05020076 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION "5
BUILDING ADDRESS: LOS GATOS ROOFING PE ""'05020076
PqTA722 DR
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY NO. CONTROL NO.
298-9399
ARCHITECTAENGINEER:
B-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
JILDG ELECT 0 PLUMB MECH
0 0
LOp "Ho"that
EDCONTRd under provisions
/
w I ion? affirm than I am licensed Business
under provisions of Chapter 9(commencing Job Description
2� with Section 0(10)af Division Sof the Business and Professions Code.ren my license is
fuitf eaneerfeet 0 J REROOF W�ASHPHALT
5 i Licc Class Llc.N
z;0 Date Contractor
f; ARCHITECTSDECIARA ION
3 w U k 1 unn�y pl s shell he u ublie mamas
ylaraposoulaf-
3 OWNER-BUILDER DECLARATION
<Y 1 hemby alarm that 1 am exempt from Nc Communities License law for the
O O following mason.(So,Wn 7W 1.5,Buinc o,xd Profession Code:Any city or county
vutei m which ayuilu a prnnim In cnnwn.alter,improve.Ocmnlish,or repair any swnum
prior m its issuance.also requires the applicant for such Permit to rile a signed statement
,2< that he is licensed pursuant to the provision of Me Conlraztori Uccnx Law(Chapter 9 Sq.Ft.Floor Area Valuation
4-n (commencing with Section 7000)of Division 3 of the Business and Profusions Code)or
'0y - Has he is exempt therefrom and me basis for the alleged caemption.Any violation of
Section 7031.5 by any applicant for it permitsubject,Ne applicant to a civil penalty of 3 6Q`@7�ID53Je(0 0 Occupancy Type
not mom man five hundred dollars(1500). rH� /k P Y YP
❑1,u owner of the poputy,m my employes win wage u thev sole compcwUan, N_11A n
will do the work and theslruaula u not imendedoroRerm fnrsale(Ste.71114,Bud. ((� t rs. -
anPmfesdon Cmc:The Gnuxsoes Uccrim law don arm apply m an ow.,of %gRequlredanspections
property who buildsorimpmvesMarcos,and whodoessuch work himselforthmugh his 9
Own employes,provided that such improvements am not mounded xoRerm Impale.If. a.0
however,me building or impovemens issold within one year of completion.me owner- , R
Wilder will have Ute burden of proving that M did not build or improve for purpose of
El I,as owner of the Sec.7property,,Business exclusively eofessi ns win lionised conwcmrs m t„e�/I,y�q� f✓ J
ecromconstL t me es non (gee.in in werofand professions Cade:)The Contractor's and
apse Law dors not apply m an owner of property who Wilds or improv theuon,xd
who sel.acls for such projects with aconuacwrts)liaoed pursuantm0te Gnlrxwea
0 1 am law.
❑1 am exempt under Sec. .B d:P C for this mown
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ora:of the following declaration:
❑I have and will maintain acanincam of consela to self-Insum for Workers Compen-
sation,as provided for by Section 37M of dte labor Code,for me performance of me
work for which this permit is issued.
❑1 have and will maintain Worker's COmpenau m Inti ..as reyvimd by Section
37W of the labor Code,for me pertormxce of Ne work for which tis permit is issued.
My Workeea Compensation Insumnc dip poliey number am: n,�
Glricr.�PoliN No.: -'Lda
CERTIFICATE
COMPENSATION INSURANCE
(This section need not W completed if the permit is fora a hundred dollars($100)
,it less.)
1 certify thrd in Ne performance of the work for which this permit is issued,1 shall not
employ any person in any manner at as in become subject to the Worksrd Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making mu Couricate of Exemption.you should
become subject to me Worker's Compensation mvision of the Labor Coda you must
Z forthwith comply with such provision or this permit shall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
7- I hereby affirm roam then is convection lending agency I'or me performance or
DSme work for which mu Permit is issued(Sec.3097,Civ.C.)
0 Lenders Name
. z Lender's Address
V Q 1 certify mat I have read this application and state that me above information is
Fcorrect.I agree to comply with all city and county ordinances and state laws relating to
0�7 Wilding convection,and hereby sumarix mprouctmives of this city m enter upon me
ahovomenuond progeny for inspection purpoup.
FW (We)agree on save.indemnify and keep harmless dm City of Cupertino ageint
N Habitues,judgments,ensu no expenses which may in any way aceohe against said City
U in consequence of the guarding of this permit.
^ APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU E REGULATIONS.
Re-roofs
Signaw c tic Ppb�Convac”" Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appties err fretum building Occupant some or handle havarduus material
u defined by drc Cupertino Municipal Code.Chapter 9.13,and me Health and Safety
Code.
C]yes �No All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will me applicant or future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
.mit hamdous air contaminants as dcMcd by the Bay Area Air Quality Management all new materials for inspection.
District!
❑Yes UlNu
Ihavc reel Nodesardnbn,255 5,255ls 3 it2uum@rChapter dthird me Califs, ` 1
nix Health&Sa¢ty Cadc,Sections 25505,25533 it 255J4.IunlMrsund theifthc building
doesnm rte; yh athe me,mm It imyme or a
ra ce,uicteoz ,ccpach, mlmC
myuimmc ks h nee mrmpl;nemEcate araapxcy. Signature of Applicant Date
0 er tar authadrnd agcm Damw
��' All roof coverings to be Class "B"or better
wn
Community Development
10300 Torre Avenue
i Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS' PERMIT #
OZ 1 LIJ-02- 0D 7G
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR Lqr p FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & ' work
Cement FinisNng
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating VO
Insulation 12
Landscaping 6'4/
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
or
Owner/Contractor Signature Date
I
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
EIT Fax: (408) 777-3333
i
CUPE1\1 INO
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 canbe 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: /, 40-P 441ar 0.4.1dt-`
pp J i
___Job.Site.Address: 1O191V.._,�,4YT/ 'd,��F�`./A�p/tr, . _._Ile,
.
Roofing Company Name: 1�L94�S /CSDfi.✓j
Applicant's Signature:� Date:
® Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
1 '
REROOF U v
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
-70 O#78 7
Building Address:
Owner's Name: Phone#:
610
Contractor: Phone :# License#:
r s oo 1i7 - 3 S1�0 70 7
Contact: Phone : Q / j Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )4� Asphalt Shingles
X Wood Shakes ❑ Wood.Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
El To be Removed ❑ Provide Mfg.Installation Specs.
® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic ❑
Job Description:A0.
Residential ® CommerEial ❑
Fire Zone: Yes ❑ No X Confirmed with Planning De t. if
there are any restrictions: u
Cost of Project: of Type of Construction:le do/ Occupancy group:
Qty. if
A licable Fee ID Fee Descri tion Fee Grou
BPERMFEE Bld Permit Fees BUILDING
- -
BENERGY... . . . . _Ener ._.- -.. .. .- . . . - BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CD