05080264 (2) CITY OF CUPERTINO �
BUILDING DIVISION PERMIT ,CONTRACTOR4NFORMATIONN,t,
BUILDINCADDRESS: NEIGHBORS ROOFING AND GUT tTND.05080264
OW NER'S NAME: PERMIT ISSUE DATE
KENETH & BETSY
ONE:
SANITARY NO, CONTROL NO.
(408) 629-7922
ARCHOECTIENGINEER: BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
v00 LICENSED CONTRACT'OR'S DECLARATION
WU❑ I hereby affirm that I am hemmed under pmvisions of Chapter 9(commencing Job Description
?W with Section 7000)of Division Sof Mc Business sod Profession Cook.and my license is
in(tell rmm`arWe a 6 REROOF-T/O COMP. /INSTALL PRESIDENTIAL.
o t3 z Limit Class L Lic.N
Z;:F Date Contractor rf 'Pyly� p�.k� �] f�'
ZZ ARCHITECTS DECLARATION lI�y`��A' Ax�J'E
C i I undcrvand my plans shall M used u public mcnrds }� �1 ttgg ET�"o^
it.0
LLt; Licensed Professional
,p< OWNER-BUILDER DECLARATION /�55
<Z� I hereby affirm that I am exempt from Me Con motor's License Law for the niN"I -IVZOOS
C o following reason.(Section 703 1.3,Business and Profession Cale:Any city or county
X$Tai which requires a permit to commucL alcor.wpmw,demolish,or repair any atsucwre $9000< .• _ .,
yai prior to its issuance.aim rormunt Me applicant for such Mrmit to rile a signed xutcmcns
< thatbeislicensedpursuanttotheprovisionsofdrcContractor'sLicenxlAw(Chapter9 Sq.Ft.Floor AreabU � .'x�{, �Valuation
7'11 (commencing with Section7000)ofDivision3ortheBusinessandProfessionsCode)or I�C"� r
y — that he Is exempt Memfmm and Me basis for Me alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit.subicros Me applicant w a civil penalty of reef 0
not mom Man BK hundred dollars(sago). Occupancy Type
❑I,as owner of the pmpeny,err my employva with wages u Meir wlc wmpenmtlmn.
will de the work,and Me aractute is not intended ora@md formic(Sec.7064,Business
and Pmression Code:The Cmnvatoes Liam Law don not apply M in owner of Required Inspections
pmputy who builds or impureness themon,and who dmessuch work himselfor through his
own employees,provided that such improvements are not intended croRemA formic.If.
however,Me building or improvement is mid within one year of completion,Me owner-
builder will have Me burden of pmving Mat M did not build or improve for purpose of
mM.).
❑1,as owner of the propcny,am exclusively convecting with licensed contmaors to
construct the project(Sec.7066.Business and Profession Cade:)The Commutes Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with o contsactm(al licensed pursuant o Me Conuacmri
License Law.
❑1 on exempt under Sec. .B S,P C for this rtAwn
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perialty of perjury one of Me following declarations:
I have and will maintain a Ceninato of Consent an self-inure for Wormes Compcn-
135%
ion,as provided for by Section 3700 of the Labor Code,for Me peAammnce of the
rk for which this permit is issued.
have and will maintain Worker's Compensation Tnsurmer,as required by Section
ofMe LAW,Code,for Me pcdormmm.f Mn voh ror which this permit is issued.
yWorkfsCnmpeasatimn town anter and Policy numbermier,s w Policy No.:l -
imFTCATE FEKEMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(this seen.need not be completed if Mc Permit is formic hundred dollars(SIM)
in lns.)
I certify Mat in Me performance of Me work for which Mis Permit is issued,1 shell not
employ any permn in my manner w u to become subject to Mai WorkersCompensation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject M the Worker's Compensation previsions of the Labor Code,you must
.J O foMwiM comply with such provision or Mia permit shall M deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm Mat Mere is a convuctinn lending agency for Me performance of .
tY Me work for which this permit is issued(Sec.3(197,Co,C.)
(+] A Lcndcr's Name
D•
a Z Undeis Address
U O I ttnee that 1 plyhaveread this application and stain Met and
above information nlatiun u
0 F rotted.1 onstr ct comply with all city and county ordinances and sec t laws r upon
m
V abovingconswetiun,and hembyaction ertprexmativcs of this city roenter upon the
r IJJ above.(Wei.9 1.citysave for demnify anpuryoses
F gy (We)ague m mw,indemnify and kap harmless the y a of Cain no against
h innoidesdence f Mecostsmd eapcnusmit. may in any way attruc against said City
U z APPLICANTeUNDERSTANDSgranting this ANDrWILL COMPLY WITH ALL NON-POINT Issued by: Date _'Sec—p,f
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
/ 2
Signature of ApplicaRDate
HAZARDODO US MATERIALS DISCLOSURE Type of Roof
Willapplicantor future building occupanterreoreLamanmaterial
az ,
dcrincd by
Me Cupertino andw
ino Municipal Code.Chapter 9.12,and the HaIM m0 Safety
Code.Section 25532(11)? All roofs shall be inspected prior to an roofing material beim Installed.
r-1 Yes G"k, P P Y g g
Will the applicant or future building occupant esu ruminator or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanrdnua air connmiants as defined by Me Bay Arca Air Quality Management all new materials for inspection.
6Vict?
C)Yes aBNo
I have read Me hams nusmaterialasequircmcn¢under Chapitr6.95 of Me Califon
nu HcalM&Safety CaM.Scctioas25505.25533 and 25534.1 undcrvmd MatifMc Wilding
docs not commit,have a tenant Mat it is my responsibility to of,the one upm.of Me
requirements w1mehmust xmet p" rwissmanttmLaccninateoroccupancy. Signature of Applicant Date
✓AO L.o.rL Go�-��—,
All roof coverings to be Class "B"or better
Owner ser out mm<d agate � Dote
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
Ian &Pe o bf--d.6�Z9269i
OWNER'S NAME: K'e e a Pill PHONE # Yo 8 6"2c Z Z
GENERAL CONTRACTOR: FAX #
r> ll
I am not using any subcontractors: 2<e � yo /0 Np ems"- 5—
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
�= 3o-os'-
Owner/Contractor
o-os'Owner/Contractor Signature Date
Community Development Department
jJ Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�TINO 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-mariufacfurers 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: K.11,20 0-h d 'Le �s �,4 7 1 /(
Job Site Address 11 >S--1 &Yly t tyoDrl ,V
Roofing Company Name:
1
Applicant's Signature: `--F^0 n zz 2e Date: !L 6 �
o—
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY OF
�CUPERTINO PERMIT APPLICATION FORM
APN #3 SDate: —
Building Address:
112 lu O &_V, CU O
Owner's Name: Phone #:
e l- all d A" 11 40 62 2-
Contractor:
Contractor: Phone #: License #:
v' ro o � 0f- C, 3 � 3
Contact: Phone#: Cupertino Business License#:
0\!D 2 Lf 0 -1,. X86 2 0 6
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
R Asphalt Shingles GC Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O.Report#
R To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
0 co o J I n e ca
Residential +[ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
14 O�
Qty. if
A licable 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
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