06020131 (2) CITY OF CUPERTINOt.�
BUILDING DIVISION PERMITiC�NTRAcTOR INF®RMATION,R
BUILDING ADDRESS: KEVIN 6ULLIVALN ROOFING PERMIT NO.0602013
7647 ORANGE BLOSSOM DR
OWNER'S NAME: PERMIT ISSUE DATE
ANNA WONN 1696 VALLEY OAKS DR. 02/22/2006
NE: SANITARY NO. CONTROL NO.
(408) 842-1057
ARCHr1ECL(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONTRACTOR'S DECLARATION Ib Description
Y
u❑ 1 hereby affirmhat tI am llcemed OBSCTI unds novisioms of Chapmr 9(commencing p
E wish Section 7WM))of Division 3 ofthe Business and Professions Cod,,and my license is
n�a imm�mrceandefrceL REROOF--T/O SHAKE INSTALL SHINGLES,
;_ Liccnx Cl Lic14� 7/16" OSB + 30LB FELT + ASPHALT SHINGLES
nt-� Dale h Cantranor c.d C-r La.4M.,.Aa-
ARCHMICTSDECLARATION LIFETIME WARRANTY)
s< I.'
ndonsomd my plans shall x vred as public mo,ma,
Fi
po� Lxensedherebyaffir HALE®
S OWNER-BUILDER DECLARATION
E<I hereby.(Sect on 1 em exempt from dr Cssions r'e License Law for the
O O following moan.Permit
t 7113 LA Bulinus and professions Cale:Any city or county
m� which requires a issuance.also hs construct,the,altar,imprtrsu demolish.Permit
tnr arepair any swcmx
5ziiprior¢itsensedpurse require thevisiapposof for xchpmmiuoienseLaw statement � fUQU
Ex Oat he Sq.Ft. Floor Valuation
Yl-$ (commencing with Section]000)of Division 3ofOkBusinwand Professions Code)or $9000
e F3.- But he u exempt tWmfmm and the basis for Out alleged eumption.Any violation of
Section 7031.5 by airy applicant for a Permit subjects the applicant to a civil penalty of APN Number T
not..than five hundred dollars(550 C0). y yr
❑I,mo neofd.pmpe"y,mmyemployceswiNvngesastheirmlecompcnudon, flu 1LD11=
will do the work and thestruaum is not intended offered formle(Sce.704,t.Busimss
and Profcsdom Cod,:The Contractor's License law dors not apply m an owner of Required Inspections
Popery who builds orimprovu thereon,and who doessuch work himself or through his
Own cmploycu,pmvidcd Nm such improvements are,nothomoked oroffmol for sale.If.
however.the building or improvement is sold within one year of completion.the owner.
builder will have Or burden of proving that he did nut Wild or improve for purpose of
sale.).
❑h as Owner of the property,am exltnowly contracting with IicensW contractors.
concoct she project(Sec.7(1,14.Business and Professions Code:)The Contractor's Li
scree law docs not apply to an owner of property who Wilds or improves Orman,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractoes
License law.
❑I Om exempt under 5s.. .B&P C for Nis mason
ICAIW"
n Dau
WORKER'S COMPENSATION DECLARATION
I hereby alarm under Penalty of perjury one of she following declamtions:
I haw and will maintain a Certifier.of Co..,16 self-insure for WorkeekCompcn-
ch.as provided for by Section 3700 of the Labor Cada,for the perf...a.of the .
rk for wh' Nis permit is issued.
ve and will maintain Worker's Compensation Insurance,ar myuimd by Section
of the labor Code,for Ne performance of the work far which this permit is issued.
Worker's Cowm,cmation Insurance carrier and Policy number am:
rier: S7, r6-lo"n Policy No.: .S-Z ✓7-Qr
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This uctim need not becompuud if the permit is Imam,hundred dollars($100)
nr less.)
I emify Nat in the performance of the work for which this permit u issued,I shall not
employ any person in any manneran as to become subject to the Workers'Compensation
Laws of California.Da.
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
became subject to the Worker's Compensation provisions of Bre labor Code.you most
.,Z foodwitA comply with such Provfsiom or this permit shall be deemed revoked.
'EO CONSTRUCTION LENDING AGENCY
'Ta .N. 1 hereby affirm Nat mere is a construction lending agency for the arfor maim of
C' the work for which this permit .ysued(Sec.3041.Civ.C.)
IT]0 Lender's Name II
'D 2 Lender's Address
V 0 1 certify that 1 have mad Nis appli m.O and state mat the.Wvc information is
Y. F correct.l agree.comply with all city and county ordinances and state laws totaling to
O V building concoction,and hereby authorim mpreschlaives of Nis city to enter upon the
H ymstw-memioned pmpeny for impection purposes.
(We)agree to save,indemnify and keep harmless IW City of Cupertino against
In liabilities.judgments,costs and expenses which may in any way accrue against said City
UZ, in cmaol.r.,c Of the granting of this permit.
n--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCC R GULATIO
7 Zr+ � Re-roofs
Sngnmum of ApplicmUCommx r' Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Or applicant or few.Wilding..pan[atom or haMlc havamous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Ads&pdc,S....25532(.)? All roofs shall be inspected prior to any roofing material being installed.
Yon ON.
Will the applic.m or forum building Occupant use equipment or devices which If a roof is installed.without first obtaining an inspection,I agree to remove
Phil hovardous air contaminants u Jcfincd by the Bay Area Air Quality Management all new materials for inspection.
Diroie]
❑Yes ONO
I have marl the Waardous maurialsrequirements mokoCWpterti.95 of the Califor
nu Hcal"Safmy Cod,.Sections 25N)5,25533 and25534.IuMcrmvd Natirte Wilding .t e—
ur
docs not cmmly hast a.mint Nat it is my mspeoubdity m notify IW occupant of the /1' —� O
rcy 'mmenm which must bJe me merwiaatranee efacerdrn:a.nr«,tr an,y. Signature of Applicant Date
owne�ofiasl.gem 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
JOB ADDRESS: PERMIT #
OWNER'S NAME: � ! PHONE # Dov
GENERAL CONTRACTOR: gj*a f 6 ,S. 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
Tile
4,-57-- 2 cY
er/ ontractor afore Date
Community Development Department
3 Building Division
jrr
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO 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.
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: A.AJA bdt�u,✓
Job Site Address:
Roofing Company Name: -zvwQ` 196 tfc—
Applicant's Signature.zz/ // Date:4ewd(
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
armw
CITY OF CUPERTINO
REROOF D 002 /3
CUPEI�TINO PERMIT APPLICATION FORM
APN # 3 / / // Date: 2�
Ob U
Building Address:
Lc SJ
Owner's Name: Phone#:
wa 2a _foo
Contractor: Phone#: License#:
�,✓�- uu E� sll �a37r!—
Contact: hone#: Cupertino Business License#:
667-cJT
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ B ilt-Up roof
❑ Q�.s�phalt Shingles O,'Asphalt Shingles
SLo"Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu5ber of existing coverings_I ❑ 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:
J&Job Description:
vf-5!. KES 04zfu 7116`6_54-t 36 t�. 6CL7
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning ,D�Pt. if
there are any restrictions: u
Cost of Project: Type of Coon n: O cupanc group:
dtE t
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
I