06010070 (2) CITY OF CUPERTINO All
BUILDING DIVISIONp]-i'RMI'[' gconRwl
BUILDINGADDRESS: PFAHLER' S ROOFING & WATER RCPSPO06010070
10505 MILLER AVE (BACK/RE
T OWNER'S NAME: PERMITISUEDATE
f FRANK WOODS 17788 BERTA CANYON PD 01/12/2006
NE: SANITARY NO. CONTROL NO.
(408) 224-9013
AR CHITECT/ENGINEER: BUILDING PERMIT INFO
9LDGO ELECT f� PLUMB MECH
O D
30o LICENSEDCONRACfOR'SDECLARATION JobDescri tion
I hereby affirm that 1 am limned under provisions of Chapter 9(commencing p
n� with Section 70p)ofDivlslon 3af Ne Businessand Professkns de.and my license ie
IA full fora and affect. REROOF-T/O SHINGL��S, ING�{j T,L SHINGLES
j Z Lkenm Clw Lk.N -�I_I�Pa.
eC3 9 Dam�r,;y CmOver
HRELTS DECLARATION iIJ� IAp1j1Y.1{WDI,)IP[fA/RI^gl\i(Ir�gtrP11�'_-'ILkINh/Jy/Y)
y 1 understand my plena ahall Mused As public mcorw
N Licensed Prefeahm.) atlf1 - 2006
gOWNER-BUILDER DECLARATION J/-1,)y L
COO therapy,(firm that 1 am exempt from dm Contns Co License Law for the
COO o following reason,(Smear]ID I.s,Business and Professions Code;Any city or roomy ^ ._.A�
S$ which requires a permit to cnnsam,altar,barman,demolish,or repair any structureA�ure p A '�R A $8400
_z't^ Poor At its issuaece,also requires the applicant farsuch permit to file a signed sm,mcm I,.I I�
F
that he is licensed pursuant rothe preWionsof Nc Conuacmrs Um.Law(Claim,9 Sq.Ft.Floor Are f� Valuation
B (commencing with Secuan 7010)M Division 3 of the Buslneasand Profwion&Code)or
that he k exempt Narefmm and the buts for he alleged exemption.Any violation or
Section 703 LS by any applicant for a permit subjects Me applkanl to a civil penally of
not mom than five hundred dollar(5500). r Occupancy Type
❑1,u oww of tiro property,or my employee with wages u 1Mbmk compensadon,
will do tiro work and the atmctum hour intended ma@sed Imaek(Sec.70th,Business
and Prefesoat,Cade:The Contractor's License Law doe not apply m an owner of Required Inspections
propeny who builds m i m proves Memo.and who dao such work h Imself ar through his
awn employees,previded Natauch improvemmss Am not Inumc ed oraneed for sale.If.
however,the building or improvement is sold within ane year of compleuon,the owner.
Wilder MB Mae Ne burden of proving that he did not Mild or Improve for purpose of
ask.).
❑1,As owner of Ne property,am exclusively contracting with licensed contractors N
construct Ne project(Sec.Truss,Business and Professions Cade:)The Cmtracrors U.
came Law does not apply to an owner of property who builds of Improved thereon,and
who contracts far such projects with a contrmwt(s)licensed pursuant to the Contrmmrs
License U.
I am exempt under Sm. .B R P C for this mason
Owner Data
73071WORKERS COMPENSATION OECLARATION
I hereby afflrm under penslty of perjury am of the following declantiou:
1 ham and will mormul.A CenlOem of Camara in self-insum far WorkersCompen-
M
on.u providetl for by Smtion 5700 of dm ubor Code,for the performance of Ne
t for which Nis permit is inued.
1 have and will maintain Workers Conpewtion Insurance,As required by Section
of Ne laMr Code.far Ne performance of Ne work for which this permit is lasered.
Workers ComPewtiot Imarmice prior send Policy number tie:
rrier. A.I'/ 6. Policy No.:
C FI TEOFEKEMPTION FROM 0 ERS COMPENSATION INSURANCE
mmu mclim need ret Mcompleted Kim permit is foram hundred dollars(SIM)
or lw.)
1 certify that In Ne performance of to work for which this Permit is issued.l sMll no
employ any person in any ammorAn As In bcrmme abject to Mae Warkars'Compewuan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this CeniOeam of Esemmarn,you AWuW
become subject to Ne Worker's ComPewtion provisions of Me Labor Code,you am
0 Z fmOwith comply with such Provisions or this permit shall he dmmed revoked.
Q
ti CONSTRUCTION LENDING AGENCY
'r..m IMrewhich mi that thea uamMmc.30 lending agency for the prfurmanm of
Dl u wish fm which Nis permit E lssuetl(Sec.3097,Civ.C.)
6W.Q Lenders Name
=Z (antlers Address
()Q I cereify Nn 1 have mad this application and sum that dm above information is
{s.F correct.l agree to comply with all city and county omma es and sum laws misting to
0 Wilding construction.And hereby authorise mpresenmtimcar Nis city to env upon Ne
W aWa-mentioned property for inspection purposes.
�"LL (We)Agra to seam,indemnify and keep harmlw tis,City of Cupertino against
..m N liabilities,judgments,costs and expenses which may in any way same against said City
U7 in consequence of NC Sranung Militia PcrmiL
a7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — V6/
SOURCEUGULATION
slgAutr rAppik:n�ic - ser b1` Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie applicant or future building occupantsmm Or handle hazardous malarial
a defined by the Cupertino Municipal Code.Chapter 9.13.and the Fkalth and Safety
caM.Section 7553:(.)a
❑Yns 90All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant um equipment m devise which If a roof is installed without first obtaining an inspection,I agree to remove
It ha"Adnm air comaminanu u defiled by the Bay Amo Air Quality Management all new materials for inspection.
DuuictT
t]ras �No
Ihammad NehuaNwsmakrlalsmquir 255undcrChap WLhuof Ne Wilding
do HcaW L:Safcry have
a scream, et It i 7My res o2553/,1 M Moan hat occtha nt Or On t-/ 2- 0,C
Jam ret currently haw a lanenl Net It u my responsibility m notify tiw omupw of Ne
mquhamen, ch must be met poor w Issuance of a Certificate orOcmpacy. Signature Of Applicant Date
owner or an od,edas —) L All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UINO
Building Department
JOB ADDRESS: PERMIT #
V p� be-, do76
OWNIM'SNAME: PHONE # 2 O l
GENERAL CONTRACTOR: 0dGAprr c ca FAX #
I am not using any subcontractors: . f:2 /l/� 1 — /7- O
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 Signature Date
Community Development Department
Building Division
f City of Cupertino
10300 Torre Avenue
( ` UPECITY OF Telephone: (408)777-3228
��'�O Fax: (408)777-3333
IO
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.
Homeowner's Name: E5ZAm-: ��JJ n 1/
CV 1
Job Site Address: 1 O 2)s-- ( 4f 4 A
Roofing Company Name: /1-1r I.nS• /COI O r I ri
ApplicanfsSignature:
= � Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFfft /
CUPERTINO PERMIT APPLICATION FORM
APN# 3 69 16 a -Z _6 Date:
Building Address:
In O1))A-c& rZeneLanc-tet
Owner's Name: Phone#:
N "L b - b/ 7
C tractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
- go /
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles 9" Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 13 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: El
Job Description:
:Lfln (z P
Residential Commercial
Fire Zone: Yes ❑ No 0— Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Proj ct: Type of Construction: Occupancgroup:
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