05090231 (2) CITY OF CUPER'1'INO -''ae�s sa ✓-raw�x ' ' ?+
BUILDING DIVISION PERMIT y,CONTRACTORIINFORMATION ,%
BUILDING ADDRESS: SHELTON ROOFING PERMITNO.05090231
20061 FORE
OWNER'S NAME: PERMIT LSSUE DATE
ANTHONY WHITE _ 1988 LEGHO
NE:
SANITARY N0, CONTROL N0.
(650) 961-7699
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED CON1RACfOR'S DECLARATION
mC 1 hW
ereby affirm al I am li ensued under previsions of Chooser 9(commencing Job Description
ZW with Section 7")inDivision S of twe Business and Professions Code.and my liceve is
c. inmBfo adl,fk 3 Liv/ d ej / REROOF--T/OC SHAKES, ADD COMP. SHINGLES
Ll? License Lic.N
n=p Dole O Contractor 54 - �I ((�y
ARCHI CTS DECLAR N y„1'1
w 1 understand try plans used h' Ids D . /B[FJ t a 1A'' ICpeSe.SrNp
,au •5t
Lo.t; Licensed Professional
0 NER�BUIIDER DE RATION
'� f 1 hereby from Nos 1 am exempt form We Cimorm ors License Law for the nra
1
00 following mason.(Section 703 1.3,Business and Profccsions Code:Any city or county 1
K$f which requires a Permit in conduct.alter.improve,demolish,or repair any structure $12839
ami prior in its issuance.also mquims the applicant for such NMI to sic it signed memmenl
< month islicensed purmanuothe provisions;nfIsm ContrmmriLucnseLaw(Chapmr9 Sq. Ft. Floor Area �. q 14 +, �),y'�,y�s�,Valuation
xFp (commencing with Section 70)0)of Division 3 of We Business and POofassiora Code)or y^ �iA .a' �gpl rf
y $ that baa exempt therefrom and Ne basis for the alleged exemption.Any violation of jl ,9• WR N M
Section 7031.5 by arty applicant for a permit subjects be applicant to a civil pertahy of �Oceupancy Type
not more than five hundred dollars(5500).
❑1,az owner of the pmpcny,or my emplayas with wages as We'v sole campewness
will da thework.ands,The Co isnot intended Lichosarawdoca not appttJ0an. wner of Required Inspections
and Professions Code The improves
Re on. nd who law doh not apply tom owner is q P
own enywho bisipro iimpmves WeOronoandwho doessuchwarthiretie,edhmugh his
ownemployeh,presidedmatsuch impmsxmenuare not intendedor mo@red for tile. r-
however.the building hi improvement is sold within one year of completion,me owner-
builder
of
builds will have the burden of proving that Ire did not Wild or improve for purpose of
sale.).
h as mvner of the progeny,am cxclalvdy contracting with licensed contractors to
Co.,.,me project(Sea 7044,Business and Profh4ions Code:)Tom Ciddracsor's Li.
cense Law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conductorial licensed pursuanuo me Conlracmr`s
License Lan
I am caempt under Sec. ,B&PC for this mrson
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe jury one of the following decimations:
J 1 have and will maintain a Cenifieate of Cownt in mil-iname for Worker's Crimped-
Union,as provided for by Section 3700 of the labor Cade,for me pcAormance of me
work for which this permit is issurtl.
I have and will maintain Worker's CampCns20011 Insurance,as required by Section
700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Cnmg]sadon lnaumnee carrier and Policy number art:
Card Policy No.:'5 Z a 4 41
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becompletedRife permit is foront hundred dollars(Sip))
or las.)
1 ceelfy that in the performance of ht work for which Look permit a issued,I shall nut
employ any permit in any manner an as a become subject o de Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cenifieam of Exemption,you shuuM
become subject to the Worker's Compensation provisions of me LaWr Code,you most
�O forthwith comply with such provisions or this perm it shall the deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
(-. I hemtry of lop mal mere its conswninn lending agency In,the Performance of
D'. 7 the work for which his permit is armed(Sec.3097.Civ.C.)
(t] Q LCdcr'a Not ,
p, Lcndcr's Address
V Q 1 Bend,that 1 have read his applicmion and sett that the above information Is
a F CorreeL 1 agree m comply win all city and county aNinances and state laws mining to
O V Wilding construction,and hereby authorise representatives of this city to enter upon ft
C[7 show mentioned pmpeny for inspection purposes.
(We)agree to save,indemnify and keep hamorou the City of Cupertino against
F far. liabilities.judgments,costs and expenses which may in any way accrue against said City
V z APPLnICA act oNDERgrand N oft D WIL OMPV(WITH ALL ON-POINT Issued by: Date �—S?e zSJ
SOURC GUL S. I
� � 930(/03 Re-roofs 07
Signature of Applicam/Con anchor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupantsmm or handle havaNaus material
az&FLncd by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safely
ewe.Schon 25532(a)7
0Ya []flyer All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devieca which If a roof is installed without first obtaining an inspection,I agree to remove
.mit bavardnus air w middrums as deflect by the Bay Area Air Quality Management all new materials for inspection.
Disdicl7 y�
❑Yes CJ nu
I have mail me haamdous materials requinmc tit under Cheaper 6.95 of the Califon
nia Health&SafctyCWc,Secuons 25505.25533 and 25534.1 undersand mat done Wilding 3o O g
does not currently have a anent,mat it is my reeponsihility m notify the occupmt of the
.,.:rent which mus Wm orwissu cofv Ccrufcam of up cY.
9 . , Signature of Applicant Dale
10 5 All roof coverings to be Class "B"or better
O ncr orauthaneedagcnt Dat
Community Development
10300 Torre Avenue
s' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
O Sv
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR p �/ ,�� FAX#
I am not using any subcontractors: ZX4�Qg —/tea • 3 a os
Signature ate
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
e /Contr cg�Lt;e Date
Community Development Department
tt�� sr Building Division
r 1 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U P E kT'I A I�® 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 1.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.
Homeowners Name:
Job Site Address: d D
Roofing Company Name: ��`
Applicant's Signature: �✓ Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
X12'" REROOF
CITY OF /
CUPERTINO PERMIT APPLICATION FORM
APN #31 K 3 3 o �_� Date: 3Lila s
Building Address:
Owner's Name: Phone#:
Contracto . Phone#: License #:
C, 65o z. 61 i
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
XWood 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:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: S yR of Construction: Occupancy group:
/2 , 939
Qty. if
A2plicable 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