03100218 (2) CITY OF CUPERTINO a ,nk /� ' ' 'T'*,r
BUILDING DIVISION PERMIT OL\ 1\t�CT0R*FOO {viATIQN f
6UILDING ADDRESS: DONE RIGHT INC PERMIT Nt3p 3100
2 19—
' 10710 ORLINE CT
OWNER'S NAME: 1129 LONG FELLOW AVE PERMIT ISSUE DATE
MICHAEL & JUDY O ' BRIEN 10/31/2003
NE (408) 377-8777 SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� E! (�
100 LICENSED CONTRACTOR'S DECLARATION
� ❑ 1 artery affirm Net I am licensed under provisions of Chapter 9(commencing Job Description
Z W with Scction7IXk))uf Division 9'of doso�arsan ProfessionsC de.and mylicamicis REROOF
?O<O y in mB fo,eea,,a�«act. -^ r, r6rc.«`'J" b2.
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q2 ARCHITECTS LARATION
�WU l understand my plans shall arus apublic records
C� Licensed Pmfcssiunal
g OWNER-BUILDER DECLARATION
N I hereby affirm Nal 1 am exempt from Nc Contractor's License Low for the
O O following mason.(Section 7031.5,Business and Professions Code:Any city m county
m which rtyuircs a peril to construct,ellen improve,demolish,or repair any structure $23800
to-zto poor its issuance,also requires the applicant for such permit to file a signed Statement
csp that he islitensedpursuant otheprevisionsoftheContracmr'sLicecoLaw(Chapter9 Sq. Ft. Floor Area Valuation
al- (commencing wi th Section 7")of Division 3 of the Business and Professions Code)or
Nat he is exempt Ncmfrom and the basis for the.alleged exemption.Any violation of 35922059 . 00
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of enc ApN Number Occupancy
not more than five hundred dollars($500). p y Type
❑I,as owner of the property,or my employees with wages as Neirscle compensation,
will do Nc work,and the swctote is not intended or offered for sale(Sec.7094,Business
and Professions Code,The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon.and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
Waldo,however,the building at improvement is holt within one year of completion,the owner,
r,th M1aw the burden of proving that ar did not build or improve for theNums.own of
r,
aicJ.
❑I,as owner of the property,am exclusively compacting with licensed contractors to
come La the es not (Sec,o in Business and ray who ons Code:)The Contractor's Std
come Law does not apply to an owner of properly who builds or improve Nemon,and
who contracts for such projects with o contraetor(s)licensed pursuanuo Ne Contractor's License L.Lew.
CDI
❑ am exempt under sec. ,B&PCfor this
Owner Date
WORKER'S COMPENSATION DECLARATION
Ihereby of ore under penalty of perjury one of the following declarations:
'l have and will mai main a Certificate of Consent to self-insure for Worker's
so
.provided for by Secdmn 3700 of Ne Labor Code,far the puff.mr,.rue of the
work for which this peril is tossed.
❑I have and will maintain Worker's Compensation Insurance,as acquired by Section
37W of the Labor Code,for the performance of the work for which this peril is issued
My Worker's Compensation Insurancecarrierand Policy num bar ate:
Ca ''y� �.�-�,1 !kl If! Polity No.: 1
✓V^'�C RTIFICATE OF RMP IGN OR,
COMPENSATION INSURANCE
(This seclinn need not be completed if the Permit is forma,hundred dollars(51011)
or less.)
1 certify that in be performance of the work for which this permit is Issued,I shall not
employ any person in any mannerm as in become subject to the Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificale of Exemption,you should
become subject to the Worker a Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall ar deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
I hereby affirm Nat Nero is a construction lending agency for the performance of
Ys > Nc work for which this permit is issued(Sec.3017,CIO,C.)
Q Lenders Name
z Lender's Address
;)Q 1 certify that I have rad this application and sum that the above information is -
y (✓ correct.1 agree to comply with all city and county ordinances and state laws relating to
V building consuuction,and hereby amthoriaempmeteraposts Of Nis city to color upon the
aabove-mentioned prortary
costs
for inspection
es purpwhich may
ti (We)agme to save,indemnify and keep harmless the City of Cap, against
h Iiaconsequence of nts.
granting
of this eawMch may in any way accmc against and City R
)7 A consequence of UNDERSTANDS
of this permit. V
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
,�yw JAN ZT(0131)0 Re-roofs
Signature of Applica VComnctor _
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hoe andous material
es defined by the Cupentno Mandrel Code,Chapter 9.12,and the Health and Safety
dc,Section 25532(a)7 All roofs shall be inspected prior to an roofing material being❑Yea p p Y g g installed.
Will;he applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hovardous vis contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
trim? /
❑Yea ep6
Ihave&Satmad I theh,&Nb.,mus ma305.25533ls requirements r ithaifNc Califon IO I
doesn lthffi Safety Colic,arrant, anti 2mymod25534.1 understand Nat ilNcbuor00 ( --I)WAA/lA "—
Jmcs not currently arvc a tenant.Net it is my rcsponsihility m nntlfy lar anoy. of Nc l.1 .//l
yuircmcnts which must mel pnor les issuance of a CeniOca mf Oe,upaug Signature of Applicant Date
o
Owner or authmrircJ agent All roof coverings to be Class "B" or better
re
Community Development Department
Building Division
1 City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
UPEkTINO 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: m)c h g d if TLi L` O` Lan
Job Site Address: o -P �C`0' _kz 1
Roofing Company Name: ��'"i,ah
A plica" Signature: 'ANV' M ,Cy � Date:& �l I Q�
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
i
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 ) 2_ , Date: 3 0 j.
Building Address:
\O
j
Owner's Name: Phone#-2Z` —C)-7 2
6 —
Contractor: Phone#: _ License'7L]/,�) '
Done EibhVax) C-�!�e7 `I
Contact: Phone#: Cupertino Business License#:
i
Type of Roof Covering:
Existing: Proposed:
9
❑ Buil[-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) S)Y-.I ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs. j
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: I
Job Description: Z2.cgl- qC F <4�cz fwF \A V1 uaI 3o VA (2l }-
L A( \�
Residential Commercial ❑
Fire Zone: Yes ❑ N Confirmed with Planning Det. if
there are anric' s:1 LJ
Cost of Pr 'ect: T of Construction: Occupancy gr
O •oo `05
M
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ApIP4bjb 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
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