04090250 (2) CITY OF CUPERTINO '"°" '��
BUILDING DIVISION PERMIT - CONTRACTOR II'NFORMA.TION
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Bu1LDING ADDRESS: STEVENSON' S ROOFING PEaMrr ND04090250
131 HULCE= RE)
OWNER'S NAME: PERMIT@'UE DATE
KIM WO
ONE: SANITARY 96. CONTROL NO.
(650) 969-5134
ARCHITECLENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
0 0
uoO LICENSEDCONTRACnOR'SDECLARATION Job Descript�IIVALE®
U 1 hcrchy affirm that 1 em CONTRACTOR
under pmvisions of Chapter 9(cnmmcndng
wiNSecdan TUf10)of Dlvi.km3.ftheB.{�at�e-srdiProfeuinreCode,andmylicenuia
Air in 1: fa de a Cf" (oe REROOF W/CLAY TILE MCA
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F' ARCHITECTS ATION OCT 78 2004 -
JCCRR�� understand my p ans shall M used .blit retards
yU
C G Licensed Pmfc-ionel
BUILDING
3 OWNER-BUILDER DECLARATION
1 later,hy= that I em exempt froumh
m Ne ConvLicense Law for the
r.no following rtes...(Sectiun T1131.5,Business and Prefessime;Code:Any oily or county
$ which requires a Permit to construct,almr.impaw.demolish,or repair try structure
hZi priormiuissuance.alurequirtstheapplicniforuch Permit¢Elcasignedsm¢mem Sq. Ft.FlValuation
< matbeuliccmaeJpuruanttoNCPmvisionsaflMConvumrilJamnuLaw(Chaptm9 oor Area
(commencing with Sostion1000)af Division3of Ne Business-d Professions Cade)ur
.- Net M u exempt therefrom red the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to e civil penalty of 3 261YNWIFNISNerO 0 Occupancy Type
not more Nan Bw hundred dollars($500).
0I,uownerofthepropeny,mmyemploymwithcagesutheir-lecomp oadon,
will out Ne work.and Neawn.¢limit intended.,offered forsale(Sce.TU4a,Business Required Inspections
and Professions Code:The Contractor's License d
e Lew .not apply re an owner of q P
property who builds or improve thereon.and who dao such work himself or through his
.employ..provided that such improwmenm art nor intended osaffenA forule.If,
however,the Wilding or impmwment is held within aro year of completion.due manual-
Wilder will hove the Wreen of proving Net W did not Wild or borrow for purpose of
salt.).
0 1,as owner of the propeny,em exclusively convecting with licensed convectors to
constroct IM project(Sec.TDM,Business aM Professions Code:)The ConuRtori U.
come Law dm not pply in in owner of property who Wilds or improves thmon.and,
who concocts for such projects with a conuactor(s)licensed pursuant Or the Contmdo's
Licerse Law.
❑lamexemptunder Sec. ,B&PCfor Nismuun
Owner u
Da
WORKERS COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury ate of the following declarations:
1 haw and will maintain aCenihcau of Coment to elf-insure for Workers Compere
-tion,u provi4d for by Section 3700 of NW
Ne Lar Code,fill Ne Pcrfomtame of IM
work for which Nis Permit is issued.
❑I have and will maintain Worker's Compeuamr,luuranct.u required by Section
300 of Ne Labor Code,for the performance of the work for which Nis Permit is Issued.
My Worker am at ton Ins. carrier and Policy numb t
Clpyf: �Pa . J
,� CE ICAOF IXFb1Pf1 OM WORKER '
COMPENSATION INSURANCE
This section raced not W cumpleud if be permit is for one hundred dollars($1011
or lass.)
1 calory that in the performance of the work for which this permit is issued.I shall net
employ any pawn in any manneran as to become subject to she Workers Compeuatinn
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Ccnifiulc or Exemption,you should
become subject to Ou Wanors Compensation pmvisions of me Lahnr Code,you mum
.UZ forthwith comply with such provisions or this Permit shall W demandmwkcd.
zO CONSTRUCTION LENDING AGENCY
(—' Ihereby a all.Nat these iv constrN
traction lending agency for e performance of
E 7 the wort fm which thio permit is issued(Sec.3D91.Civ.C.)
Ltd Q Lenders Name
O. Lender's Address
U 0 1 certify Nm
Nat 1 have ad This application and sum Nat the about i r.molL un is
Lk. trema.I agree to comply with all city and county oodimences and sum laws running to
pU Wilding construction.and hereby auNori-mphimines,tof this Of
mcmaupon the
above-mentioned property for inspection Puquuv
(We)erg unve;indemnify-d keep harmless the City of Cupcnino against
F'N
Heaton, mcnm;comland capcnus which may in any way eccmc against said City
U Z in co cc of the grahling of Nis Permit. Date
r. CAPPAUNDER AANDS AND WILL COMPLY WITH ALL NON-HINT Issued by:ULATI SfRe-roofs
VCoumator
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupant short or handle h tie rdous material
as defined by tM Cupertino Municipal Code.Cbmwr 9.12,and IM Health and Safety
Crate.So tion 35532(.)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes Nu
If a roof is installed without first obtaining an inspection,I agree to remove
Will dm applies.err antsa building by the B use Area
Air Qu or Mara which
mit hnraNnu air conuminanu-defined by the Bay Arta Air Quality MuagcmcntZmor inspection.
Gimlet?
0YesIha hnaNuusmatermisrequimmcnts underChapmr6.95 ofthe C.lifor.
nuHmI afctyC Savors 25505.25533-d2553e.I UMcnmrM Uses ifmc Wilding
the
re me ,whim us Mmetriorwomanceofaccnifceuo(occupant Dafe
All roof coverings to be Class"B" or better
. ant u
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
-*- ) T OO
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature 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 S
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
' Building Division
1 City of Cupertino
10300 Torre Avenue
one: (408)777-3228
CITY OF TelephFax: (408)77-3333
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) h1-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: (e")
Job Site Address: h`//z g&
Roofing Company Name:
A pli
cant's Signator r : Date:?/7G
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
Suirvq, IREROOF ° °
�CUPERTINO PERMIT APPLICATION FORM
APN # f Date:
r p
Building Address:
Owner's Name: ` hone#:
fO 1C 4AEfL
Contractor: Phone #: ,?5�6`b/33 License#: 3J
Contact: - Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: ' Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ _ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes 1 �1/� t�( -5._ ... ❑ Wood Shakes
❑ Wood Shingles '^II L3 Wood Shingles
C3 Other(Specify) 4( 4 ItX twi/ ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
NIP I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Polic ❑
Job Description:
m
ResidentialCommercial
5.6 s 5
Fire Zone: Ye ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: E
Cost of Project: Type of Construction: Occupancy group:
_ S
Qty. if
A li e Fee ID Fee Descri ption 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
7, 7�S
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