04070039 (2) CITY OF CUPERTINO MIe�nry'N ('� ky�a,N 'yi '
BUILDING DIVISION PERT �L�,'# `0T,0R_j_N •,,0RMATir?�IVLM,
BUILDINGADDRESS: KIMBERLY PAGE PERMITN004070039
/ OWNER'S NAME: PERMIT LSEUE DATE
ONE:KIMBERLY SANTfARY O. QCO. NO.
lV/
ARCHrMCrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_op
LICENSED COMAC]OR'SDECLARATION JobDescrip[i
m I hereby affirm Net I am licensed under provisions of Chapter 9(commencing
< with Section]IXgl)of Division 7 elite Business and Professions Code,and my license if HNALED
<� Lfall
neClassdercemt. REROOF W/PLY. SHEET & SHINGLES
5 Z
License Clea Le.N JAN �Y
?yq�- Dam-Ccouractor ARCHITECTS DECLARATION JAN L 2005
I..&.tend my piens.hell he used.public records
0�
o Licenser ro[hereby affirm
BUILDING
y OWNER-BUILDER DECLARATION
I hereby affirm that 11. exempt from dee Comanah LiAny c Lew for my
p 0 which following roes a permit
to 1DLS.Business and Proimprove.
de um Code:Any tiny or tautly
which Reyuirta•permit re cnvwcl,ellen improve,h Permit 1 file
Repair any atucwrt
prior m,licensed i p ase n to r c Ne applicant for such permit m.a signed Chlemem
thatWiecpSection 00e of Diviouaf the Co nuacmhLaomlaw(Chepter9 Sq.Ft.Floor Area Vanua ton
cR (ca,as st ngwith5erelon and th Division J afdWamivssand
...My NCeM)of
_ Net be u eampt thertfum end the hoes far the alleged emmption.My violation of
Section]071.5 by my applicant for a prem t,subjects the applicant to e civil penalty of 3 5AI I419120;lo 0 Occupancy Type
oar mom then five hundred dalWs(S300).
❑I,uawnerof Ne property,army employees wide wages as de4ulecompenudon,
will do the work-end theawcnure isnot intended oraResed for sale(Sec.7044.Business
and P ofemiov Cade:The Conuactars License Law does not apply to an Mass of Required Inspections
Property who bulldsorimprovestherton,and whodassu bs wmkhimelf orthrough his
MR employees,provided that such improvements ate not Intended oroResed formic.If.
however,the building or improvement is sold within one year of completion.the owner.
builder will have dee human of proving that he did not build a Improve for purpose of
al.j.
❑1,as owner of the property,em mclmively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractor's I.I.
cone law does not apply a an owner of property who Wilds or improves thereon.cad,
who contracts for such prejacts with a contractor(s)licensed poaam a the Conuacur's
L'enm law,
I am exempt under Sec. .B&P C for this semen
caner - w .
ORIt 'S cOFMIIO i DECLARATJONI hembYaffirmd<rpercyoro of the following dalantiov:
1 Wve end will mento•CeNOcate of Covent a self-esum for Workee.Compen-
cation,u provided for by Seetion 7700 of the labor Cade,for the Performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
7700 of the labor Care,for the perfarmm.of ds,work far which this permit is issued
My Workers Compensation Insurance carrier and Policy number aRe:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CThis sec0on need notbecompleted true:Permit isforane hundred dollars(SIM)
or less.)
1 certify that in a per mmance of the work for which this permit Is intend,l shell not
employ anypc nin ny n�AADcrfRa to hloomc subjenmthe Worl rs'C m ansatlan�
Laws of Calif 'a etc
ApPlicam
NOTICETO PPI, NT If, cr eking this Certificate of Exemption,you should
become auhjen m m Worker's Compensation provisions of the labor Coda,you must
.,O foMwith comply with such provisions of this permit shell be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[--i I thereby eR tat Net Vert I..construcim.3M.ding agency far the pefornanaof
r
CL the work for which this permit is toad(Sec.709'i,Civ.C.)
W�Q Landers Name
=z larder's Add.
V 0 I certify that I have Read tris application and mss Na the above information is
F-' comma I agree to comply with all city and county testimonies and stale lewd rotating to
0 U building construction,and hereby auNoria Representatives of this city at enter upon the
4L1 aWvcrnentioned property for inspeNon purposes
gy (Wc)agree to rove,indemnify and kap harmless the City of Cupertino against r
fq liabilities,judgments.caro and expcvca which may in my way acme against said City
V z in consequence of thegaming of this pe
�-^ APPLICANT UNDERSTANDS AND\)ILL hl WITH ALL NON-POINT Issued by: Dat
SOURCE REGULA Ns. _
Re-roofs
Signature of Applican nuuc t, am
H ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store orhandle Ismamous material
m denned by the Cupertino Municipal Code.Chapter 9.12,and Ole Health and Safety
cwe,sayonzssJz(.n ✓✓( All roofs shall be inspected prior to any roofing materia being installed.
❑Ya �Nu
Will the applicant orf hum building occupant use equipment or devices which If a roof is installed witho r twining an inspectio ,I agree to remove
mit hareomm.I,c mmainants u retired by the Bay Am.Air Quality Management all new IIfor inspe 'On.
District? a,(��
❑Yes //v\^'`
Ihevereadthelsis mormis viremcnu rChap¢r6.95ofthc Cslifon
me Health&safctyCodc,Satiwu25505. d25 bersamd thRifthc Wilrin8
Jars non curtendY hest a tenant that in' my 'ity atify Ihm occupand of use
req 'rementswhic musbema bent u f assn anry, ignature Apphcan Date
owar ar antharirad. t Dam 4 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
�UPEkTINO
Building Department,,-q o 7c> o3
JOB ADD PERMIT#
OWNER'S N�M- PHONE #
GENERAL CONTRA O 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
er/C4 c or Signature ate
Community Development Department
/ Building Division
J j City of
Cd
no
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
4UPEkTINO
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. i' e
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: t tq- )11c� 4P_
Job Site Address: Vf05 (/6ZA-f-Ie,,E
Roofing Company Name: 2c ca r� VK dc�
A "cant's Si�g�nature: Date:
\�t/QSIND�XI
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Community Development ..
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
11UPERTINO
Building De artment
JOB A KESS: ,_ l o l l F`sS v p e_ PERMIT# 0+0,}0000 Q,}O0
OWNER'S 1 A-J I �gKNE # 5-10-57.0 -3900
GENERALCONTRACTOR: 9� AX #
I am not using any subcontractors.✓�j ✓`1 —�
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 T11,C r- 5-%r FA aFP
Septic Tank
Sheet Metal
Sheet Rock
Tile
--z�
/Contractor Signature Date
CITY OF CUPERTINO C
REROOF /
CUPERFINO PERMIT APPLICATION FORM
APN# D
ate.
3,s7 ! � -
Building Address:
U-a
Owner's Name: Phone#:
K�tacz4Y � 407- 77-7 - �
Contractor. R Phone#: c License#:
Contact: oow� Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )K Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
K 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:
-Cvuev W.0
Residential ❑ Comm cial ❑ j ski 'i v,Z/iec
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projects ow Type of Construction: Occupancy group:
t ,
QtY•
A ale Fee ID Fee Description Fee Group
Ly 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