04080115 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT tGONTRACTOR INFORMATION
BUILDING ADDRESS: PERMIT ND.
JNSJ ROOFING INC 04080115
OW NER'S NAME: PERMIT ISSUE DALE
ONE:
SANITARY 0 OL NO.
ARCHITEC(ENGINEER: /� BUILDING PERMIT INFO
&za ELECT PLUMB MECH
M,17 o 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
v
am
hm
Y F I cby.!film that I am licensed prmrisimu m
of Chapter 9(mmencing o�®
witsS qum mel of Division3of NCBuj�uuM Pmfrss' mCodc,endmyliccvcia
infppi. aodefecy3e7 [ 73rt E REROOF V 23 2
Lic(fi C 1.:. 1 c.x Q
r p Da¢ Contractor �9, 04
to
ARCHffECTS IARATION ® ®�
my plans shall he used public records
;�� Limn rural
3 OWNER-BUILDER DECLARATION
'�<Y hereby strum that 1 am e,mpt!runs on Contractor's License Law for the
z
Ho f 1 mg reason.(Section 7(131.5,Businem and Prof..ssions Cade:Any city or county
x s; ch¢,tires a permit m construct.Suer,imprnw,demolish,or ic,.4 any swcmrt
u"^ normsissuance,also.quires the applicant for such permit file a signed statement
Nat he is licensed pursuant the provisions of the Contractors Limnse Law(Chapter 9 Sq.Ft. Floor Area Valuate n
as (commencing with Section 70()(f)of Division J of the Business and Professions Cade)or
i $ that he is exempt therefrom and the basis tar the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 ft;3y er 0 0 Occupancy Type
no,mmc than five handrail dollars(5500).
❑1,as owner of the property,or my employees with wags as their Sole compensation,
will do the work,and the Structure is not intended of nffned far vle(Sec.7044.Business
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 employees,provided thatesch improwmmut an,not intended oroRered far We.If.
however.Ne building.,improvement is to within one year of completion.the owner.
builder will have tie burden of proving that he did not build.r improve for purpon,of
ale.).
0 I,as owner of the progeny,am mclusivcly contracting with licensed mntrem
crs to
construct the project(Sec.7044,Business and Professions Cade:)The Contractors Li.
ere taw docs not apply to an owner of property who builds Or improve Ncean,and,
who contracts for such pmje=with a contracior(s)licensed pursuant to the Contractors _
License law.
p 1 am exempt under See. ,B&P C for that reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I law and will maintain a Certificate of Consent to self-insure for Workers C.mpen.
ration,as provided for by Section 37W of the labor Code.for the performance of the
work for which this permit is issued.
Q I haw and will maintain Workers Compensation Insurance,ss required by Section
J] the Labor Code,for tic p nornamm of the work for which this permit is issued.
icer s Cn tMnsation lnsumne5ramrend Policynumhcrain.
Ca cc W oliccyytlN..: 4
CERTIFICATEOFEXEMPTIOF.fltOM W KERS
COMPENSATION INSURANCE
(This section need not Mcompleed if the Permit is fmonehundned dollars($(0()
or Ice.)
I ccnify that in the ponformance of the work for which this permit is issued.l Shall Out
employ any person in any mxnnerso as to become subject to the Wmkcrs'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making Nis Certificate of Eaemptuon,you should
become subject to the Workers Compensation provisions of file Labor Code,you must
.� Z forthwith comply with such provisions or this permit Nall IS,deemed revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency lot the performance of
ail the wtirk for which this permit is issued(Sec.3(197,Civ.C.)
I[7 Q Lender's Name
G Lenders Add.
U 0I ccnify that 1 haw rad Nis application aM sae Nn dee.bow infotmatian is
LI, rcancer.1 agree to comply with all city and county andinances and Suite laws relating On
U building construction,and hereby authone repmsentauwts of this city in enter upon the
Y' above-mcntiancd property for inspection proposes.
D. (We)agree n mw,'ademmty and keep harmless the City of Cupertino against
Ffn Ilahllltics.judgmc .cam mdet" macs which may in anyway accrue against mid City
of
U Z APPLICANs rattail.
on-orTSU 00" RSTAon"IfinNDS AIND WILL COMPLY WITH ALL NON-POI Issued by: Date '
SOURCE REG TIONS.
an Wil Re-roofs
gnewrc of plicaH _AZARDOUS MATERIALS DISCLOSURE ata Type of Roof
the ap'hcmt tar No.building occupant S o.or handle hararduus maenal
u fin by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
e. mon sssufan
Yes All roofs shall be inspected prior to any roofing material being installed.
rANa
Will the applicant or
�fuGmm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hu,ardous air conmminaF as dcfmcd by the Bay Area Air Quality Management all new mater" for inspection.
District'
❑Yes �Nu
1 have road the tvardons mmun.1sequiremcns under Chaper6.95.f de Califm-
m,H.hb&SafetyCode,•{{sums 25515,25537 and 25534.1 understand!thatifthe Wilding G�.
dos not currently haw I: arta Nm it u my responsibility w noti/y the ore pant of the 16
requirements which mu, met prior m issuance of a Certifir Occup cy. gra leant Dffie
_/
Owne .,auto.. s i Dat All roof coverings to be Class "B"or better
Community Development
E 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
ID S & b C,4 tt t� D o I I S
OWNER'S NAME: D PHONE # p Z7-1 —(.(7(
GENERAL CONTRACTOR: ZYNSS FAX #
I am not using any subcontractors: l 3 b
Signature Dak/
Please check applicable subcontr crs d complete the following information:
SUBCONTRACTOk 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
Til
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
OCITYF Telephone: (408)777-3228
U PE QTI NO 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.
IMPORTANT: ;,'.''•ti'.
1. Flat roofs must have a minimum of 1/4"per foot slope and demorishate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on mspecfion ,J;. • --::
I understand and will comply with the above stated policy on re-roofing:pl
Homeowner's Name: _�L6N2tt P!Fe- 6,5
1 r
Job Site Address: Ir��880 Fr�-�o C�, �Id9,
Roofing Company Name:
Aplicantrs Signature: Date: 8 ��
\�l/llDLx1 '
Greg eel ..
Building Official
Revised 1/30/03 ;s _
Printed on Recycled Paper - + `
r
CITY OF CUPERTINO
. REROOF C)o
l S
CUPERTINO PERMIT APPLICATION FORM
APN# 326— 1.O — OSS Date: 8 /(.2-10
Building Address: O O r*K$QU `o g
Owner's Name: _r Phone#:
�e An2� ro •cS a.�.•ro .��c
Contractor: Ph ne#: License#:
JNSJ 73g98p
Contact: Phone#: t Cupertino Business License#:
Type of Roof Covering:
Existin ProP ose
�
p/Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nuf existing coverings 13Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 1 With Cu rtino's Tear Off Policy: ❑
,Job Description: u
Residential ❑ ' Commercial
Fire Zone: Yes ❑ No Confirmed with Planning De t.,if
there are any« restrictions: 'a,
Cost of Project- Type of Occup—ancy'gro p:c
.
Qty. if
A li a e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING .
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK ` Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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