04070192 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR"INk'.ORM.4.TION:`'
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BUILDING ADDRESS: JNSJ ROOFING INC 1111"N'04070192
iGNE:
ER'S NAME: PERIAMISSSUEDATE
CUPER SANITARY O. CONTROL NO.
82796171
40
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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000 LICENSED CONTRACTOR'S DECLARATION Job Description
U
;WE 1 hereby affirm Chet 1 am licensed under provisions of Chapter 9(Commencing /1
�2 with Section 7")of Division 3 ofthe R9tinw sand Frofeaions Code.and my license is
fall roreeanaerr
Cle 99 D REROOF AUG
j b Z Liccnu s Lk.o 20
OZ=� Dam Connum
D
F J ARCHITE CLA 01 A��®���
1 understand nJ my plans shall d as public rt nand 'P`OR
yV
Bob Licensed Professional
OWNER BUILDER DECLARATION
1 hereby mem affirm on 1 am cusin sfroms an Nc Contractor's Liccnu Lew for da: I(
ve O o following roup..permit
u IIA I.S.Business and Ne.detluu Code:Any easy of County `eV
X m which ncquira a pmmis so cnnwvcs alcor,impmw,demolish.m repair any grocmm
m—sn prior to its issuance.also tequims the applicant for such permit o file a signed sun
:mem
rx< that he is licensed pursuant.the provisions of the Connector's License Law(Charter 9 Sq.Ft. Floor Area Valuation
9 (commencing with Section 700a))of Division 3 of the Business and Profusions Code)or
y
that be u exempt theefram and de buil for rho alleged exemption.My violation of _
Section 7031.5 by any applicant fm a permit subjects the applicant m a civil porosity of 3 2%PNQ` "cr0 0 Occupancy Type
out mo.men five hundred dollars(S500). v
0 1,as owner of dte pmpony.or my cmployeu with wages u their sale compensation,
will do No work,end the sumctum u nos intended Or offered for sale(Sec.7014,Business
and Professions Code:The Contncura License law does Out apply to an owns of Required Inspections
property who builds or improves thereon,end who docs such work himself ar through his
own employ=.provided that such improvements arc not intended proffered forage.If,
however,the building or improvement is acid within ore you of completion,the notion-
builder will base On burden of proving Nat W did not build or improve for purpose of
ale.).
0 1,as owner of On,property am exclusively contracting with licensed Contractors to
consumer the project(Sec.9(X4.Business and Profusions Code:)The Conmecmr's Li
rue Law don not apply to an owner of property who Wilds or improves daemon,and
who contracts for such projects with aco arecsor(s)licensed pursuant W Ne Contractors
License Law.
1 am exempt under Sec. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afrtrre under rectify of perjury one of No following doclantiou:
1 haw and will maintain a Ccnifcon ofCmsCm w self-intim for Worker'sCOmpen-
titian,u provided for by Section 3700 of the labor Code.for the peAormance of the
..it for which Of.pcconi,is issued.
0 I hast and will maintain Worker's Compaunion Insurance.as required by Section
3700 of the IaWf Cade,for the pecormance of the work for which Nis permit is issued.
My Worker's Compensation Insmanu carrier and Policy number am:
Cartier: Polity No.:
CERTIFICATE OF EKEMPfION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W eomplewd if Ne permit is rmrom hooding dollars(SIM)
or kss)
I certify Nal in N,Rp Common at dao work for which this permit is issued,1 shall not
:.ploy any id any mann s . co c jaun OW Workcsi Compensation
Laws Of Cali no as
ipomlh
NOn TO APP CAM:If,a ff making Nis Cc 'fcae of Ezcmpion,you should
btto a subject w th When's Cohrpensation p i tore of the tabor CMB,you mum
.J O foM amply with such provisions or 'epErmh Mall W domed invoked.
Z 51 c CONSTRUCTION LENDING AGENCY
(-. I hereby affirm Not Vert is.construction knaing agenry loan dao performance of
CL 7 On work for which this permit is issued Dec.3091.Co.C.)
Igl Q Lender's Name '
0. Lender's Address
U C) I certify Out I have read this application and sato Nat Ne aWve NImongiun is
Iy f"' correct.I agree an comply with all city and county ordinances and mg,laws mining in
0U building Construction.and hereby authorin rtpre¢nuti.es of this city 10 enter upon the
W above mentioned property for inspection purposes.
(We)agree to ave,indemnify and keep harnless On City Of Cupertino against
y liabilities judgments.costs and expenses which may in any way accme against aid City 47,UZ in coanuequence of On graving of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:SOURCE REGULATIONS.
Re-roofs
Signature orAppliantlConuacmr DamHAZARDOUS MATERIALS DISCLOSURE Type of RoofWill Ne applicant or future Wilding Occpansaw¢or handle hxnudous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and dao Hea1da and Sdciyeale,seldom zsssz(a)1 All roofs shall be inspected prior to any roofing material being d.
❑1n
Will Ne applicant or future building occupant tam equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hannums air contaminants as dcfincd by she Bay Arca Air Quality Management all new materials for inspection.
District?
DYcs Nu
I haw rural the ha anhas materials requirements under CWpmrb.95 orthe Califor- b
niaHcalN&Safei,Coll Sections 25505.25533 and 25534.1 understand thatifthe building
don n w a¢rant,Nat is is my mapomahility,a mnaly Ne oacupam Of the
me 'ssuancc car a cenifieam Or Oc trpancy. SI r of Applicant Date
7 roof coverings to be Class "B" or better
Date
Community Development
�4 10300 Torre Avenue
"rte' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEKTINO
Building De artment
JOB ADDRESS: �bPERMIT(ono cf. �"OWNER'S NAME: Ste. S PHONE #
GENERAL CONTRACTOR: JNSJ FAX #
I am not using any subcontractors: 7/2-' d
Sign ture 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
Elie
ignature ate
afl
Community Development Department
Building Division
' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
OUPEkTINO
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:
t� f '
Job Site Address: D b8� �a^^` C F 1�,(dy• L
Roofing Company Name:
A plicant's Signature: Date:'-1 h-5 c`f
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 32.6 _ I 0 OSS Date:
Building Address: c ,� (I
Fra"c, C+ Rt4 . L_
Owner's Name: Phone#:
3�e AKPt t' aS sv ',� S z1k f v
Contractor: Phone#: License#:
JIJSJ ZnC. oe) 2-71-W ?399�D
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existiyr. Proposf,d:
e" Built-Up Roof H� Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu9bef of existing coverings ❑ Provide I.C.B.O.Report#
Q 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 Dept. if
there are-anrestrictions: LI
Cost of Project �, Type of Const c 'on: / Occupant: oup:
Qty.:f
A li able 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
l �7- 6 �-