04110157 (2) CITY OF CUPERTINO ' `x�� ' * tr _. . .
BUILDING DIVISION - PERMIT CONRACTQRINFRNIATZON -`-.'
BUILDING ADDRESS: - MONKS ROOFING PERMIT NO 04110157
7582 NEWCASTLE DR
OWNER'S NAME: PERMIT ISSUE DATE
GERALD GLADY 794 BERRYESSA ST 11/24/2004
ONE: - - _ - - - SANITARY NO. CONTROL N0. --
(408) 262-4797
ARCHITEC IENGINEER: - BUILDING PERMIT INFO
BLDO. ELECT - PLUMB.__ _MECH.
- o o • o •o
' +�+Oo LICENSED CONTRACT'OR'S DECLARATION Job Description -
�+ I hereby affirm Nal I am licensed under,provisbns of Chi pwr 9(commencing - P - -
with u 7")oWimin.3 of dw Bus' s dPmfeuinn Co e, orylicenuis
I-pN ofnll sand y* (7 REROOF W/COMP. -. -. .
q z Lice sac - 'IJe.g _ _
n� Da Contraetor
As shall used /��Z
�i , ,1 wHerstanJ my piste shall be loud u per ie rtenrds -
3W Licensed professional
'�g.0 OWNER-BUILDER DECLARATION !rJ
3<f I kohy.(firm Nei I am exempt from Ne Cmarwmr's License Law for the
p O following moon.(Satin 11131.5.Business and Pnefessiuos Code:Any city or minty
Y.
B� which requires a permit to consumer,alter,improve,demolish,or repair any strucmm
rZ�n prior to its issuaxe,also requires duammlieent for such Permit to file a signed statement --
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that kis licensed pursuant to tk pmvisiom of the Contractor',License UW(Chapter 9 Sq.Ft. Floor Area - , -Valuation ___-- .-
(commencing with Section lBBB)of Division 3 of rhe Business and Profess ons Code)or
that k u exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 1031,5 by any applicant fora permit subjects the applicant to a civil penalty of Or Occupancy Type
not mom than Ew hundred dollen($500).
01.as owner ofthe properly,or my cmployoos with wages u deirsole compensation, - -
- will doth .&-and dteswclure is not intended oroferad formic(Sm.1011.Business _ -.. ... _ Required Inspection - ..
and Profesilom Code:The Conmcuses'Licrnu law don not apply to an owner of Q p - "
propeny who builds or improves Marson.and who does such work himself or though his
Own employees,provided that such impmwmenU art nor Intended oro@red formle.If.
however:the building or improvement is sold within one you o(compleuon,she owner-
builder will have No burden of moving Nat k did not Wild or improve for purpose of -
.1.).
❑1,as owner of Ne property.em mudmdwly ronuset'ng with licensed conuecors to
construct tk project(Sec.7(sl Business and Pmf sadoro Code:)The Conmeers Li-
cove Law does not pply to an owner of property,who builds or hoprova Naeon,and. -
whoconmctsfor such projects with a contractods)Bernard pursuant In the Contractors
Lrcmelsw. ,
El am exempt under Sac. .B k P C for Nis rtnun
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hemby affmm under penalty of perjury one of the fallowing dalmatians:
❑1 have and will maintain a Certificate of Consent to u1f-Insure fa WorkersCompen-
sat'on,u provided for by Section 3100 of the labor Code,for the pcRore mea of Ne
work for which this permit is issued
❑1 ban and will maintain Workees Compensation Imurmm,as required by Sardine -
3700 of Ne labor Code,for the perforrourroj of the work for which this permit u issued,
My Works/�§_Cprn mmlon In ilea
Ca r3 nlcrnumber
l
CERTIFICATE E FROM ORKER '
COMPENSATION INSURANCE
(]
L/fI/
,
(Thu auction need not k completed Vthe permit is fmou hundred ridlaus(SIM)
rack)
1 certify Not in the performance of Ne work for which this permit is issued I shall not
employ any person in any manncru m to become subject o the Workers'Compcvauan
Laws of California.Data _
Applicant _. ..NOTICE TO APPLICANT:If.after making thU Ccnificam of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
.JO foMwiN comply with such provisions or this Permit shall bvok
e doomed reed.
