04090264 (2) CITY OF CUPERTINO 5+s-><XV,". Vic` « �° ""6Mir `
Ru)Lrnnc Drvfslon PERMIT x !4WU lC`�TOWINFORMATION,
BUILDING ADDRESS: JNSJ ROOFING INC PEaMr...04090264
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY N0. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
"Ce LICENSED CONTRACTOR'S DECLARATION Job Description C l
y V F 1 hereby affirm Not 1 am limned under provisions of Chapter 9(commencing P rr
< t5) with Section 7")of Division 3 of Ne Business and Professions Code,and my license is
?M, NALED
to fon and<rr«t�.3 Lica
t'ERT*1'O1
a0 REROOF W/LITWEIT. CONCR. TILE
Ica
comOCT 1 2004
RCHITE DEC:I understand my plans shall be ta ' ds
3r.
o t; Licensed PnsfcsUonal BUILDING
OWNER-BUILDER DECLARATION
9y 1 hereby aRrm Nat I am exempt form the Cantra tors License Law for the
i o O following ruin(scedun 7(131.5,eusitress and Pmfcasino Code:Any city or county
u�$2which republics a permit ht Conswm,else,,improve,demolish.or repair any structure
Fiyprior N its issuance.also requires the applicamforsuch permit to rile a signed statement
< al he is licensedpu;�ro".teporvisi...ftheContractoriU..Ls. Sq. Ft. Floor Area Valuation
N
¢�$ (commencing with Semian 7000)of Division 3 of the Business and Professions Code)ur
ey_ that he is exempt therefrom and the basis for dm eilcgee scat Any vW.don of
Secdon 70315 by any applicant for a Permit subjects the applicant an a civil penalty of 3 SVP.I`bl4uRdbeO 0 Occupancy Type
not more Nan fin hundred dollars($500). .
❑I.asowmerafdre ft unia intended
with wgesasthei(Sec.70".casadon.
will da thcwonsnti,end e: he Comnere melerimm�ense Law
des not apply in
owner of Required Inspections
and property
Professions Code:The om thamor's nd who Law dors not apply re an owner of q P
pmpeny who builds or improves Neiman,end who dads such work himself m.rough his
own employees.lding or improw h impmsemcna art not ear of C mpeerte for sa mer-
hawmw.the buildingarimprowmenala sold within 1 year of completion.Ntawmn
builder will nave dre Wrdm of proving Wt he did twt Wild m improv for pugme of
.in J.
0 I,as owner of dm progeny,am aseluive)y contracting with Ikensed contractors in
cominset the projeet(Sec.7044.Easiness and Professions Cade:)The Contractors Li.
cense Law des not apply ne an owner of property who Wilds or improves Merton,and
who contracts for such proem;with a contractor(s)licensed pursuant re Ne ConaumYs
License Ls-
0 1..exempt under Sec. .B A,P C fa,this moon
OwnerData
WORKERS COMPENIO
SATN DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 have and will maintain a Certificate of Consent a self-insum for Werear's Compun-
sada.,as provided for by Section 3700 of the Labor Code,for dre performance of the
work far which this permit is issued.
0 1 ban and will maintain Worker's Compensation Insurance,m required by Section
3700 of the Labor Code,for thc pmfmmanec of Ne work for which this Permit is issued.
My Workers Compensation Insurance Cartier and Policy number me:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
IThH section need anion completed irthe permit Is forone hundreddallars($100)
m less.)
1 certify Nat in the performanm of the work for which this Permit is issued,1091 not
employ any person in any manner tare g ?Pryrshe.Wolters'Compensation
Laws of California.Dat-
Applicant
NOTICE TO APPLICANT:If,after making Is c 'Eco;of -em"
shout
become aubjm m the Worked Cempcnsation Porvt of Nc 'C Code,you muse
�Z forthwith comply with such Previsions ar Nis Permit,hal ed rewkcd.
z O CONSTRUCTION LENDING AGENCY
E4Wrehy affirmrat dthere I,.consuuclinn lending agency for the performance of
> ree work for which this permit is Wood(Sec.3097.Civ.C.)
lel Q Lsnders Name
6, Under's Address
U 0 I certify that 1 have mad Nis application and state that the eban infomaiun is
1L t" Cance,.1 agree to comply with all city and county ordinances and state laws testing to
0O Wilting constrthor
uction.and hereby auise mpmsmntatiws of Nois city tmer upon the
}LI] above-mentioned property for inspection pmlwses.
(We)agree to save.indemnify and keep harmless Ne City of Cupertino against
ryliabilities.judgment.costs and expenses which may in anyway accme against said City
V z APPLICA4NTCof line UNDERSTANDSthis
AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date rel
SOURCE REGULATIONS. (I /G
Re-roofs
Signaurc of ApplianVContricmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne'oil (tarroom building occupant sem or handle huardou mactial
as attired by da Coastline Municipal Cade.Chapter 9.12,and Nt Health and Safety
Cale%d..
Section 35533(.)1 � / All roofs shall be inspected prior to any roofing material being installed.
N
the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
s air cmuminan as def cd by the Ray Area Air Quality Management all new materials for inspection.
read Ne by rdus materials requirements under Chapter 6.95 of dm Cithfoo Sections 355(IS.Z5533 ax12553d.1 undcraavM thazifNc Wilding 2 Q
ndy haw a a it u my respomibiliry m nadly Ue occupmt of Nc a issuance of a dem "a,of Occupancy. Signat s of App ieant DatAll roof coverings to be Class"B"or better
orindd agent Dam
Community Development
��,5 10300 Torre Avenue
ij '+L :Y' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: -P8,51 (javw-�. &0-0, IT C) 09 X t
OWNER'S NAME: CAS PHONE #
GENERAL CONTRACTOR:
I am not using any subcontractors: �
Si ature Date l
Please check applicable subcontrac m wing 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 JtoJV401;1731Q80
Septic Tank
Sheet Metal
Sheet Rock
Tile
)KZn• 4 zT e
er/ ntractor Sign tore Date
Community Development Department
Building Division
r t City of Cupertino
J
10300 Torre Avenue
Telephone:
CITY OF Fax: (408)7/7-3333
qUPEkTINO
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: Jah u^'k�
Job Site Address: ZI bSI Hzrvwyt '
Roofing Company Name: S o T,--<<
A plicant's Signature: Date: 4 YZ oy
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF V 9 2
CITY
PERMIT APPLICATION FORM
APN # 357 ( b — 131 Date: q_ 21 ^6
Building Address:
z► &sl HQ.rwt-s�
Owner's Name: Phone#:
� C
Contractor: jPhone#: License #: 7 3 O
1082?T-bl1l
Contact: Phone #: Q Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
De'Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) e Other(Specify) Wr`r`L
fik
Number of existing coverings 0'�Provide I.C.B.O.Repvit#3VVo
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Crru ertino's Tear Off Polic
Job Description: C?) .$Inas- r*a 1t
Residential Commercial ❑
Fire Zone: Yes-ED] No Confirmed with Planning Det. if
there are any st>;ictions: LJ
Cos of Project: ! Type of Const coni: Occupan
Qty. if
A li b Fee ID Fee Descri tion 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
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