04090070 (2) CITY OF CUPERTINO $ �nwg, ?�
BUILDING DIVISION PERMIT trCONTRAC�'TOR INFORMATION �i
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BUILDING ADDRESS: PERMIT NO.
REAL-T INSPECTION & REPAIR SER 04090070
AM STATES DR PERMIT ISSUE DATE
{ONE: SANITARY 'CONTROL NO.
(AnD) COG-2244
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
asi00 LICENSED CONTRACTOR'S DECLARATION Job Descri (]
in� I hereby affirm that I am liaemud under Provisions of Chapter 9(commencing P
with Secli 7U'XBmf Division Sof NC Bu upmfessimns Coda,andmylicenwis FINALED
in full fort effect.
nt2= Licemc LIC.11 REROOF W/SHINGLES
^Vi Dam ARCHITECTSConD reCLAR TION - APPLY 1/2 " CDXr 30#FELT SEP e3 2004
wnxrstandmyplaraahad El Km m PRESIDENTIAL TL W/RIDGE VENT
Dgu
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Licensed Pmf ssinnal U L®I
`' 3 OWNER-BUILDER DECLARATION
0k IG
hereby al7rm Nal 1 am exempt from the Contractor's Liecnu law for the
F.00 following rr ..(Section RD 1.5.Business and Profea6uns CCM:Any city ar county
m which requima a Permit in consumer.after.Improw,demolksh,or repair any stmctum
prior m in issuance.also mqunis the applicantorsuch permit to Bre a signed matement
< that he isliccneedpurmanltodoprovisionsofMeContractor'sLicenseLaw(Chapter9 Sq. Ft.Floor Area Valuation
as (commencing with Section 70(10)of Division 3 of the Business and Professions Code)or
i Nat he is exempt therefrom and the bmu for the alleged exemption.Any violation Of
Section 7031.5 by any applicant for a permit subjects the applicator o a civil penalty of ApN Number Occupancy Type
not mom On Ow hundred dollars($%(B) P Y YP
❑I,"Moscrof Neproponri or my employee with wagmss Neirulc compensation.
will de the work and Ne structure is nolimuoumd or offend for safe(Ses.1014,Business 36923035 . 00
and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improve thereon.and who does such work himself or through his
Own employ=,provided Nat such improvements sum nothranded rroRered forsake.It.
however Ne building or improvement is sold within one yea ofcumpletion.Meowxr-
builder will haw Ne burden of proving that be did Int build or improve for purpose of
sok.).
❑1,as owner of Ne progeny,am exclusively contracting with licensed enroll to
conswct NC project(Sec.7044,Business and Profusions Code:)The Conoacur's Li-
come Law does not apply to an owner of property who Nil"or improv Nemon,and
who contracts for such projects with a contractor(s)Roomed pursuant o the Conummes
LTaw.
I am eaemPt under Sec ,B&P C for Nis mason
Owner Dae
WORKER'S COMPENSATION DECLARATION
1 hereby affirm un"r penalty of perjury one of the following declarations:
1 hew and will maintain aCertifieam ofComent in ul6inmm for Workeh Compen-
t n,as provided for by Section 37M of Ne Labor Cade,for Ne performance of Ne
work for which Mia permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3900 of the labor Code.for Ne performance of Ne work for which this permit is issued.
ray Workers Compensation lnaunntt carrier and Policy number an:
17`amcr: Policy No.:
CERTIFICATE OF EtrEMP 10,2OM WORKERS'
COMPENSATION IN
TITis section need not bre completed Kthe Formals for one hundred dollars(SICO)
or Icss.)
1 certify Nat in the p ofirro nce of the work for which this Permit u issgeQ.I shall not
employany person irony manncrsossmbrco subjocuo IM Work.yy��os�pensatir_n
Laws of Calif`omia.ON I
APPlicant JJ
bwQT1ic s10 APP ICA :If,atom making this visions of of Exemption,you should
Wep)re subject y the Worker's Coons or ons
provisions of de Lad r Co",you must
.,2 faMwith comply with such previsions or Nis permiuhall be deemed revmkcd. -
z CONSTRUCTION LENDING AGENCY
[—i I hereby affirm that Nem is a construction lending agency for Ne performance of
LL' the work for which Nis permit u issued(Ser.3091,Civ.C.)
!y Q lender's Name
z Tender's Address
U Q I coolly than I have read this application and slow Nal the above information is
E-' cancer.I agree m comply with all city and county ordinances and slide laws mining to
�U building construction.-and hereby amhorin mpreumtives of Nis city m enter upon Me
shove-memiuned property for inspection put,owea
F G3. (We)agree to saw,indemnify and keep harmless Ne City of Cupertino against
fq ale
liabilities,judgments.costs and espenses which may in any way getout against laid City �7
(-7 ,Z, in consequence of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NON-POINT Issued by: D
SIS�SOU GEZeL �//J�
rcof ApplicantrConuacror /D Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Lmtd Type of Roof
Will the i,licam m furore building occupant stem or handle haaNums"aerial
as defined by Ne Cupertino Municipal Co",Chapter 9.13,and the Health and Safety
Cade,OYooca 35532(a)? )(No All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or Toren Wilding attupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it Numerous air comaminano is defined by Nc Bay Ams Air Quality Maoagemcnl all new materials for inspection.
District?
❑yes
Ihave mal Neh ,ardous materials requimmenta under, Chapter 6.95oftheCalifor-
niaHcalth&Safcty CC ,Sccdom25505.25533v 25534.1umkr d iHM building
lov—
does not currently have
a irnan4 Nat it u my rcaponsihility m wtify Nc«Upmt of Ne
neuirtm mustbcmctp' wma ecora m acm,ney. Signature of Applicant Date
49
Owner.,. nmi,e agent D e All roof coverings to be Class "B" or better
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
d;, 6 17 U) -ks 4 ids /,<. 0 (qo715
OWNER'S NAME: u PHONE # 4 6 - (off
GENERAL CONTRACTOR: -TibREMOW #
I am not using any subcontractors:
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
Contractor Signature l3ate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
O Fax: (408)777-3333 UPEkTIN
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 co^m�ply with the above stated policy on re-roofing.
Homeowner's Name: FJ� N Mu
Job Site Address: /D 817 W •
Roofing Company Name: ReAL- s�N,6`P�c�IO►� �e (2g�a2
A phcant's Signature: �L Date: '0YGreg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF RE R®®RTINO
' UTTOF ,JD��O
CUPERTINO PERMIT APPLICATION FORM �V(
APN # ) ?� 6 Date: Qb 3 6
Building Address:
/ct ' 7 Il) . F A e
Owner's Name: Phone#:
1Jo1�4 Mur:cr N
Contractor: Phone#: License#:
IRk t � s �EPar2 °/4(o - Z2 5/3883
Contact: Phone#: Cupertino Business License#:
�reN« �c iD�t 96 —zZ '2Llb-�l 41
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X 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:
TE atouC-- Z oo A"L V / °r,-b-1, 3 0-UF e LT �2Es1 TIA L W �ENY
Residential Commercial ❑ NEw G"n612s OUSTOVt5
Fire Zone: Yes ❑ No Confirmed with-Planning I. if
1 there (e any restrictions: '
'st of Project: Type ofns ctionj Oc pancy g p:
/Z 600
i r
if
pWable 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
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11 . 3