03090034 (2) CI'rY OF CUPEWf[NO
BUILDING DIVISION PEIMIT , -0NTRA TOR INFORMATION
BUILDING ADDRESS: PERMIT NO
R A CONSTRUCTION 03090034
:4)rtal MQ GLELLAN RE)
OWNER'S NAME: 559 CAMPBELL TECH PARKWAY PERMIT ISSUE DATE
TTPT
Tar
PHONE: (408) 369-9921 SANITARY TR
C NOLNO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ion LICENSED CONTRACTOR'S DECLARATION
mF I hoary affirm that 1 em licensed undcs provisluns of Cb Pier 9(cnmmen g Job Description
�Z`uf with ](llkyof Diviaion3oftM Busincu etitiBlJfcuians Cndc.anJ myl' rax is
,qiI.fullf sand Crrc /W
Licenac CIds. Lie. RE-ROOF
=� Data CunDEC
udcrsand my plans shall used as public
records
W
`ON Licensed Professional SEP 1
E 3 OWNER-BUILDER DECLARATION O �QO
lE 1 hcmhy affirm Thal 1 am exempt from the Commodes License Law for the
20 following moan.(Section 7031.5.Business and Pmfeasium Code:Any city or county d
C m� which requires a pnmit to construct,+Imr,imprme,demolish,Or minor any Structurebig 111..
u�<
prior o its isuance,also requires the pplicant for such Permit to file a signed nsmmcnt
that he is licensed pursuant to the provisions of the Croatia's License Law(Chapter 9 Sq. Ft. Floor Area s[on
2F$ (commencingwith$CLII(m7000)ofDivision3n(theBusinessandPrufcssionsCode)or �w
�..
that he is exempt Ihcrtfrom.and the basisfor the alleged exemption.Any violation of r)91f;oin on
Section 7031.5 by any applicant fora permit subjects the applicant m a civil pcathy of APN Number _. Occupancy Type
not more than five hundred dollars($500). - - - —--
❑ has owner nine property,or my employees with wagesas their mlc compensation,
will do the work.and the awctum is not intended proffered for win(Sim.7W,Bomare 305 - FRAME Required Inspections
and Professions Code:The Contsxmre's License Law does opt apply to an owner of q p
property who buildsm improves themon,and who duessuch work himselfor through his 307 — INSULATION
awn employees,provided that such improvements are not intended oroffered for ale.If. 6O1 — ROOF TEAR OFF
however,the building or improvement is mid within one year of completion,the owner.
builder will base the burden of proving Nat M did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
ale).
❑ h as owner of the progeny,am exclusively contracting with licensed castration to
603 - ROOF BATTENS ._ ..
consumer the project(Sam.7044,Business and Pretensions Cade:)The Comncmri Li. 604 — ROOF IN-PROGRESS
come law dons not apply ban owner of progeny who builds ar insiam.doctor and,
who convects for such projects with a to ntmctos(s)licen¢d pursuant to dire Condmtoes
License Law.
❑I con exempt under Sea .B&PC for this moon
weer Dam
WORKER'S COMPENSATIONDECLARATION .. .. ,-
embYa(fnm unticr penally of perjury ane of the fallowing daldr.tlans: . . .. .. ..._. .. ...
I have and will maintain a Cenificom of Consent to self-ioure for Worker's Canapes.
sation,u provided for by Section 37M of to Labor Code,for the performance of the
work for which Nis pomil is issued.
❑I have and will maintain Worker's Compensation Insurance,a required by Senion
37W of the Labor Code.for the performance of the work for which this permit is issued.
My Workees Com met ian nsunn came Std Palicynumnber�a[q��L�Jy��,D
ERTI gCATE EN FRANCE ERS'
' COMPENSATIO INSURANCE
(Thu xaitm recd not M cpmpiemd if the permit in(arOM hundrtd dnllanlSlfl(q
or less)
1 cenify that in Ne perfm,mnce of the work for which this permit is issued.I shall net
employ any person in any manner m a m MeamO anbjeel to IM Workeri Compensation
Laws of C.hrmoi..Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificete of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
7 Z fonhwi N Comply with Such provisions or this Permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY _
1 hereby affirm that Nero is a construction lending agency ler the performance of
Yd the work for which this patrol is iaucd(Sec.Jug?.Civ.C.)
