04080224 (2) CITY OF CUPERTINOi "%4 ''� �.�y,,/�'.y� ,;x �t r
BUILDING DIVISION PERMIT CONLRACTWINFORMATION
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PPEG04080224
' OWNER'S NAME: PBRMITISSUEDATB
IE: SANITARY 0. CONTROL NO.
(408) 92S-999c;
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION O
H. 1 herchy affirm that 1 Am Iicansed under provisions of Chapter 9(commencing ]o
n<
with
SmdonT")of Division Sof the Business end Profmames Cook.aM mylioanu is
y infellroN And Off `a 2 Sq 'I REROOF W/COMP
Z Licenso
Lic.
ol- Date J Baa u TIDN P ' SEP 9 2004
WU I undersand my pl..A,hall Mused m public rtcards
ted
Licensed to OWNER-BUILDER DECLARATION ECLARATION
I hochy ire 1 em exempt(rm the Conwnah
License Law for the
y0 (0110wiftg .(Saon]fOL3,Business am CWr:Anycyar aunty
BUILDING
awhichrequires A permitaconstruct,all.,,improve.demolish.m ,.I, ten:
hI also mtdon,apfor rmiuto Rlea signed otamment
'otWfmam Pursuant.he provisions.(ft Ctmentnate Law
(CMpmr9 Sq.F[. Floor Area
(Commencing witl Section
7 )of Division]of me Business and vCode)or Valuation
that I-tsermlmefmn.4the bur for the Illopolemmpdon.Any violation or
Section ury applicant fm a permit subjects 0e epplicannoacbol penalty of
not more than rave hundred doom($soo). 39�A�I�5er0O 6ccuPaney7
7
Pe
0 1,u owner Of doe propeny,m my employees with wg.3 es theb sale cumpensstion,
will do the work,end the Immune is not intended or offered for Wein(Sec.1044,Business
and Prolamin-Code:The Cmarmu e,Littnx law does not apply in An owner of Required Inspections
property who buildsor improv domma,and he doessuch workhimul(ar Hough his
own emplOynea,provided that such improvements Are not intended oroffered(orale.IL
however,On building Or improvement is sold within One yev of compledon,me owner.
builder will have the burden of paving drat M did net build or improve for purpose of
sale.).
0 1.As owner of the propeng em melmively convecting with licensed canners to
construct the project(See.7044,Business and Prefusiom Code)The Convector's Li.
came law tlas not apply m an owner or property who builds or improv memon,and
who conte,ts for such Pmjeem with a eonueetor(s)licensed pursuant in run Conoseloes
License Law.
O l Am mempt under Sec. ,B&P C for thr season
Owner Data
Ah WORKERS COMPENSATION DECLARATION
1 heeby affirm under penalty of perjury one of the(allowing declarations:
I haw and wlll main.,.a CerOfcate of Consent in atir.la en for Worker'.Comport.
urian,As provided for by Section 3100 of the labor Cade.far the perfmmance of dm
work for which thin permit is issued.
0 1 have And will mimin Worker's CompensNon Itumenca.As Muimd by Section
3100 of the labor Cade,for the performance of the work forwhich this permit is Issued.
M TWorkcr'=COmpenutia nsunnca artiPaOpaltry numbcS rami
.��ee..d{CERTIFICATE OF EXEM PN . OM WORKERS'
COMPENSATI)NINSURANCE
(This section need not Wc.mpleed if the permit is fafonc hundred dollen(SIM)
nr IcuJ
I certify that in the performance ar dre work far which this permit It isum,I shall not
emPloy any person in any mmneran u m beam,subject in the Workeri Compensation
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,After msking this Cenifica e of Exemption.you should
become subject no the Wohm's Compensation provision of the Labor Cndc,you mus
wJ O (aMwith comply with such provision or this permit shall be deemed revoked.
E ;; CONSTRUCTION LENDING AGENCY
(~ I hereby affrm that mere is A construction lending agency lar me performance of
thc werk fur which this permit r Issued Sec.9Y91,Civ,C.)
Afender's Nam.
=2 lander.Address
U Q 1 aofy mat 1 have read this application ted sum that the,bow Information r
gg, r. correct.I AIMto comply with all city and county ordinances and Aute laws elating to
D U holding conswnion,and herebyeuthartee epeunutiv of this city to order upon me
(z) ebovcm,judg e.b.0.y for imposition expenses
whichpurposes V`'_IJ KJV
(We)Age.re save,indemnify and keep harmlem the City of CuN,H.Again. x \
ter Z incoliabilnsmpa cc of the
loom and expenawhich may in any way see=against said City
(„),z in covequcncc of the%canting of this permit.
r.
so
APPLICANT
ANDS AND WILL COMPLY A{.LL NON-POINT Issued by:511um AppbcanVCanvanar Date Re-roofs
HAZARDOUS MATERIALS DIkLOSURE Type of Roof
Will me applicant or future building occupant Som or handle lotmoou ma ec sl
u defnd by dm Cupertino Munieiol Code,Chapter 9.11,end me Health and Safely
ode.Seatian 25s3z(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Ym {r Na
Will the applicant or future building Occupant sax equipment or devices which If a roof is installed with first obtaining an inspection,I agree to remove
I,hanrdom air contaminants As defined by me Bay Area Air Quality Management all new materlalS r'0[InSpeCt100.
D'bVlCll
I have maJ the h:vanlnsmateriale myviromcnla undcrCMpter695of me Glifoo- / /'
nr HcalmkSafnyCadc,Secdmn233p5.25sJJ and 23334.1unMrsuM thuifmc building _ ��O /
dna not currently have te I'll
apomibility mn.til' the mcupant of me I C- L+•
OC cola w on dor.I. a of a Ccourt cupancy.
z - U Signature of Applicant Date
Owncr.reath.m.dam.d Date All roof coverings to be Clav/q)r better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#MkTINO
Building De artment
JOB ADDRESS: �� l LG N N A I A�� PERMIT
OWNER'S NAME: 6T(fvk�, � L`I NNS PHONE #
GENERAL CONTRACTOR: -pwo(-1 N FAX # = (0 J-6 - -11 m I
orJ xrr-u.CA-7 v n,, I q c.
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
x Roofing L°1J t L-tA A N s 1 W TAS--04
Septic Tank
Sheet Metal
Sheet Rock
e
2� �OLq _
er Co for Signature Date
Community Development Department
aiiol
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
* CITY OF Fax: (408)777-3333
1UPEkJ1N0
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.
t
Homeowner's Name:
Job Site Address: L 0 iJ N A' �vL�
Roofing Com me: U 5 Cd1 I4 11Zll C (N
A plican 's Signature: Date: 2-� +p J
%Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUP
ERTINO
REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# J51 — 9 0 2� 1
Date:
Building Address: ri L6uNA Lf-Nl` U
Owner's Name: V� s 1 y� �< Phone#:
Contractor: i / Phone#: License#:
A-1)4 q - 626 -72-7 (5
Contact: Phone#: Cupertino Business License#:
4A- L-ZI -1413 v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings L ❑ Provide I.C.B.O.Report#
VTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Te az Off Policy:
Job Description: ' emav� GX6TW G 2 LMtrx-5 6Y- 'Rutrw (-MAA-Ke
I rkw Nom( IZ" 1 a;F 0 l5 CA,h S �1 CoMP
Residential C mmercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni 'f
there are anctions:
Cost of Project: 12 Type of Construc ' Occup group:
Qty. V
A ca 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
203 2 