Z' CONSTRUCTION LENDING AGENCY
't.w wNw I knmy olErm Net Vert is a construction lending agency for the performance of
LY? the work for which Nis permit is issued(Sec.3M.Civ.C.)
Q Lendcr's Name
=z Lculm's Address
U 0 I certify that 1 have read Nis application and slow Net the shove Infoonat un Is
gy F correct I agree to comply with all city and county ordinances and sure laws relating to
Q U building construction.and hereby auNadu repmsenmiM of this city to color upon the
W
JAPPNT
'oned progeny for importune purposes.
agree tores,indemnify and kap harnleu the City ofC.Nn,n.against
dgmcnu,cart and expcnaas which ma in any way accrue egaimtsaidCity
ee of the gnm'ngof th'spe i.
UNDER', N ILL C Y WITH ALL NON-POINT I sued by: -•Date
E T
e-roofs
ignewrc of ApplicanVContncor I Data
HAZARDOUS MATERIALS D',CLOSURE Type of Roof
Will the applicant or future Wilding occupant sore or handle hanrduus mawdal
as defused by ds Cupenlno Municipal Code.Cimino,9.13,and the Hcalu and Safety -
odc.S
don 25533(.)1 All roofs shall be inspected prior to any roofing material being installed.
as
Will Nc applicant or f erre building occupant sett equipment at devices which If a roof is ' stalled without first obtaining an inspection,I agree to remove
it Weerdous air rmmm'nan defined by the Bay Amo Air Quality Minagcmcnt all new t rials for inspection.
District?
❑Yes ❑ u
Iltlrwoad thehars U.m 505,255uiomcn334.lu CWpurh.95of the Califon
nim Hsu &Sa(cty Cadc.Satiom15505,25573 and]5531.1 undcrstvb thuiftk W'Iding
Jrcs n r$urently haw p moan,Nutty om omibility u nodly tk occupant eel Ne
myui' 'nUwhichmuu In
mum".CertificawofE)ccuan 2,W ign tureOfApplicant _� Date
owner NOriud a co Da - - All roof coverings to be Class 'B"or better -s-7
fi. Community Development
10300 Torre Avenue
t'' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
j UPERTINO
Building Department
JO Ap PERMIT
�RESS: #U /
S 2 .c.w Cas -t� 4 Dg--
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: yti _ J AX #
I am not using any subcontractors.'
Signature Date
Please check applicable subcontractors and complete the following information:
60 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 rn �ri S �ZU 1 h
Septic Tank
Sheet Metal
Sheet Rock
Tile
zre2 v
Owner Contractor Signature Date
Community Development Department
Building Division
1 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
� Fax: (408)777-3333
U PEI�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 Y4 "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: e/n Q��� c�ly
Job Site Address: / 5 t�o2 A lI�W
Roofing Company Name: ol�),kj oU//11 i ,1/
A plicant's Signature: 'el Date:-�y
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
' REROOF
CUPEPiNO PERMIT'APPLICATION FORM
•
APN# Date:
A6
r /
Building Address:
Owros Name: g4 Phone#:
#:
Contractor: Phone#: License#:
tact:, Phone#: Cup e no usiness License#:
Gut bks a6� -097 I
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles al Asphalt Shingles
zik 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.
NI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
eve off StAZ,S .17�)s a J s W -fir'� �c 11 u
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Co�� med-�tth-Plan if
ere are an restrictions:
Cost of Project: Type of ti Occupancy p:
l� 6 ��' /
ty,ifl
App�cale Fee ID Fee Description Fee Group
BPERMFEE Blq& Permit Fees BUILDING
BENERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
27k�7