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05040046 (2)
CITY OFCUPERTINO17 BUILDING DIVISION PERMIT X0TAXOTOWIlvk'17R�1IATION n BUILDING ADDRESS: CONRAD ROOFING SERVICE PERMIT1,1105040046 OWNER'S NAME: PERMIT ISSUB DATE Ali ONE: SANITARY O. C OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO PLUMB MECH Q Q �00 LICENSED CONTRACTOR'S DECLARATION Job S I 1 herebyaffirm that 1 am licensed under previsions of Chapter 9(commencing with Section 1").f DIAsim 3af the Business and Profenmv Code,and MY license k .'>i IiLICnfullmmdeDttLC-j9 Lp,g llf S7� REROOF W/ SHINGLES y//6-_ m$- DateCl` Cadmium, 2005 3S ARCHITECTS DECLARATION a`'�'�—v I understand my plans slWl be used n public recnrdt u I p ®' �I L ted Licensed Professional OWNER-ea n.DBR DECLARATION E n I I hareht alarm that 11. exempt from Ne ConuaclCo License Law for the i p O following meson.(Scion 7tonsu Business sed Improve. de tudi Code:My city m corny $�i priori requires;a permit ra cnnstrvn,alter,improve,demnhab,fi mash any structure z y prim in its i licensed p also mqulro tine inions offosaoh permit m film signed statcmrnt -< IhathalalkgwithSntion7 the pmviclovnfNeCanuxtor'anProfesw(CNpmr9 Sq.Ft.Floor Area Valuation gg $ (nom a Is exempt pt ti Section and the Division r the al eged cos and l on.My Code)ud,W or Of 10 — Nai he u exempt Uterefrom end tha bate for Ne Waged",•mptim.My NouUm of Seim 7071.5 by uty applicant for a permit Subjects the applicant to a Civil penalty of 3 6410 0 Occupancy Type not mem Dun five hundred dollars(SSW} 0 I,as owner of the property,or my employee with wages as Noir sok tompewuon. will do the mark,and the mucom Isnot intended or offered fertile(Sec.70e,Boainess and Professions Code:The Containers Licetue Law does ret apply m an owner or Required Inspections property who builds ser improver thereon,and who does such work hima If or through his awn employees,provided that Such imptervemenu are not Intended orortermd for We.IL however,the building or Improvement issmld within rete year of completion,the owner. builder will ban W burden of pmving that he did not build or improve for purpose of ala.). 0 1.is owner of the property.am exclusively contesting with licensed mntrommn to conatmet din pmjm(Sec.70m,Business and Prefeuiens Code:)The Cor uaemYs Li. cove Law does not apply in an owner of property who builds or improve Nemon,and, who contracts for ouch prejeets with a conuantor(s)licensed punusm or Ile Contractors Licence Law. 0 laommmplunder See ,BAPCfosthianaon Owner Data WORKER'S COMPENSATION DECLARATION I hembY alrimt under peoslty of perjury am of Ne following declmashav: than and will maintain a CeNOesu a(Consnua sel6inaum for Worker's Company. as provided for by Setim 37W of um Labor Code,for she performanm of the wads for which this permit Is Wood. M-flurve and will maintain Worker's Compensation Wurance,as required by Section 37W of the Labor Code,for the performance of the weds for which this permit is latent My Workers Compeor5i,Ion1Cartier and Policy number are: Cartier: f�i I'T++� PoIic Nm.:Ui 0*0112T —Cf CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sctrim need not becompleted If tee permit is form hundmddoRa s(SIM) or Ica.) I certify Ebel in the performance of the work for which this Permit Is Issued,I shall not employ any person In my manner an as In become abject to the Workars'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT'If.after malting this Certificate of Exemplion.you should become subje t in the Worwri Compensation provisions of the Labor Code,you most 0 Q forthwith comply with such provisions m this permit shall bw e deemed rekcd. ,Z,MCONSIEUCTION LENDING AGENCY [—r (hereby allirm that them is a construction lending agency for da:performance of ai the work fur which this permit is Issued(Sec.3097,Civ.C.) aLenders Nemo 0 z Lenders AJd. U0 I certify Net I hew mad this application aha some that the thew Infomnllun Is U.F comm I More in comply with all city and county ordinances and ante lawn relating Ice 0 V building construction.¢dhereby authorise representatives or this city to enter upan the [17 above-mentioned property for Impassion purpoaa. (We)agree to an.indemnify and seep harmless the City of Cupertino against y Ilabllitie,judgmenu,cord and expenses which may in my way acme against aid City C)^v in conuence of the APPLICANT UNDERSTANDS Aof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG NS./ `�� g-g—or Re-roofs Signmum of Applien✓Canuanor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mmupmtmom orhandle haallous material as dented by the Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety Code,SttYet 35333(¢)7 __/ All roofs shall be inspected prior to any roofing material being installed. ❑Yer (y Nu Will dm applicant or furore building ottupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove It haysmous air conuminanu as defined by the Bay Area Air Quality Mwgemem all new materials for inspection. i.incl7 --// Dyes GKO Ihavemad thehvudmsmaterial25333 amenu under Chapter that drive Wilding nit HcdN A Safely Code,Sections 73505,15573 anti 23330.1 understood sive Kdte Wilding does not cu-Oil haw a tenant,that It u MY MPmulbllity m mmIY the meuPant of the requimme rim xmetpdarmiananmoracedsnr,mofamtpmry. Signature of Applicant Date y-8_L,r Ownmur authodrndegcnl Dom All roof coverings to be Class"Bra or better Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEkTINO Building De artment JOBADDRESS: 15'30 Wof� PERMIT # 0s0v)oa Y OWNER'S NAME: rt Ycx 60 � PHONE # 5 %- 71 8 L 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 Tile i. Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U PEI�TI NO 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 Temoval of all riew material down to the sfieathing, - 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: . 040I.A91Iu.r E� Job Site Address: 1930 �CiMco k I J qy Roofing Company Name: , ^w a ✓1 EdLa S-c>cy� �. Applicant's Signature: / L/ L.. Date: • Greg Casteel Building Official . Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF Tb .CUPERj'TIN0 PERMIT APPLICATION FORM APN# 3 6( I S b l Date: _ ,Building Address: S 10 Pr IM co S-� LJ Owner's Name: Phone#: 996- 7/ f9Z Contractor:- - Phone#: )_9 4-761 S. License#: co Contact: Phone#: Cupertino Business License#: 41 L C�ac�,I..q,,. ZSo-1.941, Type of Roof Covering: Existing: - Proposed: ❑ - Built-Up Roof - . ... _- _ ❑ Built-Up roof ❑ Asphalt Shingles fides Asphalt Shingles Wb Wood Shakes ❑ Wood Shakes t'Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings Z ❑ Provide I.C.B.O.Report# 9"'To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy: L�]' Job Description: T< rr- QEF i ,k.s +--�,M, t ?//L" oft3 Jk,,tk-t r JoK A- 6-n r- G-cw.a �+r Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ - ._ . Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project- 3 Z©� Type of Construction: Occupancy group: _ Qty. if - Applicable Fee ID ' Fee Descri tion 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