04110097 (2) CITY OF,CUPERTINO ' . y4°''"�{�' �' p` ♦ '
NJ
'BUILDING DIVISION . �PERMIT`�" +"a. I .,,.••.
- - '"' PERMITN -'
BUILDINGAODRess: EL CAMINO ROOFING CO INC `b4110097 '_'
1622 MILLER�AV
OWNER'S NA ME: - - PERMIT ISSUE DATE
Ah JANE WINBY' 1650 S 7TH ST
ONE: - SANITARY NO. CONTROL NO. -
(408) 292-7644
ARCHITECT/ENGINEER: - _ BUILDING PERMIT INFO
_... -. _..._..-.._�....-. . .,...., _,,.,._.._..._,.�..:�..._ BLDG ELECT PLUMB MITCH '
uoo LICENSED CONTRACIO SDECLARATION - -
�+ 1 bemby,affirm that 1 em licensed and provisions of Chapter 9(commencing Job Description
uhSectlon 70(111)nf DiWalon3of the Bpa.a nd Pro(cssiona Code,and rayl rouse is
il r�r.nrmea REROOF
O�Z License
zl-.O Dam
j �v�� •. ntic nd Plana shall)he merits U0.�ds / �''y�-/(��� _. .. _ _-._.
y
a. Li.rued Pmfcssi...I rJ• C '
m OWNER-BUILDER DECLARATION
I .y herebyon.(Sem thin 1 1. exempt Item the ContmnCo License Law for the
O O following moron.(Section 71131$Business mp ve,demolish.
Code:Any city or county
E:0
$� whichmyuims a permit m cnneweL alien Improve,tlemnluh,nr repair any svucwm � � - �- �-` " '_"' ' - �--
m�l�a prior to its issuenee,also requireuhe applicant forsuch permit to file a signed statement OO
that he is limmed punuant m On provisions of the Contractors Ltmnse Law(Chapter 9 .. -. Sq.Ft. Floor Area. '- - - "'VaIUBIien --'-'--'- "—
(commancingwith Section 7000)ofDivision 7nf the Business and Profmsinm CWle)or
..
that be u exempt therefrom and the basis for the alleged eaemptlon,Any violation of
Section 7031,5 by any applicam for a permit subjects the applicant to a civil penally of a Occupancy Type
not mom Nen Eve hundred delta.($500).
OL as owner ofthe property,or my employees with wages as their sok compewUon.'
willdo thewerk.and theswdum isnotimmnled crofted forsale(Sm.7014;Eusinces ,..,', r -
had Professions Code:The Contractor's License Law dors not apply m an owner of - 'RBgUICed InSpOCtIOBS
property who bu ilds or improves thereon.and who does such work hi mself or through his
own employees,provided thatsooh improvements am not intendedoreRerct forsale.If, -
however,the building or improvement is sold within one year ofcompletion.she owner- "' - -_---.
builder will have Rte Wrden of proving that be did not Wild or improve for purpose of
sale.).
0 1.as Owner of the property,am exclusively contracting with licensed convectors to
construct the project(Sec.7044,Business and Professions Code:)The Conmcmr's Li- _
cense law dors not apply to an owner of property who Wilda or improves therean,and
who contracts for such projects wide a eantracter(s)licensed pursuant to the Centimeters
License Law. -
❑1 am exempt under Sec. .B&P C for this mason
Gore, Data
WORKER'SCOMPENSATIONDECLARATION
41 I hereby affirm under Penalty of perjury one of dm following declarations:
❑I ham and will maintain aCerefcate of Consent to self-InsumforWorousCompen-
sation,as provided for by Section 37110 of dee labor Code,for the performance of dee -
workforwhichthispermitlsissued. '
1 have and will maintain Worker's Compensation Insumnee,as required by Section -
37WofdmLaWrCodeforthe,performan ofdee work for which this permit is issued.
