05080262 (2) CITY OF CUPERTINO n � '�+& 1 �' q ' '`" •'i` in
BUILDING DIVISION PERMIT 6C0NTkX&T,0R INFORMATIOa
BUILDING ADDRESS: PERMIT NO.05080262
OWNER'S NAME: PERMIT ISSUE DATE
Alk NAW-Y RFAVERS 08/30/2005
NE: SANITARY NO. CONTROL NO.
7A!CHITECTfENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uLICENSED CONTRAC OR'S DECLARATIONae 1 hereby affirm that I am limnxd under provisions Of Chapter 9(commencinglob Description
re Section 71g10)afDivision 3ofthe Business and Prufessiaru Codc.and my been.is
ull forte and erreenx elss Lica 82. ?S REROOF-T/O COMP. /INSTALL COMP. SHINGLES
tet7caN�mr Ir17�=G CONTRACTOR: FAKKEMA ROOFING
ARCHITECTS DECLARATION
041 understand my plans shall he used as public meet&
Of
n Licensed Professional
iOWNER-BUILDER DECLARATION
sv,I 1 hereby affirm that 1 am exempt from the Contractor's License La for the
p0 ralbwinglesson.(Sccdun 70]15.Business and Profcm'nns Calk:Any cit county
K m which acquires a permit m construct,alter.improve,dcmofuh,m term' ray awnu o
-'^ rriormiu issuance,also myuiry the applicant far such rcrmittu Flea 'gnedstatemem
��'< that he is littnxd pursuanuo the provision of the Contraztoh Lice
Law(Chapter 9 Sq. Ft. Floor Area Valuat$6400
w—a (commencing with Section 7JD0)of Division3nf the Business an rofessionx Code)ur
i
that he is exempt therefrom and the basis for the alleged c lion.Any violation of
Scmion7031.5by any applinnt for apermitsubjecuthcap man uoaciviipcnallyof APN Number Occupancy Type
not more Nan five hundred dollars;(S500).
P Y YP
❑ I,as owner ofthe propany,or my empioyces with gat as their xle compensation. 35931013 . 00
will do thewore.and thcawnure isnotintended ora emdforsale(Sac.70a4,Business Re aired Ins eCUODS
and Professions Cods:The Cong=r's Littnx aw does not apply to an Owner of q p
property who builds Orimproves thereon,antl h donsuch work hindelfor through his
Own cmployw,provided that such improveme are not intended or offered for sale.It.
however.Ne building ar Improvement sal ithin one year of completion.the owmr-
builder will have the burden of proving. he did not build or improve for puryox of (p{
y M
❑1,as owner of the
property.am ea lost,
C usively contracting with licensed contractors to t
construct the project(Sec.IV,B Tress and Professions Code:)The Contractor's Li. a�ai�I y/LO"C�Tv\q)p
cense law docs not apply ad an Mr of property who builds or improves theman,and n {
whocommetaforsuchpmjec on acomactoKs)licensed pursuant the Contractors � � a••y
License Law. Y
❑1 am esempt under Se B Al P C far dids..on ZOO f
Owner Data
RKER'S COMPENSATION DECLARATION }si•
/.e
by rata under penalty of perjury one or the following declmationle ��Cs ill maintain a Cenifiesac of Consent toself-iruurc for Worker's Compote tl.'ry{�video for by Section 37W of the labor Code,for the performantt of the +@Iq✓Jch this permit is issued.
will maintain Woukcls Compensation Insuran¢,ss.qu ted by Section
bor CodCo n,meadan Inxnna canis and Policy number atePolity Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu union need at be completed if the rcrmit is fmone hundred dollars(Swap
or Icss.)
1 eenifv that in the performance of the work for which this rattail.IS issued.I shall nut
emrloysoy rerun in any manner gq_u mbecom uhiect to the Workers'Compemmion
laws of CalifornMp.3• U `7—��X) 7
Applicant YL
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become suhject to the Workers Compensation provisions of the labor Code,you must
JZ forthwith comply with such provisions or this permit shall be deemed rooked.
zCONSTRUCTION LENDING AGENCY
'f+ Ihc.hyalBrm that there ism comtructinn lending agency lot the farritancc of
tY the work for
which Nis permit is issued(Stere 3(1 Civ,C.)
fy Qlender's Name
= ,z lender's Address
V 0 I certify that I have read"'appliealo d rote thn the above information is
ly F' correct.1 agree 10 comply with all city an umy oNinanm and sate laws relating m
V building construction.and hcrebya ..rrcxnutivrs or this city menter urnn the
shove-mentioned purely for coon pulp.
(•,� G (We)agree m sat ndemnify and km0lrmmless the City or Cupertino against
fn liabilities,judgmcn osis end eapcnxs which may in tiny way eccmc against said City
UZ in eonsequen the gmming of this umbit.
^ APPLI UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S E REGULATIONS.
Re-roofs
Signature of ApplicartiCormselor Date
HAZA
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future buildingOccupant stemor handle Health add
as defined by the Cupertino Municipal Code.Charter 9.17,end the Health and Safety
` cndesc❑ycazss3z(aP All roofs shall be inspected prior to any roofing material being installed.
Ycs
Will the applicant or fmurc building=upant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i1 m,,mb sea air comaminanu as defined by the Bay Ama Air Quality Managcmcm all new materials or inspect on.
isuia?
❑Yes u
IhwcroaJ the hnaNuan 25S)als.qui.menu341 understand
dust if the Califon ^ ��
nim Heal th&Safety aScdoos755f15.my o sno75s34.l to noel rad a occult Willing 7
docs not currently have a moan',Nat it is my responsibility m notify the acuranwf the
.gWrcmenu hi ..It be tp ssuanceafaeeNficateorOccupancy. Signature fApplicant Date
owner nr marled.gemDate
s All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
4 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: GLT/-(.1-rVL�5 PHONE # 37
GENERAL CONTRACTOR: A-Nlf'AAA FAX # Z-2 -5 7 Z b
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 CI(Afr-eYJ
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner Contractor Signature Date
Community Development Department
Building Division
X4:1 i.rte
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
-U P C R T I IV 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
arid-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 �Lywith the above stated policy on/rhe-roofing.
fJ
Homeowner's Name: A " ,, (1 (TI—A- Aw -2`
Job Site Address: _ I 3S FA l(< C- aUO(90 kkl—
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 3 3(0i3 Date:
Buildingddress:
11 S l,_A)-r,JD0t Avc
Owner's Name: Phone #:
4 c-At/ '12�
Contractor, Phone #: License #:
f44-C MA W C- 66- C--3<7- �Z t1�7s
Conta Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings •Z, ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: T-C-> lf—C(5-F Ccs z\)_�A J /
Residential X Commercial Fj
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project Type Type of Constry(J�t�io—n: Occupancy group:
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
4-' 3 �
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