06020115 (2) ;7'974
TY OF CUPERTINO "' 'T Wt` z
BUILDING DIVISION PERMIT CONTRACTOR INF�pORMATLON
$<f'rn.Ka ATTI�<,.� fn
LDINGADDRESS: JIM KRAUSE ROOFING PERMIT NO,06020115
PUMPKIN DR
ER'S NAME: PERMIT ISSUE DAIS
VIRGINIA MCDOWELL 2310 DIANA AVE 02/21/2006
NE: SANITARY NO. CONTROL NO.
(408) 779-0704
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
(� 0 � 0
°00 LICENSED CONTRACTOR'S DECLARATION JbDescri tion
w❑ 1 ho
ereby affvm that I am licensed under provisions of Chapter 9(commencing P
� W with Section7(N)of Division3ofthc Businmand Profwssiam Code,andmylihmsis
m'? in full forteande acs
�} 2 REROOF--T/O SHAKE, INSTALL SHINGLES .
aLiccnw�Cl9�sss Lic.I
�-� Drewp�Cunlrtcmr ���.}
ARCHTIELTS DECLk'RAS'ION
¢ 1 undersand my plans shall he used is public rtmrds
5yU
k Licensed Professional
S OWNER-BUILDER DECLARATION
q 1 hereby affirm that 1 am exempt from the Contractor's License Law(ter the
20 follnwing mason.(Section 7131.5,Business and Professions Calc:Any city or county
which requires a permit to eomuuct,allot,improve,demolish,or repair any structure $12000
5Zi
poor it)its issuance.also requires the applicant for such permit to file a signed statement
ESC that he is licensed puremoul in the previsionx of do,Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
ask$ (Commencing with Section 7")of Division 3 of the Business and Professions Coie)or
Q that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
nm more than five hundred dmhrs(g ), r Occupancy Type
❑I,a a owner of the property,or my employees with wage as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sex.7004,Business
and Professions Code:The Contractor's 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 Nm such improvements art not intended proffered forsa e.If. j
however.the
ave fie, or improvement issoldhe
not year of completion.thdmase of
builder will have the burden of proving that he did not build or Improve for puryose of
trek.).
❑1,as owner of Be property,am exclusively convecting with IittruW....to D/
comwct the pmject(Sec.7044,Business and Prolmions Code:)The Contractor's Lt. b
cove law dors not apply to an owner of property.who Wilda or improves Ihemon,and
who contracts for such projects with acontractons)licensed pursuant to the Contractor's
Lt..taw.
❑I am exempt under Sew .B h P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cne ifente Of Consent o self-imum for Workci s Compen-
n6on,as provided for by Section 3700 of the labor Code.for the petformanee of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
A00 of the labor Code,for the performance of the Work for which this permit is issued.
My W nl cfa Compensation Insure yearier and Pali,number am:
r
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OTU rceioo need not hecompeeted lithe permit is fofoa hundred dollars(SIM)
or less.)
I cenifv that in the performance of the work for which this permit is issued.I shall not
cmpioy any person in any manner an as to become subject to the WorkersCompenadon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcate of Exemption,you should
become subject to the Worker's Compensation previsions of the labor Cade,you mow
.JO forthwith comply with such provisions or this permit shall W deemed revoked.
z y CONSTRUCTION LENDING AGENCY
'e+ l hereby affvm Nat dmrt is.cmuvuninn lending agency for the performance of
a the work for which this permit u issued(Sec.3097,Civ.C.)
fA A Lender's Name
az Lender's Address
U 0 1 Certify Na I have rtad this application and ser¢that the Aheve bef ormoo n u
I,.F vortca.l Agra 0 comply with all city and county ordinanas and state laws nearing to
G U building construction,and hereby authorise mpresc e3tives of this City to enter upon the
r[g) above-mentioned property for inspection purpuyar0
(We)agree Io save,indemnify and d�ececp less the City of Cupertino against
N liabilities.judgmcmts,costs and nses0 ich ayinanywayucrucagaimtsaul City
U z to c 'trence of the gami,
SAPPLIC OURC E UND ILL COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs
Signator A cant/ reactor low
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding eccupant cvarus
ore orhandle hdomaterial
u defined by the Cuanino Municipal Code.Chapter 9.17,and lM Health and Safety
,goiLtole,Semen zss3z(an All roofs shall be inspected prior to an roofing material beim
o Yea ON. P P Y g g installed.
Will thea applicant or future building Occupant use a If a roof is installed without first o tainin an inspection,I agree to remove
pP B p equipment or ticHcrs which / 7 g P
FE haardous air contaminants as defined by the Bay Arta Air Quality Management all new materialsfor ins 10 .
District
❑Yes ❑Nu
I have read the hzaarduus annals repuimmcnu under Chapter 6.95 of dte Califon L�
nia Heal th6 SalctyCode; ag os 2j 65 533 and 25534.I undersand Nat if Ne,Wilding
does n scurrcntly have ebam,A msporechility to nodfy the aeupant of the
myvi crosw f ssx norw issuance ofa Ccttifwase of [cup , Signature 7Cad Date
y Q
Own rautb i; ant Dow All roof coverings to be Class"B"or better
stm
Community Development
C pe0 Torre Avenue
rtino CA 95014
Telephone(408) 777-3228
CITY OF
Fax(408)777-3333
UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: /{ ' _ PHONE #
GENERAL CONTRAC R: /2{ , 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
1/
r/C or Signature ate
Community Development Department
f Building Division
lL:
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
IRUPEkTINO 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-roofin g .
Homeowner's Name: 1//W
11
� —7
Job Site Address: l / /
Roofing Company Name:
Applicant's Signature: Date:
aGreg Casteel 7
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#3 Z Date:
Building Address:
Owner's Na\mg: Phone#:
Contract r: Phone#: ° License#:
Yv. 7 7_^67d
Co act: P one#: Cupertino Business License#: .
ri . � 79 -o 04 aL11
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles O—Asphalt Shingles
Cr Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O 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 Descriptions: -T zo Y oT �, . r 1y S lay -7/1 0S6 30 i b 2
Residential Commerc al ❑
Fire Zone: Yes ❑ No Q— Confirmed with Planning Dept. if
there are an restrictions: 15
Cost of Project:� Type o Co nstruction: Occupancy gro3up:
V
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
� � 33 13b