05110038 (2) CITY OF CUPERTINO •� Y +� `"^ �� ' � `' "`' ' ''
BUILDING DIVISION PERMIT-'01�1'��2A�Tp Y `OMA'TI(31 '
BUILDING ADDRESS: DADDARIO ROOFING MMIT NO.05110038
20556 MC CLELLAN RD
OWNER'S NAME: PERhffI ISSUE DATE
alk GERMAINE BERNARD 1734 WILLA WAY 11/08/200S
NE: SANITARY NO. CONTROL NO.
(831) 476-9109
ARCN17EC17ENGINEER: BUILDING PERMIT INFO
'BLDO ELECT PLUMB MECFI
17 t� 0
j o o LICENSED CONTRACTOR'S DECLARATION Job DOSCTI 1
MI�� 1 heretty spin Nm 1 am licensed under provisions of Chapur 9(Commencing
We Suction 7000)ol'Divisien7 ofthe Buunwsed Pmfesumu Codased my oenm u
in full raw. REROOF--T/O COMP. , INSTALL '(,eI`rQ+rll`J7[E1
?�? LIc.T w Lic.N bl.`�atn7 �i `I �
Data i _v0 u S Conn G aN0 CGvI A
7ARCHf1ECrS DECV,RATION ,A]0' L�
I understand nd my plansshall W used u Prostin worries 'YO
e u. Liccmed Pmfcsuonel /�}{�
O
OWNER-BUILDERampsfrom
m Ce Cons ON
1 heresy eBm that 1 exempt from the RATION Ucense Law for the
o O following maven.(Section 7071.5,Business and Poofesslens Cade:My city at county
which mqu(nu a permit to cmmrtmt slur.improve,elcmelW,or repair my s anar m nom. $6100
i>.n prior at im issuance.also requims the applicant for such permit in 0m a signed asomem
€< Out he is licensed purmanl to the provisions of tic Commactori UCore Law(Chapter 9 Sq.Ft.Floor Area Valuation
9 (commencing with Sauon 7000)of Division 7 of the Business and ProRsuons Code)m
Na he is exempt durafrom and the basis fon W alleged exemption.Any violation of
Section 7071.5 by AM Applicant for a Persil subjects the applicant in a civil penatry of qQ;Ver 7U Ocdtfpancy Type
act roam than flee hundred dolmas ISM
❑I,uownerofthapsoputy,armymoployemwiNmguuNeuwleeompe don,
willem the wok.md thessu mmen s notlmm�dad araffsxd forsek(Sec.7044,BusinessRaired Inspections
tib Pmressions Cade:To conuandos out License law doem apply w m e owner or q p
property who builds or improves Laercoa and wo does such work hkuelf or Lawsuits his
own employees,provided thatsueh Improvements am notinerMed woQened for sale.If,
bowaer.the building or Improvement is mid wlllunom year of complauns.dm marer.
builder MR have de bumm of proving WI Im did mm hulk or improve for purpose of
ark.).
❑1.u owner of Can property.w exclusively canuacung with licensed wnuasws in
consume,Lae project(See.7044.Business and Professions Critic)The Contractors U.
cense taw done Pat apply as m owner or pmpenywbo Wilda or Improve therm,and
who conumu for such projeeu With a conmecur(s)licensed par ism to den Canuwme,
LIesnse Law.
❑Ism uemDt under Sea ,B&PCforthsreaan
0. Das
73071WORKERS COMPENSATION DECLARATION
I hereby infirm under penslly of perjury am of tan following decimations: �
I hem and will maintain a eati0mm or consent tu self-w-um far wakes contract.
.
ort,u provided for by Seeman 7700 of the labor Cade,fa Lha perfammnCo of W
rk for which this permit is Wmd
1 neve and MII maintain Workers CompensWan Insurance,u required by Section
0 ofLae Latta Code.ran W perfarmanceaftho ware farwhlch this permit m issued
yWerteR C rope bon kwranCo a and Po0ry number Am:
ier. Polley Na.:�g.` QQdy
CERTIFICA GF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu waken reed notoce mpkma if the permit Is format hunLaeddPOaa(SI00)
or lead
I certify that in the pert..of the wart fon which thin permit is Wired.I Nall tel
employ any person in my Cancer an u to become abject in the Workea'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,arm,making this CemResm of Bannerman,yCo scum
Eecon a subject in the Watters Compensation provisions of ted tabor Code,you mus
vJ Q forthwith comply with such provisions Or this permit shall o deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby infirm that Nem is a construed..lending agency for the performance of
!Yi mm work for which this pemN is Wised(Sri.7097,Civ.C.)
W Q Landers Nsme
a Z Lenders Addrtse
C.)O 1 certify that I Me fend this application arm sum this ted move information in
y'j correct i elm to comply MN all city and County ordinwes AM sum um mlaung m
0 SU^ building cansuunion,and hereby audboum representatives of this City too mrupon Na
cove-menumed Property for impaction purposes
agree ro era,"we"ify and kap harmess the lCity of Cupertino against
IisMliu..1migswnu.caw and expenses which may in my wry urns gdrunaid City
V",[ in consequence of the grmdng f this permit.
APPLICANT UNDERSTAN S A WILL COMPLY WITH ALL NON-POINT Issued by: Date Q a'
SOUR ULATIONS.
- Re-roofs
drFisiden of PKIZOM02MATERIALS DISCLOSURE Dam Type of Roof
Will the applleanl or future building acupmtoom orhandla hAsmom material
u defined by dm Cupertino Municipal Cade.Chapter 9.11 and the Health and Safety
ade.Section 155774)7 p All roofs shall be inspected prior to any roofing material being installed.
Wa Ce
❑
Will the applicant w future Wilding ascupml um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit huadom air comamtmms u ticOmcd by Lae Bay Area Air Quality Management all new materials for inspection.
DisulcG
Oyu
I have mid the humMmematerials requirements underChapmr6.95 orthe Calvar.
Ala I=]"Ssfcly Code.Secdas25505.25577 and 15734.1 undemmnd NBift a building
dCar an,cunmtiy how a te L mu hol my responsibility m reify the ocoupant of de
rural It '
It OLbemet r m maraccmrmwafoccupmwy Signature of Applicant Date
- All roof coverings to be Class"B"or better
th rig at Date
Community Development
10300 Torre Avenue
acm
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPE(�TINO
Building Department
JOB ADDRESS: PERMIT #
s �4 1 0 S-// o a 3
OWNER'S NAME: n PHONE S 7G_ ,t s:!S
GENERAL CONTRACTO Ori ao FAX# I 7 q I o
I am not using any subcontractors: : ;2
Sign '^e f 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
lumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
11 ops
er/ ontrfor§ignature Date
Community Development Department
Building Division
fa, City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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 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 with the above stated policy on re-roofing.
r
Homeowner's Name: oe vwt.a I Y<-0 B.o-Y-\a-"
job Site Address: 2,o fgUa Gto I M c, C.l e h A/--, to
Roofing Company Namef a JJ d eao r=,\- t c4
Applicant's Signature: Date: I t_a 8 US
eGreg Casteel LL��
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
d' REROOF o S'// v C122
CUPERTINo PERMIT APPLICATION FORM
APN# p Date:
1 — d
Building Address:
fv
Owner's Name: Phone#:
a
Contr yr : Phone#: License#:
a l,o tzaclLvlct ( V31 ) e4-I&-91007 o73 '1
Contact: Phone#: Cupertino Business License#:
k r ti
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O,'Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
13 To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 11
1— v C T ,Is Ar" (k m 2rResidential Commercial Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cos of Project: Type of Construction: Occupancy group:
00 I o
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