05080146 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT Co DTORANFORMATION
..0 ter
BUILDING ADDRESS: KNIGHT ROOFING CO PERMIT NO 05080146
_�qq HENEY CREEK PT
iNo
ER'S NAME: PERMIT ISSUE DATE
CARLE HYKFMA 4201S 02900D RD 081.17/2005
NE: SANITARY NO. CONTROL NO.
5104389077
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
w❑ I hereby affirm Nat I am licensed under provuiom of Charter 9(commencing Job Description
wish Section 7gKnuf Division 3 of to Business and Professions Code,and my license is
r n in full force and effect.
Licensee Lk.N .11O
REROOF-T/O WOOD SHAKE/ INSTAL SHEATHING,
;moo Dam r contractor r w r� CLASS A COMP. SHINGLES )
ARCHITECTS DEC RATION j ���{ "
I understand my plsns shall be uacm
d as Public rcNs 'V,,
JyU
p a y Licensed PnResxinnel
r.p OWNER-BUILDER DECLARATION CiomION
C 0 1 Wraxo .(Ores Nat 1 1. exempt from Ne Con ons Co License Law for the m
p 0 which following meson.(Section t ]II]LS,Business and Professions Code:Anyrepair
A y or rCountysous
m which myus u n permit m cmuvucl.alter.improve.h Permiah.in repair any statement 5iy pstheor InI.scensed isslso uance, 1.ireS(be the applicant for C.c Permit file asLaw Chip.,
-
m a Nat W is licensed pursuam m tW pmvisiom of NC Contrumr License law(Chapter 9 Sq.Ft. Floor Area 'V6141111i 310
yh� (commencing wish Section 7CM)of Division Sof the Business and Professions Coda)or Aj.jan
i
that he is exempt therefrom and the,basis for the alleged exemption.Any violation of tli7 _
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of V
not mom Nan Eve hundred dollen(5500. APN Number ®CCC,III Type
I.m owner oftlie property. 34248023 . 00 roA,SN
❑ p ,"eoj.m...imandeder,i wages
will dotcwork,endto awmurtisnotintended orofferedst not c(Sec.]Una,owner
And Professions Code:The Contracter,License law does not apply if An owner of Required Inspections
property who employees,provi improves ratan,and who does suchended omulf ortrough lila
sewn er.dim building
pr such rat is scmcnu are,not intended m let es,for sale.owner.
f.
however..the building or improvement is sold within one year of completion,the,.of
builder will have clic buNen or proving Nat M did not build or improve fur purpose of
sale.).
❑1.as owner of the prrperty,am exclusively contracting wit licensed contractors to
construct the project(Sec.71354,Business and Professions Code:)The Contractor's Li-
come law docs not apply to in owner of property who Wilds or improves Merton,and,
who moracia for such projects wit a contractor(,)licensed pursuasn in the Contractor
License taw.
❑I am exempt under See. ' ,B&P C for this reason
owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury one of Ne following declarations:
1 have and will maintain a Certificate of Comenl to self-insure for Worker's Coni
ion,u provided for by Sectlrn 3700 of the labor Code,for to pterfmmance of to
1FI37'W
rk for which his permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of to Labor Code.for Ne performance of doe wart for which Nis permit is issued.
y Worker's Compensation Insurance carrier and Policy number art:rrier. So a4r (v.-rP Polity ROMWOR I yw I
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7Tls section need not W completed if the permit is for one hundred dollars nI010
or fns.)
1 cenify tat in the performance of the work for which Nis permit is issued.1 shall not
employer}'person in any manner An As to become subject I.the Wooten Compenssuon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should
become subject to the worker's Compensation provisions or the later comic.you must
.J2 forthwith comply with such provisions or this permit sial l W deemed owkw.
Z O CONSTRUCTION LENDING AGENCY
(•" I hereby affirm that there is a construction lending agency for to performance of
�i
the work for which Nu permit is issued(Sec.309],Civ.C.)
QLtndcrs Name
2 Lender's Address
U O 1 certify that 1 have read this application and state tat the shout information is
U, F correct.l agree to comply wit all city and county anti es and stale laws relating to
0 building construction,and hereby authorize represenmtims of this city to enter upon the
shave-mentioned property for inspection purposes.
F.py (We)agree to save,indemnify and keep harmless Ne City of Cupertino against
N liabilities.Judgments.casts and expenses which may in any way accrue against said City
U in consaquenec of to grations,of Nis perm it. /
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DateOl dT
SOURCE REGyLATIONS. /�L
/�r� 1511-7 fit^ Re-roofs
Signature of pppft. for Date
HAZARDOUS MATERIALS DISCLOSURE -Type of Roof
Will the applicant or future building occupant amm or handle havrdous material
m defined by tc Cupertino Municipal Code.Cbapter 9.12,ntd she Health and Safety
ewe,pr.25s32u>+ No All roofs shall be inspected prior to any roofing material being installed.
Will due applicant or furore wading occupant use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
tit hazardous air cameraman.As defined by the Bay Area Air Quality Management all new materials for inspection.
istrict7
❑Yes No
1 have mail the havantnus materials requirtmenu under Chapter 6.95 of the Califor-
nis Heart&Sam yCade.smote.25Y)5.25533 aw 25534.1 understand tatif t e Wilding
does not currently how a tenant that it is my nesixo siltility 0 truly NC=upert or Ne
/ require hires;gvme, hcmu...fACc.1icatc.1`xepaney Signature of Applicant Date
ownn«arawri're mate All roof coverings to be Class "B"or better
^;,,�•.� • Community Development
a 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
o -,;,Ti i4 tie C ROC-L p fo to 1 t/,13
OWNER'S NAME: j-d PHONE # Sc � -fU-9'o77
GENERAL CONTRACTOR All(-7ty/-/`(Do Frn/H S�,zvjce-y FAX#
I am not using any subcontractors:
Signa e Date
Please check applicable subcontractors and complete the following information:
61 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing O
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
Owner/Contractor Signature Date
Community Development Department
f� Building Division
City of Cupertino
EEE??? 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P S IST I N® 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 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: ( 14`1,<C,- ¢
Job Site Address (0 312 H C"Vel C(t(CK el .
Roofing Company Name: M/1C1t-f SCiZc/Ices
Applicant's Signature: . Z� ����- Date: 1
Greg Casteel
Building Official
Revised 11/2/04
D.:..,nd nn Omimin.i Oenar
CITY OF CUPERTINO
cin or
REROOF QS
CUPEkTINO PERMIT APPLICATION FORM
APN # 2 Date:
3 2 6 �/ 8-1-05
Building Address:
10399 Heney Creek P1 . Cupertino
Owner's Name: Phone#:
Carle Hykema
_650 965-8575
Contractor: Phone#: License #:
Knight Roofing Services 438 9077 844108
Contact: Greg Knight ht Phone#: 510 438 9077 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof 0 Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
A Wood Shakes , ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
;I To be Removed ❑ Provide Mfgr.Installation Specs.
® I Have Read, Understand and Will Comply With,Cu ertino's Tear Off Policy: ❑
Job Description: Tear off wood shake . Install sheathing . , Install Class A
Composition shingle .
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: $ 16 , 310 Type of Construction: Occupancy group:
Re—roof
Qty. if
Applicable 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