My WWorrkk.' CmFewetion Imo tttt ie nd Policy m ram:
Cardprfv ( )icy FROM
- '�
✓/ CERTIFICATE OF EXEMPTION FROMWORKE S
COMPENSATION INSURANCE
(Thu secit.need not be completed iftbe parous is for nc hundred dollars($100)
or less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as m become subject to the Workers'Compensation -
Laws of California,One
Applicant
NOTICE TO APPLICANT:If,after making this Cendisma of Exemption,you should
become subject m the Worker's Compeosation provisions of the Labor Cow,you muss
Z forthwith comply with such provisions or this permit shall be deemed revokrd.
z-i O CONSTRUCTION LENDING AGENCY
[r Ihembyaffno Nat Nem is a convection kndingagency,far the performance.(
the work fur which Nis permit is issuc l(Sec.3097,Civ.C.)
W�Q Lender's Name
D Z Lenders Address
U0 1 certify that I have read this application and wa,Nat the above information is
D. P coned.1 agree to comply with all city and county ordinances and state laws mlating to
O U building convection,and hereby souherne representatives of this city to enter upon the
W ahove-mcmioncd property for inspection purposes.
ow (We)agree to save,indemnify and keep harmloss the City of Cupertino against
ti to liabilities,judgments,costs and expenses which may in any way same ageinslaaid City J
U Z in consequence of the granting of this permit.
^v
APPL19ANT UNDERSTANDS AND WILL COMPLY WITTI A N -POINT Issued by: Date f rC7
SOUE EGULATIONS.
I Re-roofs
SignaApplicanUCon"wou - Dam
HAZARDOUS MATERIALS DI CLOSURE Type of Roof
Will the applicant or future building occupant store or handle Weamous material
as defined by dee Cupertino Monte It .Chapter 9.13,and the Health and Safety
Code,Section 25532(a)7
0Ycs All roofs shall be inspected prior to any roofing material being installed.
Will the applicant er fuwrc braid' g a upem uac cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to re ove -
cmit havardaus air conmminanu as ncd by the Bay Amo Air Quality Management all new materials for inspection.
Disvin7
❑Yes
Ihavcread the hosardon materials requirements under Chapter 6.95 of the Califna (
?C(nia Health&SafetyCWc,Secdom25YJ5,25533md75534.tun man thot'fdec Wil ding �� I �.
does not currently have a mnan4 that it is my responsibility,m nqul'y N cupant f the
reyvimmc vrvhich mustbe met pri.ruthaterom.fa Cenifmaut of upSigna eof Applicant ate
owner or euthorimd agent ate '- - All roof coverings to be Class'B" or better
Community Development
10300 Torre Avenue
i, Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
UPEkTINO
Building Department
JOB AESS: PERMIT #
2,, 11.12-C Ate,
OWNER'S N K, P # L
GENERAL CONTlaCTOR. FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation ,f
Landscaping
Lathing /
Masonry j
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing ,
Septic Tank
Sheet Metal
Sheet Rock
T'
Owner/Contractor Signature \_ ate
-Community Development Department
Building Division
all City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
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.
a�
Homeowner's Name:
job Site Address: ` �' ' ' `�II Q V�
Roofing Company Name: G O
Applicant'sSignature: Date:
Greg Casteel
Building Official
Revised 11/2/04 -
- Pdnred on Recvcled Paper -
CITY OFA CUP((��E�,RTINO
CI F REROOH`
COPE F NO PERMIT APPLICATION FORM
APN#.j�
Building Address:
Owner's ame: Phone#:
b
Con g tor: Phone#: License #:
Contact: one#: Cupertino Business License #:
63 �
Type of Roof Covering:
Exi • Proposed:
PBuilt-Up Roof i t- p roof
❑ Asphalt Shingles ❑ Asphalt Shingles
— o ,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:,
Residents -.r].-�- ._ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with P n Dep . if
A 99 there are anstri ions: LI
Cost of PT: Type of•Co s cf n: Occupanc grou e� .
•f
li a le Fee ID Fee Description Fee Group
PERMFEE Bldg Permit Fees BUILDING
B NERGY Energy BUILDING
/ SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BP•LANCHK - Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Z777Z