certificateof Consent to self-insure for Worker's Compen-
1.0m.as provided for by Sce,inn 3700 of Ne Labor Code,for the perforator.of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as ho uimd by Section
37W of the Labor Code.for ree performance of the work for which this permit is issued.
My Wmkce,CoTmpewtion Insv/p'na nlmer end Policy n7--
CERTIFICATE
r atyw�O�
Cartier.' .SI dTe TI�YIA Policy No.: — _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not Wcompleu:d irsle permit is fmoochundted dollars(SIM)
or less.)
I certify Nat in Nc perfurtmate of the work for which this Iw.1,is issued,l dull nos
employ any person in any number an as to berme subject a the Workeri Compensation
Laws of California.Data
Applicata
NOTICE TO APPLICANT:If,after making Ibex Ceninam of Exemption,you should
become subject to the Workers Ca rramoolm provisions of one Lmm Code.YOU must
.J ,Z forthwith comply with such provisions or Nis prom it shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of
LYi the work fur which this permit is issued(ST.3097,Civ.C.)
Uj Q Lender's Name
a
Z Lender's Ambess
a
V Q 1 certify that I hast fwd this application and more Nu to above information re
II.F-' Wilda 1 agree to comply with all city and county ordinances and sum laws r upon
he
V almm-mentiding wcti0nmdlemby authon p rposes.nutiru of Nis city to enter opnn lM
C[1 strove-(we)are property for inspection purposes
(•-' f1 (We)agree m ave,indemnify and kip harmless the City of against against
in consequence
of th.cral and dapemseamit. may in my waYaccrue against mid City ,
V z APPL CANTeUNDERSTANDSibis
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /6)
i SQr1'CE R LATIOMy
r Re-roofs
n u
B' rc of Applicamopare i
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Na,Cupertino
or future building e,Chard store or handle hmalt and
az defined Lion
the Cupertino Municipal Code,Chapmr 9.12,and the Health and Safety
We.sc❑ety.25532(°)+/. C". All roofs shall be inspected prior to any roofing material being installed.
Will me applicml or future building Occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
It hamrdmx air mountainous as drEard by the BUY Area Air Quality Management all new materials for inspection.
Diamict1 y
El Yea ! Ll nu
1 have mal the be arodous mammals tequimrnetra under Chapter 6.95 ofd a Califon
ria Hwlth&Safety Code,Secvats 25505.25533 and 25536.1 undersand that ifdc building
does not currently have a u:nmt,Nat it IS my responsibility to notify the scup.,of da,
aj� menu which mclpnormissuaRc of a Cutirmam or Occupancy. Signature of Applicant Date
or mmprisa.gam Data All roof coverings to be Class"B"or better
Community Development
m 10300 Torre Avenue
F % Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
9
Building Department
JOB ADDRESS: PERMIT #
l o - R s e J . b Q9lL'
OWNER'S NAME: B PHONE #
GENERAL CONTRACTOR: uW 2 FAX #
I am not using any subcontractors: t-w`L7 16-S—0
Signature Date
Please check applicable subcontractoind 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
*UPEkCITY OF' Telephone: (408)777-3228
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.
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 comply with the above
stated policy on re-roofing.
Homeowner's Name: YlA e f: 1,,P(e
Job Site Address: G LIT O — G 1 `L Z D I S ti av IV
Roofing Company Name: 1 6 ) "R_1
Applicant's Signature: Date: /D_ e�
isGreg Casteel
Building Official
Revised 71/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFTy 0
CUPEkTINO PERMIT APPLICATION FORM
APN "37.5' / U/ 7 Date:
O -
Building Address: 1
GIC10 _ 601 ,17- W
Owner's Name: Phone#:
5 l�t� e �to8 - 2 �2 - 531
Contractor: Phone#: License #:
U) IL2 40T- 360- SillP G 3-7
Contact: Phone #: Cupertino Business License#:
CA yob- 3(0o- `f/Il
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles SVS__Asphalt Shingles
>L—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>. love - cRoo-k wL 6 3v
Residential �' . 'Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Proje t: Type of Construction: Occupancy group:
II 000• 00
Qty. if
Applicable 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