04080121 (2) CITY OF CUPERTINO "
BUILDING DIVISION PERMIT .CONTRACTOR TNFO'RM , 40th u
BUILDING ADDRESS: PERMIT NO.
ROOFCO OF SILICON VALLEY 04080121
PERMITISSUBDATE
OWNER'S NAME:
SANITARY N . 0 OL NO.
NE:
BUILDING PERMITINFO
ARCHITECDENGINEER: BLDG ELECT PLUMB MECH
O
LOO
LICENSED that I CONnsed under amy oro or amp IDS f� tL E D
I Imrtby affirm that 1 am 1lcensed under S DEC es DECLARATION
cr Y(commencing
with Section 78813)of Division 3 of the Buss•...am Pro bre Code,andm license is
imfalllemeaadaffact. 3 3,64 `7REROOF W/BUILD UP
nq_b n.mn.e cl :. �� c manor
? � ARCHTIECTS DECLA IDN AUG 43 2004
I understand my plans shall W used as public mcnrds
i s F� Licensed Pmfessional BUILDING
3 OWNER-BUILDER DECLARATION
MI 1 hemby aluam m Net I exempt from do, w
c Cmncmrs License Law for the
K a O following moron.(Section 7031.5.Business and Pmfesdons Code:Any city of county
.�a wM1ich rtyobas a Permit a)rameyueL altar,impmw.demolish,in repair any structure
Fly
Pon rWitsisauanec,alsumquimitheepplicamforsuchpermivaRlcasignedsutement Ft.Floor Area Valuan n
F < mahcisliecnaedpursuunUotheprovislons of the Contractors License Lew(Chattel9 Sq•
e(zC$ (commencing with Section 7800)of Division 3 of the Business and Pmfesalnns Code)or
that he is emmpt therefrom and the busts for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of 3"S. 00f 0 0 Occupancy Type
net mom than Ow hundred dollars(550%
I,a owner of dm pmpony,or my employees with wages as their sole compensation,
willdothework.and Nestructute is not intended oroffertd for sale(Sm.7044.Business Reections uired Ins ections
and Pmrm fessioCode:The Cmdo c nes License law data rmt apply he an owner of 9 P
property who builds or impmsms therton,and who does such work himself or through his
ownemployecs,provided that such impmwments am not intended or offered for sale.If.
Wmvea the Wilding or impm nment is cold within arc year of compleaen,me owner-
builder will haw:the burden of proving that he did not Wild or improve for purpose of
sale 1
❑1,as owner of the property,am exclusively contracting with licensed conhacWrs to
construct Ne pmjem(Sec.70x4.Business end Professions Code:)The Contractor's Li
cents Law dont oat apply m an owner of propeny who builds or improves thereon,and
who convects for such pmjem with a contractor(s)licensed pursuant to the Con"con S
Lie".Law.
1 am exempt under Sec .B&P C for this reason
Owner Data
WORKERS COMPENSATION OECLARATION
1 hemby off no
under penalty of perjury one of the following declaatiom:
1 haw end will maintain a Cartiaceta of Consent to wit--insurt for Worker's Compcn.
Cation,as provided for by Section 37M of the Labor Code,for the performance of the
work for which Nis permit u issued.
1 Mw and will maintain Worker's Compensation Insurance,as required by Section
7] of lW Inbar Code,far Ne K rermaocc of the work forwhich Nis permit is issued.
CuWerkcr'sC,`om cmationl v4nce nicrandPolicynu/ (d�-Z?
Cartier: Policy No.:
CER IFIGTE OF E%EMMON FROM WORKERS'
COMPENSATION INSURANCE
(Tho section need norm completed if the permit Is foram hundred unit=(SIM)
toss.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner sou he become subject to him Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,aria,making Nit Campeau:or Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code•you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
ZN CONSTRUCTION LENDING AGENCY
[r l hemhyal0rm in.,there is a construction lonaingagomy Ter the performance of
a
the work fur which Nu permit is issued(Sec.3097,Civ.C.)
W~n. Lender's Name -
a,z Lender's Address
V 0 I cenify Net I hew mad Nis application and sum Nat me above information is
D[,F' correct 1 agree to comply with all city and county ordinances and amu laws totaling to
0 V building construction,and hereby authom,repreacnutiwa of Nis city in on=upon the
LTa above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino agairut
ylholides,judgments.super and expenses which may in any way acme against said City /
U in consequence of the granting of this permit. (/
^' APPLICANT UND STANDS AND WILL COMPLY WITH LL NO -POINT Issued by:S Date
5 RCE AT Ng. l
_ _ Re-roofs
gnu re ofAppli HAZARDOUSMATERIALSDISCLOSURE tor Ocu Type of Roof
Will Ne applicant or future building occupanutom m handle hawadous material
u de0ned by the Cupenim Municipal Code.Chapter 9.12,and i m Health dna Safety
cede,seatiom zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will Nc applicant or(mum building accupem taco equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanrdnus sir contaminants a defined by the Bay Area Air Qualily Management all new materials for inspection.
Disvic,7
Dyes
I have mail the bvanious materials myuimments under contact 6.95 of do Califon
his Heelde&Safety Cock,Sections]5505.35533 and 25534.1 undentand met if one,Wilding 8 ! a(
docs n enll w a comm Nat it is my m Wmibility W nodly the scout t of the V
m mmcnts h h u re pocautissuaaceafaCcnifaa f ccupanc Si nil re of Applicant Date
Owner the r agent Daac All roof coverings to be Class "B" or better
Community Development
s 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
11UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
BRZD Yn�v 1�'° oVe O ! 2
OWNER'S NAME: G' a PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
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
me
s.
Owner Contractor Signature Date
r,
a Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
SCUPEkTINO 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.
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: y�p C
Job Site Address: 16:90C)'
Roofing Company Name: ���' �Coi CJS
Apllcant's Signature: e--Date- "
Greg teel
Building Official
Revised 1/30/03
-" Printed on Recycled Paper
-; CITY OF CUPERTINO
REROOF 6
INCITY O
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
g/3— o/
Building Address:
lsx20 q' G
Owner's Name: Ph,ne#:
C-/&,-7e .5��� Slc�� e 253
Contrac r Phone#: License#: Q
Con Phone #: Cupertino Business License#:
l -1 - y23Z 2Z� y
Type of Roof Covering:
ExiProposed:
MBult-Up Roof guilt-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other(Specify)
Nu o existing coverings ❑ Provide LC.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:
�c �2 6u
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑-- Confirmed with Planning Do t. if
there are any restrictions: LI
C st of Project: TvDe of COtruction: Occupancy group:
Qt
A lica le 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