04070042 (2) CITY OF CUPERTINO �'�'' '"� n`...'� tom" zs`,
BUILDING DIVISION PERMIT ONT" ^, ",
BUILDING ADDRESS: T D ROOFING PERMITN004070042
OWNER'S NAME: PERMIT ISSUE DATE
ONE: T SANITARY0. C OL NO.
(402) R92-AR72
!RCHITECTMNOINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:0C LICENSED CONTRACTOR'S DECLARATION
Job DOSCnptlOn
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
aid who Settie.7WU)afDividon 3 of the Basin.,and Profcasimu Cadp,md my license I.
'Min
I. °ci s d °'� Lm.x REROOF W/LANDMARK TL FQMb' $t0
Data Cunmcmr V 8�
ns- ARCHITECTS DECLARATIO
$ I underamnd my plans shall k used m public men a
=s JUL 19 2004
;0 Lkcnsed Professional
OWNER-BUILDER DECLARATION
I hereby affirm mel 1 am exempt from the Contractors License Law for the e v
m2 following mason.(Section 7031.5,Business and Professions Cade:Any city or county �U��®���
a�$(< which requires a permit m ennswcl,alter,improve,demolish,m repair any structure
FZi prior to its issuance.aim requires the applicant far such permit to file a signed statement
p G
that Wislicensed ponuanuothe previsions ofthe ComracmrSLicense Law(Chapter 9 Sq.Ft.Floor Area Valuators
yip (commencing with Section 7")of Division or the Business and Profession&Code)or
3$ that W u mampt memfram ba
and the basis for the alleged exempRon.My violation of -�.a-pyar�}yg.�,�.a,,.�aa,�p,(�
Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penally of 3.UQ W m agagvlo 0 Occupancy Type
not mom Nan face hundred dollars(S5ML
❑I,as awwr of the property,army employees with wages a a their sole compensation,
will do the walk and the structure isnot intended oroRered for sale(Sec.7UN,Business
and P.1cum ru Code:Th.Cmaracmr's License law does at apply to an owwr of Required Inspections
property w ho Wilds or i mproves thereon.and who does such work himself or through Ain
own employwa,provided mat such impmvemenuarc notimended or offered formic.if,
however.the building or improvement is sold within can 3<ar of compleion,the owe r-
builder will have dm burden of proving mel he did not build or Improve for purpose of
axle.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70",Business and Professions Code:)The Contractors Li.
cense law dons oat apply in an owner of property who builds or improves hereon,and
who contracts for such pmjeets with a conmetar(s)licensed pursuant o the Convectors
License Law.
❑I not ea.com under Sm. ,B&P C for this moan
OwnerDate
dtWORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury on of he fallowing declarations: -
1 have and will maintsin a Ccrdfmate of Consent m self-imure far Walker
as provided for by Section 37M of the Labor Cade,for the performance of the
.it for which this permit Ice issued.
�.Mave and will maintain Workers Compensation Insurance,M required by Section
37700 of me Labor Code,for the performance of the work for which his permit is issued.
My Workers Co pensmion Insu ce cert er end Policyr umkr are:
Cartier. $ Y Policy No.: I
CERTIFICATE F EKEMPION FROM WORKERS' ,
COMPENSATION INSURANCE
(This secdw need not kcompletetl Vitro permit is forane hundred dollars(SIM)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ anypermn in any mannerse as to become subjecl to he Workan''Comparmth n
Laws of California Data
Applicant
NOTICE TO APPLICANT:IL actor making his Certificate or Exemption,you should
become suhjea to he Worker's Compensation previsions of the tabor Code.you must
O forthwith comply with such provisions or his permitshall k deemed revoked.
r2 CONSTRUCTION LENDING AGENCY
[r lbereby M.that there le s construction lending agency for the performance of
(Yi r7 me work for which this permit is Issued(Sec.3W7,Civ,C.)
W Q Lenticr's Name
a z Landers Address J-
U 21 certify that I have read his application and sum that he above information is
IL F" correct.1 agree to comply with all city and county ordinances and smm laws relating to
C building wnswctiom,and herebyauthame winceentstivecuf this city to color up.ft
toil above-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
ray fA Iiabilitim,judgments.coav and expenses which may In any way seem againstsaid City
J in consequeMEA
gon"" of this permit.
APPLIC NRSTANO AND WILL COMPLY WIT AL NON-POINT Issued by: Date
SOURC s.
R "`( Re-roofs
Signam of ApplicmU onmcmr Date
HAZARDOu IALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous materiel
U de0ncd by he Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Sect2ion 112m)7\ All roofs shall be inspected prior to any roofing material being installed.
El Will he applicant or future building occupant sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Im,ardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
[I Yea
Ihevc ad L See onmaterials re33 an,1 rats under Craton 95ofhe Caldirrit
riaHwlm& y ode Sccuuns25505,255uimtln5 un 1u Chapmtl mifthc building x(lNp{IJ'"-OS Nl.'I'A-,/✓X\ t/ l
does oat cu 8w-want.Net it is my responsibility to m fy occupant of the
mquircmc at mt issuance of a Ccmfcam fOc upmcy.
(jL! Signature of Applicant Date
Owner orauhonzcdngmt Date All roof coverings to be Class"B"or better
Community Development
aClOF
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Buildin De artment
OB ADDRESS: PERMIT #
J 1 0 asr y vJc y 0 u o'�
OWNER'S N T D Roof ; n PHONE # yo$ SCIS. 89111.
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: `J
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
Owner/Contractor e Date
Community Development Department
Building Division
agfal,
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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: �ClLY :,N*1W 0.cl 0. UpGn a r A T-0-& �. 14Gy V-
Job Site Address: t o j fl, LC%.r� W rv4
Roofing Company Name: 1 Roo t A a
'ire
Signature: Date: I ®y
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF a
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
31 ( - 0 .2 04
012 (o � 8 I
Building Address: I
10T J-artrY Wcv
uf
Owner's Name: one
GC.: vo. ,vo coo.. C'.I^o.ndra•s kit. k0. yob 666 4-01- 3
Contractor: Phone#: License#:
T P RQgzJ11 yob) 89A. SS 6 66 3a-
Cq%act: Phone#: Cupertino Business License#:
,;67 ee El0C (yob) 8q.:L, SS & x31SS
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )Q Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings L3Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: �D
hemo�e v'�t9 t � cyeVS Wooa 1 re asst
Residential Commercial ❑ c n rn a r T 1. 84z) y v- Coact P
Fire Zone: Yes El No Confirmed with Planning De t. if
there are any restrictions: CU
Cost of Project: Type of Const ction: Occupancy group:
Cl 00o — he v-00
Qt . if
A lic e 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