Y Q Undch Name
D,z, Lender's Address
J C 1 cenify the 1 have read this applicoion and safe No Ne+hove information is
1 Correct.1 Agree to comply with all city and county ordinances and sum laws reading to
�U building construction,and herebyauthorim represenutwo of this city to enter upon the
W alovm(weioned-cm property for inspectionnifakeephs. /
(We)+gree to ave,indemnify and keep hay in m the y ac of Cupcnit AgeinSt
(A incoiuu.jpec91 costs expenses which may in any way¢nue against aid City
J z inconsequence One gdf thispermit.
F-t
APPLIgAffTTRDffUtADS AND COMPLY WITH ALL NON-POINT Issued by: Date
ERE 0
Re-roofs
tgn r Applicarn/Con actor H ZARDOUS MATERIALS DISCLOSURE Da Type of Roof
Will the appliconl m future building occupant stem or handle harnrdous material' -
a defined by the Cupenino Musiei a1.Code,Chapter 9.1],and the Health and Safety
de,Section 35533(01 Music
All roofs shall be inspected prior to any roofing material being installed.
Will Neepplicem rawrebuHdingaappamaxeytdpmempraavitgswMgh If a roof is installed without first obtaining an inspection,I agree to remove
coil hezardous air Come 'manus m dcfired by the Bay Arta Air Quality Management all new materials for inspection.
District? +��U
Cl Yes
Ihave post the M.Secmxs M5rials 533malerds 55 undc nderpmdthear 6.95 ofthc Wilding - �Aican,=
nos Health&SafetyCode.Senium 235(15,355JJaru135534.1 Wmniand Nwtftiourt ingJon mol curmmly My cnan4 Nal it u my rmpomibility m msufy IM rccupanufmeyc Mmetpriormkssuanceofa ruficamofOccv aney. Lure of pplt Date
authorireJ egcn� �Dnmll roof coverings to be Cls s "B"or better
i Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEI�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 " 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:
Job Site Address: j� /
Roofing Company Name:
A phcant's Signature: Date:
Greg teel
Building Official
Revised 1/30/03
= Printed on Recycled Paper -
CITY OF CUPERTINO
40em 1 of 1 PERMIT RECEIPT OPERATOR: seem -
COPY # 2
Sec: Twp: Rng: Sub: Blk:- Lot:
APN . . . . . . . . : 35916010.00
DATE ISSUED. . . . . . . : 09/04/2003
RECEIPT #. . . . . . . . . : 23020
REFERENCE ID # . . . : 03090034
SITE ADDRESS . . . . . : 20691 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WILLIAM UPLINGER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA. 95014-2956
RECEIVED FROM . . . . : R A CONSTRUCTION
CONTRACTOR . . . . . . . : ANDREWS, RON LIC # 21382
COMPANY . . . . . . . . . . : R A CONSTRUCTION
ADDRESS . . . . . . . . . . : 559 CAMPBELL TECH PARKWAY
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
• TELEPHONE . . . . . . . . : (408) 369-9921
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8, 000.00 137.00 0.00 137.00 0.00
BSEISMICRE VALUATION 8, 000.00 0.80 0.00 0.80 0.00
BUSLIC FLAT RATE 1.00 100.00 0.00 100.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 237.80 0.00 237.60 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 237.80 11126
TOTAL RECEIPT 237.80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 0 b Date: 3
Building Address: 2 0 ! / /v(( r(/2110 Z4?
Oqil
Owner's Name: w<C�� /C Phone#: 7W1
Contractor: � � C, C c/ ` Phone#: � (�.�� License#:
Contact: Phone#: Cupertino Business License#:
yPZ
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 ❑ 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: (r /"'—�J O�� 0V
Residential lvCommercial ❑ C ( lle\
Fire Zone: Yes ❑ No 101017 Confirmed with Planning De t. if
there are any restrictions-
Cost of Project: 7 76 1 Type ofst cti It: Occupancy group:
Qty. .
A cAb*k 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