05090049 (2) CITY OF CUPERTINO
BUILDING DIVISION pC+ItIyII'rCUN=TRACTORINFORMA�ION
BUILDING ADDRESS: LOS GATOS ROOFING PERMIT NO 05090049
91 7 PPQ17TT)P.M( R CT
OWNER'S NAME: PERMRISEUEDATE
SCOTT KAO 09/08/2005
HE: SANITARY NO. CONTROL NO.
408) 298-9399
ARCHITECTIENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MneZ 0 0 0 0
siOp LICENSED CONTRACTOR'S DECLARATION JobDescri tion
i� 1 WmbY ser@m that 1 am licensed under provisions of Chapter 9(commencing P
wj ith Sao .111".
Softhc Businw end Pro(cssionsCode,and my Rcensel k{ ti� II ICes
LEE Licenseittin° L nmmroo o REROOF-T/O SHAKEYbI�NS��L 1P�.R�D. SHINGLES
if
�e C,IARCHTIECI'4 DECLARATION
y 1 unMsstand my pluu,Mll W used ss public records C
it E IJ S--P /`9 2005
tad Licensed Poefcssinnal
OWNER-BUILDER DECLARATION
EMq I nwhy.(Item that I I.S..Bump from the Cssions o License law for 1W nuc rs
a.C a following mum.(Section]fon construct,
t,Business and Professions Code:My cm or acture
+,Z r which requires a Creme m Uirelrme ,Icor,improve,h permit
er iit I m e s sig ed tummm ��(J 7,f a r+"TI $6274
s,I0 Om he
sl issumc0.el,um Le IN tbo voters nt ofOn fer such men's Limome Law(Chapter
—
NommenccewithSewion70 70M)of
3ofthe Common's ndPnclaw(,Code)9 Sq. Ft. Floor Area Valuation
zC� (commencing withSectionndth basis for
the
theBusinessexe,MPmfAny vi Code)or
Net he b esempt therefrom and the barb far Ne,Ileged exemption.Any Woledan of
Section 7031.5 by Any applicant far A permit subjects the applicant to a civil penally of Occupancy Type
net more On five hundred dollars(SSW).
❑I,uewnerof hepmpeny,mmyemployces with wAgesude:irmlecompenutlon,
midProfessions he Code:rk,And The Con ewtor's Lhomm Lowume is not intended dodoor ml appppiy man''Berme;ni •Required Inspections
property who Wilds on fmprom thuronand whodou,uch workbinuedforthuough his
own employers,provided dutsuh improvements w notin¢nded mortared forsam.if.
however.the building or Improvement I mid within one yew of completion.the owner
builder will have me Wrden of proving that ho did not Wild or Improve for purpose of
saim
❑1,As owner of the property am exclusively contracting with licensed contnetors no
construct the pmjca(Sec.7044.Business and Profession Code:)The Contncmra Li-
eene law doe,not apply m an ownu of property who Will or improves Naxen,and
who contracts for such projects with a cmuactm(s)licensed puramnt m the Commuters
License law.
❑lamexemptunder See ,B&PCforthismamn
Owner Dam -
WORKER'S COMPENSATION DECLARATION
I hereby afRrm under penalty of perjury ore of the following dulare0mu:
1 haw and will maintain aCemficem of Covent mself-imum fm Worker,Compen-
smen,u pmvdW for by Scenes 3700 of the labor Code.for we performance of the
work for which this permit is issued
❑1 haw and will maintain Workers Compensation Insurance,as required by Section
J]Op of the Labor Code,for dm performwrce of the work fm issue
which this permit Is d.
Mywmkers ore ens irmhmran cerrierand Policynumbcrare:
CaMee Yl Policy
q
Ne.:`l 1- SOS
CERTIFIC ^OFEKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need net W completed Htiw permit Ifmon hundred dollars(5100)
or tut)
1 unify that in dW performance of the work for which this permit is issued,I Ntll net
employ any person in my manner m As In become Abject to the Warken'Compenudon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:IL after making this CeniRcam of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Cade,you mum
.JO foMwi 0 comply with such prevision or this permit shill be deemed rooked.
,Z.t.~y. CONSTRUCTION LENDING AGENCY
I.w thereby efron this them I..on.a.tendo,agency for ft ormm.of
C> the work for whim coda permit I Wood(Sec 309f,Civ,C.)
W�p Landow Name ,
a z Lender,Address
L)Q 1 certify Nat I have read this Application and slow that the above information I
correct.I agree in comply with all city and county ordinances and scow lam relating to
Q building construction,and hereby authorise mpmmurroves of 04 city he enwr upon 0m
W above-mentiomd propeny for inspection purgvet
Ly,rY (We)agree on save.indemnify and trop humbouts dw City of Cupenirm against
r.�rag IIb11I0ts,jos enu.emu mdexpnuq whwh may in my myacmue against®id Cmy
t) Incoruequ a f DERST in DSthis(r WILL
y
APPLIC {1 OERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b Date '
SOURC 1'a/'fg ATIONS, l r�
Re-roofs 0acJ
Signuum of ApplicmmConRDew
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Willftapplicantor forme buildingottupmtmore seracmehaurdau,mawrim
As deRned i dw Cupanin miripsl Cade.Chapter 9.17,and the Health and Safety
Into
de.3cenon 2ds3x(a)7 All roofs shall be inspected nor to an roofing material beim Installed.
❑Yn Na P P � Y g g
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contsminam u defined by the Bay Area Air Quality Management all new materials for inspection.
mlel]
❑Yes �No
I he.hed the hwadnu muerlals requirements underChapmr6.95 of the CAIIror-
Health&Szfesy Codc.Srodtamx5505.xl5J3 aW15534,l unwonted thwirdw Wilding
es note tly ham a mnmt.Nat II I my responsmillly m notify dw omupmt of the
nimI 'ch mutWmet pierce issuance oracanincamoroccupmcy, Signature Of Applicant Date
Owner or Authorized agent Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS } Pin PC*wl�nct, C:t PERMIT #
5 b S"O�f00 4
OWNER'S NAME: PHONE # U v - -3q q
GENERAL CONTRACTOR Ls OA4- 11 FAX # Yoe
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
EA 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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OCUPEkTINO 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: >_�/ Q G
-- -- ------ -----job Sit e-Address: - -- ----_._!_.�.//'/------ // V__L.a�en C_P_--_._,VT___.�__�.. _.. _. __ . . . ..
Roofing Company Name: !(!S L�7�Gl�'� o S c �q
AA12 plicant's Signature: /1/// /GfXiDY Date: 2 q/U�
\ 6U11D�X1
GregA t .A/Peel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY_ OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 356- 11 –
$6_ 1 / O s3 Date:
Building Address:
l ro vl CQ en c e C/1
Owner's Name: Phone#t 70SG 9 ,9/`t6 s a (o
Contractor: / Phon #: License#:
�S (Tu o S lP �ok FS0070 7
Contact: Phone#: Cupertino Business License#:
0 r 23
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )K Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles pp S
❑ Other(Specify) -� Other(Specify)6ao ers a/ec eff t %` Zd
Number of existing coverings�_ ❑ Provide I.C.B.O.Report#
To be Removed V_ Provide Mfgr.Installation Specs. S far
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description: .
Residential IX Commercial
Fire Zone: Yes ❑ Nox Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Proj ct: Type of Cons ction: Occupancy group:
lv �" e�- �i 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
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