04110072 (2) CtTBUILLD NGUDPERONNO TRINPERMITkOMTIOON -
�BUILDINGADDRESS: PERMIT NO.
, . YORKSHIRE ROOFING 04110072
OWNER'SNAM PERMIT ISSUE DATE- -
SANITARY OCNO.
ONE:
[ARC=H1M=1ENGINEER: "" BUILDING PERMIT INFO
BLDG - ELECT' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
u EI hereby affirm that I am nccnmdander pmmi oma of Ch.pm,9(commanaing :Job Description. _h Section of wnion3.fNe Businasq an cure.Cocoa ndmylicenais
UllfoRC ������ t `� �� — Lm.g REROOF W/COMP. tg om Connu
�'.j' - V ARCHIECrS DECLA
�i 1 unit it my plans shall named as public retools
DSU _
0 3 Licensed Pmfessmord
OWNER-BALDER DECLARATION O/' //���) ♦1:(
1 hereby affirm Nal 1 am exempt from the Comranals Liecnm law for the
a Ko following reason.(Section 7031.5,Business and Pmfessinm Code:Any city or county
m�+ which requires a permit to ennsWct.Ohio.improve,demolon.or repair any structure lzar/I t -
�iy prion,,its iasaerme.alm requimsthaapplieamt fo...ch permit m fileasigmcd su¢mcm y;ry
<
mat hoisreemedpursuamwtheprovisions ofIS,CanttacwLaw - - Sq.Ft.Floor Area 40 ti Valua ion -
��$ (commencing with Section 7000)of Division 3 of the Business and Protestant Code)or -
_ Nm im is esmpt slumbers and the huts for she alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Nc applicant to a civil penalty of 3 0 Occupancy Type
not mom Nan Fisc hundred dollars($508
I.ushe worof and
pmprrdenim4 omntende orNwagesusaleiranle7W,Bation,
will Pr the Critic
is The Caeisnminandodara w it. 1 apply in ad Business Required Inspections
and Pmfessious Code The ns,therion, ndwho 4w dors tort apply lf an owner of - q p - -
Ownemployny .provirimprovmthermonanmentsa ensachwdedlork or ulfarNmSale.ugh Is -
ownc r,Ne Wipmvidcdthmwmimpswldwi arenotintendedmoReredfarsale.if,
builder,,Ne building art impmrcmens is sold within one year of mporn to.purpose
of
builder orifi here the burden of proving Net he did not build or impmrc fm purports of
sale.).
❑1,as owner of the proper,am exclusively contracting withAccnucd contractors to
consvum She project(Sec.7044,Business and Professions Cade:)The Contracmr's Li. -
ceme law does not apply in an corner of prepeny who httiids or Improves themon,and
who contracts for such pmjcas with a conttactor(s)licensed purati to the Cmdraumts - -- - -- - - - - — '- --- - -
License Law.
1 am eScmpwnde,Sec. .B 6 P C far this mason
Owner Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following dachustions: .
I have and will maintain a Certificate of Consent to self-intim for Worker's Compen-
137
ion,m provided for by Section 3700 of de labor Code,for the performance of the
rk for which Nu permit is issued.
CO3 1 have and will nummin Worker's Compensation Insurance,So mquimd by section
t1(lo labor Code.for the pc Kate ancc of Ne work for which this permit is issued.
y sCarepeusation Insurane carrier and Policy nu beram:rtie r '�t' � Poli N �' -
CEim ATE OF UEMP IONORKERS
COMPENSATION INSURANCE
(This seesinn need not be completed if Ne permit n forouc hundred dollars(5100)
or less.)
I coufy thus in the parfrmum.of the work for which this permit is issued.l shall not
employ any person in any manner so as w become subject to the Workers Compensation
Laws of California.Date _
Applicant - - -
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should '
become subject in the Workera Compensation previsions of the labor Code,you most
.J O forthwith comply with Such pmvisiam art Nis permit Shall he dcc and revoked.
ZN CONSTRUCTION LENDING AGENCY
[�.� I hereby affirm that Nem u a construction lending agency for the performance of
C4 No work fur which this permit is issued(Sec.3097,Civ.C.)
I!3 Q L ande's Name
D. Lent'.Address
CJ O 1 certify Nat I bare mad this application and.tae Our the above information is
U. F-' corttt.1.,me to comply with all city and county endurances and state laws elating to
0 building conslmcrion,and hereby adNaon,mpmxntalixes of Nis city to enter upon the
} above-mentioned property ror impccuon putposcS.
(We).,me or ave,indemnify and keep harmless the City of Cupenino against
F'� babildics,judgments,costs and expenses which may in any way as st aid City p " ,
C)z consequence of the gr outing of this permit. I v
q4e ICANT UNDERSTANDS AND WILL'COMPLY NON-POINT Issued by: Date 1
$� GU TIgNS, r -
U Re-roofs
o um of ApplinatOConramor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haudous material
as ...
by de Cupertino Municipal Code.Chains,9.11.and Be Health and Safety
Code.Section 25531(.)? All roofs shall be inspected prior to any roofing material being installed.
I-]Yes L31Ju _
Will the. fiaant o,for..Wildin mm.rat ase -9uipa .t or devices wnicn --If a roof is installed without firs[obtaining an inspection,I agree to remove
pp g v mcn
-mit hanardous air conaminants as definedmcn
by the Bay Arta Air Quality M...9ct all new materials for inspection.
Disricl7
❑Yes RNo
Iharc mad the haaaolnusmamrials requimmcnu untkrchapmr6Califnn
nice Health sty Code.Soetiam 25505,25533 and 2553x.IundcrstaM that if tM huiiding l\ ..fff^FFF'1111555---
ot fitly hast a Se rant.Nat it u my smp.mibRity a notify the m upann of the !
E.'n enuwhichmusthemetpriorwissuvmmafaCcolficamofOccupanry. j tureo Applicant Date
\ All roof coverings to be Class "B" or better
Owner or authorind agent Drm
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408)777-3333
�UPERTINO
Building De artment
JOB AD SS: PERMIT
5 ri t1 A-
OWNER'S N PHONEAJ
GENERAL CONTRACTOR: FAX # -
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 0
Septic Tank
Sheet Metal
Sheet Rock
Tile
U
Owner/Contractor Signature �y7 Date
Community Development Department
Building Division
»; City of Cupertino
G e 10300 Torre Avenue
CITY OF
Telephone: (408)777-3228
0 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 comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: _1157e
Roofing Company N
A plicant's Signatu Date:
\�t/�6lNOLJU
® Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF H6 "7 2,
CUPEkTINO PERMIT APPLICATION FORM
APN # 5_1 00-11 Date:
Building Address:
Owner's Name: Phone #:
-9 7
Contractor: ' Pone / License#-
-
:lv
Contact: A Phon #: Cupertino Business License#:
W 740
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
*.I Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
)l To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descri on:
/tee.o-�'// �a �xisfi•� ee
Residential ' Commercial ❑
Fire Zone: Yes ❑ No ❑ Confir
th - e any restrict s:
Cost of Proj Type f Construction: ccupanc ou
QtY i
A i ab 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
X37 .'