06010032 (2) CITY OF CUPERTINO �",
BUILDING DIVISION PERMIT �CONTRACTOR�IN1•'ORMAT
ION
.;
BUILDINcnoDRFssa. CUPERTINO ROOF, INC PERMrrmD.06010032
7750 OROGRANDE PL
NER'S NAME.
OWPERMITI$l1E DATE
jlliMONICA PROCTOR 1052 KELLY DR. 01/06/2006
Iff NE: SANITARY NO. CONTROL NO.
(408) 973-9427
RCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
boo LICENSED CONTRACTORS DECLARATION O O O O
m 1 Worley affirm that I em liceaed under provisions of Chapter 9(commencing Job Description
a, with Section 7")of Division 3 of the Business and Professions Code,and my license is F5r
nc"e in full force and effect. REROOF--T O SHAKES, . INSTALL SHINGLESS D
D Ll_ License Class ` 3 5 Lie.0
5�/ 3
Daae cumramar cA. b .
44 ARCHITECTS DECLARATION
W I uWeriand my plansshallW Card as public rtcnrds
JAN /j
g�� Licensed Professionalin 4. 5(gOq
3 OWNER-BUILDER DECLARATION (l/ D
af 1 hereby affimr that I am exempt from the Contractor's Licence law for tae Pf7h'
00 following mason.(section 7031.5,Business and Profession Code:Any city m county p Fr'
5$ which mquira a permit to construct,alter,improve,demolish,or repair any structure tltltl -bt0
_Zy priorm i6 issuance,also ocipiRa the applicant for such permit to file a signed statement
< that he is licensedpursuanltotheproviionsoftheContractor'sl1¢nulAw(Chapter9 Sq. FC Floor Area ValuatiWh
yF.O (commencing with Section 7000)or Division 3 of the Business and Profession Code)or
y Net he u exempt therefrom and On becis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant On a civil penalty of
not more Nan five hundred dollars(3500). r Occupancy Type
❑I.an owner afthe property,or my employca with wages a their sale compensation.
will do the work,slid theswcmrt is Out intended or offered forsake(Sac.7014,Busirca
and Professional Code:The Commuchi Liana Law doer fret apply t0 an owar of Required Inspections
proprny who builds or improves dmrton,and who dons i och work himself or through his
Own employees,provided Nm such improvements art not intended croRered for ale.If.
however.Ne building or improvement is mid within one year of Completion,the owner.
builder will have the burden of proving that ere did not Wild or improve for purpose of
ale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
Construct On project(Sec.7004,Business and Profession Code:)The Conuacmr's Li-
nom law does not apply to an owner of propenywW Wilds or improves thereon,and
who contracts for such projects with a conuactora)licensed pursuant to the Contractor's
License taw.
I am exempt under Sec. ,B&P C for this mason
Owner Date
1371WWORKERS COMPENSATION DECLARATION .
I hereby aB'mn under pe pity of perjury ane or the following declarations:
1 haw and will maintain a Certificate of Consent to self-insure for WorkersCompen-
"
on,a provided for by section 3700 of the Labor Code.for the performance of the
rk for which this permit is iauW.
I ban and will maintain Worker's Compensation Insurance,u required by section
of Ne la W,Coda,fon tae performan.of the work fm which Nis permit is issued.
Worker's Compenation I(n^surance carrier and Policy number a e:rtier: 53'�'< TV'.I)_Policy
CERTIFICATE OF AEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(Thessel ion recd not W completed if the permit is For one hundred dollars(g10(1)
or lass.)
1 cenify that in the performance of the work for which this Permit is issued,1 shall not
employ any person in any mannerm as to became subject o On Workers'Compewtion
Laws of Caliromia.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Certificate Or Exemption,you should
Women subject be the Worker'Comp ruction previsions of Ne Labor Code,you must
.J z forthwith Comply with such provisions or this Permit shall be domed nrvokcd.
zCONSTRUCTION LENDING AGENCY
[-. I hereby aRnn that then is a c .Orn landing agemy for the Nrfurmence,of
!Y the wurk for which this permit is issued(Sec.3M,Civ.C.)
(>]Q
Lattices Name
=z Loci Address
U C) I Certify that I haze rad this application and sum that the slow infotmatiun is
Ig, P coven.I agree to comply with all city and county ordinances and sate laws relating to
pU building construction,and hereby authorize MPmsenediws Or this city to enter upon lW
aWvc.mentioned Property,for inspection purposes n
(We)agree t0 saw,Indemnify and keep harmless the City Of Cupertino against
.Fih liab0ne`sZ, ccoftheudgments,cosuand expenses which may in any way accrue against mid City
U z anxe.AW NDER 'TANDSng of this permit. _ Issued by Date
AP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOU EGULATIO S. /`/J_
Re-roofs
Srgwum ofApphc Due
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanutore or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.I2,and the Health and Safety
ale.Section zss32(a)7
❑Yes NO
All roofs shall be inspected prior to any roofing material being installed.
^
Will the applicant or future Wilding Occupant use equipment or dcvicex which If a roof is installed without firs[obtaining an inspection,I agree to remove
it haramnua air cenaminanu as defined by the Bay Arca Air Quality Managcmcnt all new materials for inspection.
utrier7
C]Yes
I have read the hvardnusmaariis regvirtmenu under Chapter h.YSofthe Calif.,- —�
Dno
&safetymans 35X)5.15533 3and 25534.1 understand Nu if the building
anotly haw a tenant,Nal Itis my martin ility m nobly the neops,of the which muµWmetprior lar iauamm araccmWateo ac Sig—nature of Applicant Date
ownerarantWnnedagenl D„e All roof coverings to be Class"B” or better
Community Development Department
n Building Division
Q) City of Cupertino
,- 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTIN®
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.
M Homeowner's Name: I ' 1 (3V-) 1 C 0,__ 1 ta?0C+y(Z—
Job Site Address: C, C) -J,�, P 1
Roofing Company Na C- J e 2+ )
Applicant's Signature: 1 61--e Date:_J___6
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 36 20, o -2- Date: 1 - L- 06 L" O6
Building Address:
Owner's Name: Phone#: •2Sz_ SSG�o
V1'1pv.
Contractor: Phone#: License#:
cvPee + t
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles F, Asphalt Shingles
--O 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: —�
Job Description: t t
+<Co- 0-1- x' I,ct4 s I t. S t I I I2 e ny"s 0\it s e R?
Residential- Commercial ❑
Fire Zone: Yes ❑ No rl Confirmed with Planning,De t. if
there are any restrictions: Ey
Cost of Project: Type of Construction: Occupancy group:
ov 12.E e��
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
ZG
70 . S-
„T Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
. jUPEPTINO
Bu.ilding Department
JOB ADDRESS: PERMIT #
O G`^b tpL 0 601,Od 3 2
OWNER'S NAME: Mdr,, i c 5 ✓l2oc- PHONE #
GENERAL CONTRACTOR: C ) G ► ,. FAX # r
I am not using any subcontractors: e_Q
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 C lJ eee-�i
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date