04080085 (2) CITY OF COPER'FINO `
BUILDING DIVISION PLRNIIT CONTRACTOR INFORMATION
BUILDING ADDRESS: EL CAMINO ROOFING CO INC PERMITN0.04080085
a OWNER'S NAME: PERMITI55UEDATE
F
ONE:
SANITARY O. CDNTROI.NO,
(408) 292-2644
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
Yg LICENSED CONTRACTOR'SDLCLARATION I\ �I�tl r,�D
0 pP 1 hereby affirm that i am licensed antlerSpaivisitansDELLA of Chapar'1(commencing lob Deserio V\\V'I Q III IIS IILTIS_-'
]Zy� with Sectinn 7odfinf Division3 of Ne❑utincasand Professions Code,and my iccneis
'5"„ Liemlereeanderrpa� l L 2 REROOF-T/O SHAKE INSTALL
raZ Licenm Class Corer
=rc Dam 5..,\ —a�A cnmeemr M Q^tT 50YR PRESIDENTIAL AUG g�
"ppw ARCHITGCI'SDECLARATION d 2004
I understood my plans shall he used u public records
JyU
o< Liccnscd Professional II �I (I D IN fs
OWNER-BUILDER DECLARATION D U 117.117 1�1\\\\\IfII�
a 1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the
00 fullnwing moorm.(Soctiun](131.5,Business and Professions Code:Any city or county
K m which requires a pohn m reasoner.alter,improve,dem irm,ar repair any nmermre
m—'^ prior u)its issuance,also requires the applicant Torsuch permitw file a sigaed statement
dtmhcislicensedpursuanunlheprovisionsoftheContractor'sLicenselow(Chapter9 Sq.Ft. Floor Area Valut 000
�FG (commencing with Section?")0l Division 3 of the Businessand Professions Code)at
i J3 that he is exempt Therefrom and lie bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for aprabil subjects the applicant o a civil penally of APN Number Occupancy Type
not more than five hundred dollars($500). r
01,as owner or the limiter,or my employees with wages as their sale eompnulfoe, 36230024 . 00
will do the work,and the slrunum is not intended or offered for sale(Sec.734,Bush mesa
and Professions Cade:The Contractor's License Law does not apply to an owner of Required Inspections
property who huhlds m improves thereon,antl who does such work himself or through his
own employees,provided that such improvements are not handed or offered for sale.Ir.
however.the building nr improvement is sold within ane year of completion.Ne owner
builder will have the burden of proving that he did not build or improve for purpose of
talc.).
❑ 1,as owner of me prnprly,am exclusively contracting with licensed contractors to
conswct the project(Sec.004,Business and Professions Cade:)The Contractor's Li.
cense law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contreclnr(s)licensed pursuanl to the Contractor's
License Law.
❑l am exempt under Sec. ,B&P C for his moan
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affair under penalty of p jury one of the fallowing declarations:
I have and will maintain a Crai is tiz of Convol to self-insure fur Warker's Cumpcn-
emion.u provided for by Section 37W of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maitar m Warker's Campenaminn insurance,an required by action
37M of the Labor Code,for the performance of the work for which this)antl is issued.
My Worker's Compensation
/^I�nsuvncrr
ce\e caier and Policy number are
Carrier: �'F�" .N n-.✓ Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut beciandcoed if the permit is for one hundred dollars($101)
or less.)
I certify that in the performance of the work for which this permit is!wood,I shall nut
employ any person in any manner so u to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANE':If.after making this Comficate of Earn union,you shoo III
become subject to the Worker's Cam pcnsmion provisions of the Labor Cade,you must
,J 0 fotNit with comply with such provisions or his permshall he deemed revoked.
'Z CONSTRUCTION LENDING AGENCY
I hereby affirm drat lucre is a construction lending agency I'mrthe performance of
CL > rue work fur which this permit is iter ed(Sec.3097.Civ.C.)
W� A Under',Name
= z Lender's Address
V Q I cenify Thal l have read Nis application and sum that the above informrtion is
K F correct.1 agree to comply with all city and county ordinances and suite laws relating to
pU building eunswclon,and hereby amhon.neprcmnnatives of Nis city to enter.pad the
W above-mentioned properly for inspection purposes
(We)agree to save,indemnify and keep harmless the City o/Cupertino againsl
FF.tN liabilities,judgments.costs and expenses which may in anyway accme againsl said Ciny
U in consequence of the denting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU IONS.
4�� S5—11`,`( Re-roofs
Signature of Appian/Contractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant store or handle hmarduus normal
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(x)?
❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil haredous air comaminanu as formed by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑Na
1 have toad the leaando s materials relmomems under Chapur6J5o1'nueCaShar-
nia Healed&SafctyC Wc,Scotia¢25505,25533 and 25534.1 undersand mm If the building
does nal cunenlly have a tenant,Nat it is my responshbhlity to nuufy the occapanl of me
require anuwhie naxmorpoor toiominreofaCen;neaneofOccupancy, Signature of Applicant Date
Owner nr aamatized agent Dale All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
r'1 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF
Fax(408)777-3333
UPEUNO
Building Department
JOB ADDRESS, PERMIT # 0 0 0 0 S
�-S 3 �;,� lam b
OWNER'S NAME: j�,aa �o PHONE # u
GENERAL CONTRACTOR: n FAX #
C—
Fz a q 6Z
I am not using any subcontractors: `� l .—
Signature Date
Please check applicable subcontractors and complete the following information:
65 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
Allhl Tile
Owner/Contractor Signature Date
Community Development Department
j Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
IOUPEI�TINO
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: ':5A Vy\e S
lob Site Address: CJ 0 VV h o �a �t ��A- c-Q—
Roofing Company Name: �- V,
Com'
A plicant's Signature: C' Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY
CUPEf�TINO PERMIT APPLICATION FORM
APN# 3 6 z '30 O Z Date: c^ I I^ y
C �
Building Address:
Owner's Name:, Phone#: 1 62
Contractor: Phone#: License#:
JZ, agd, � 6 � w�
�; �
Contact: <Phone#: , , Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ®�sphalt Shingles
IP/Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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: ❑
'-�tJ-ob Description: (� n 1
eCLr O "t� I S`A�4'� \ Jc�l' �'e�l� �Z bS a�b Gur
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:/) Type of Construction: 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