04110087 (2) CITY OF CUPERTINO ,ua�a*+ �c
BUILDING DIVISION PERMIT CONTRAC �ORINF'ORMATIO - '
BUILDING ADDRESS: ROOFCO OF SILICON VALLEY PERMIT 19b 4110087
. 10506 E ESTATES
OWNER'S NAME: PERMrr ISSUE DATE
JANE TAI 844B EARLE AVE ii /ir�/2oort
ONE: -----. SANITARY NO, CONTROL NO.
(408) 795-3335
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG _ELECTPLUMB_MECH
LO' LICENSED CONTRACTOR'S DECLARATION - O pppaaa O
e O C 1 Mm y afrrm Ihu 1 am Teemed oMer pmvisions or Chapter 9(commencing Job DOSCfIp[i �� ._.
nen wan S u IXN1)of DivisionJerthe Buss Zr Code.and myliccmc is
in fol aadeffmL /� /�_ >J�� L/y REROOF W/COMP. - - -
LicenseClm L r - - - - - - DEC s=-
1-
Date— Contractor , _.
ARCHITECTS RA N Zo04_- --
'2 -1 I uadcrstend my plans shell I�.uaede cnNs - -- - - -
30�' y U rte. 0000'' 11 ttpJIk���
Lkenud Professional AFl I�®Ip 'Q
g 5 OWNER,BUILDER DECLARATION
3 n q 1 hertM1y affirm Nn 1 em exempt from the msmmnstCo :Any C Law for the
iO O which fuku�ir,wort emit t 7 o L5,Business and Rofesduns Code:Any oily or county
t m which reyuireA n permit 10 m.the Wet.impmvu,h pcoosh,m repair any smnmm - -
Fi< primem iscensed .slum requires the applicant for sOchpctor's Licca Law(aemcnl -
momme namint m)ofDi¢iunurdthecenvmmhr.lanseleonsCruer9 Sq.Ft. Floor Area Valuation_
QFC (commencing with Scotian 70007 of Division 3 o the Busincssand ProfcuinnaCMc)ur —
i $
that k is exempt therefrom and IN,basis for Ile alleged!exemption.Any violation of
Section 7031.5 by any.pplicam fora permit esbjOcu the applicant to a civil penalty of 3 8100 - Occupancy Type
not mNen fm Nfrac hundred dollars(3500).
0 1,as owner of the pm xrt,m my employees with wages as their sole compensation,
will do the work,and to,swmum is nos intended or offered for sale(Sec.7014,Business
and Pmfccsmns Code:The Contractor's License Law docs not apply to an owner of _ Required Inspections -
property who builds or improves thereon,and who dose such work himself or through his
own employees.provided that such improvememn tie not intended oroRere l forsake If,
however,me Wilding or improvement is sold within one year ofcompleuon,the owner- --
builder will have the burden of proving that he did not Wild or improve for purpose of -
sam).
1,as Owner of the prupeny.am exclusively convecting with licensed contractors to _
construct me project(Sec.70x4,Business and Pretensions Code:)The Contractor's Ls.
Ceram law does not apply to an owner of pmNay who builds or improves them.n,and
who contracts for such projects with a contractor(s)licensed pursuant to the Convector's
License Law.
❑I am exempt under Sec. ,B&P C for this reason
owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aRam under penalty of perjury one of Be following dmluasious:
I haw and will maintain a Ccru fine of Consent to self-insure for Worker'sComNn-
sation,as provided for by Sttuon J70o of me labor Code,for Ute performance of the
wart for which this Nrmil6 issued.
1 have and will maintain Workers Compensation Instomer,u required by Section '
3700 of me Labor Code,for the performance or the work for which this permit is issued.
My Work cr¢Cnmpersauon lnsunntt pate Pofry No.;up Inumber am: vv
.Carrier. C!
'� CERTIFlCATE OF EXEMFnoiY''O WORKERS'
COMPENSATION INSURANCE
(This section need not he complekd if she permit is foram hundred dollars($100)
arks..)
I and)y mm in Be performance of the work for which this permit is issued.I shall nut
employ any person in any manner an as m become subject to the Worlac ComNmdon
tewa of California.Date
Appinant
NOTICE TO APPLICANT:Ir.after making this Cenifcae of Esemption,you should
become subject m the Worker's Compensation provisions of the Iabnr Code,you mum
,Jz forthwith comply with such provisinas or this permit ahakl be dccmcd revoked.
z� CONSTRUCTION LENDING AGENCY
[-. 1 hereby affirm that Dere is a consv.minn lending agency forme performance of
a the work for which Bis permit is issued(Sec.3W7,Civ.C.)
U]0 Lender's Name
z lender's Address .
U0 I cenify that 1 have read this application and sue Net me above infotmatiun is
It, F' mmecL 1 ague to comply with all city and county ordinances and sure laws relating to
0 U building construction.and hereby aut ono,repoesmnldv of this city to enter upon We
.hove-nmru rtcd property for inspection pmrwscaaszr
H I,
(We)ogee m save,ande expenses;
arta kap humless Be City or Cupertino id LLY
I, Iiabiliu(We)gree On cess andexpcoseswhich may inany wayaamcagunstseid City
U z
APPLICANT CUNDERSTANDS IAND WILL COMPLY WIT ALL NON- DINT Issued by: Date
SOURCE REGULATIONS
Re-roofs
ngnawrc or ApplicaHAZARDO Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant Of fuwre If Id Occupant Atom or handle hwr ous material
as ceftncd by the Cupomoo Man pal Cedc.Chapter 9.12.and me Hcalm and Safety _
Cock.soden 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0Yns No
Will Bc.pplscam m future ding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamoous air conaminans dcEncd by the Bay Area Air Quality Management all new materials for inspection.
D'Wict
❑Yes Nu
I have read the mmardous materials requirements under Chapter6.95 of the Caliror
nix HcalB&SafmyCo ,Saco.7505.25533and25534.1undc..dmatif OC building Ute
dews not currently hmc a moan,mar it m my rea,muhnllily to notify the occupant or the
reqs retewteryignatureofApplicant Lyme
�
..m.n.d agent - a,c - All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
EEO, Cupertino CA 95014
" Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PFkIIT #
U GC e 06,
acbg: -
OWNER'S NAME: w %, ' PHONE # 09;)-- 55 '5-
GENERAL CONTRACTOR: FAX # 2£i f— 53 Sv
7
I am not using any subcontractors; �:�� o
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
bing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature ate
Community Development Department
?' Building Division
„ City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
OCITY OF Fax: (408)777-3333
UPEkTINO
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: I O 7nU �DF
Roofing Company Name: e>Jr (2o
A plicant's Signature: : —ate= '�l
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
• CUPERTINO PERMIT APPLICATION FORM
EBuilding:Address:
# �� 2i- v3 Date:– _p
C 4 esu
Own 's Name Phone #:
A-/
ontraior: Phone#: License#:
Contact Phone#: Cupertino Business License#:
�5��2�- 5 353
Type of Roof Covering:
Existing: Proposed:
O uilt-Up Roof ❑ uilt-Up roof
Asphalt Shingles Y Asphalt Shingles
❑ ooWood Shakes ❑ Wood Shakes
,rte Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nuer of existing coverings 3 ElProvide I.C.B.O.Report#
Er To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 y With Cu ertino's Tear Off Policy: Nr
Job Description:
Residential Commercial Cal-.T .
Fire Zone: Yes ❑ No 0— Confirmed with Planning-D�ept.�if
there are anrestrictions: U
Cost of Project: Type of Constructton Occupan group:
y. if
licable Fee lD 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
•
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