03100114 (2) CITY OF CUPERTINO �. g
BUILDING DIVISION' PERMIT CONTRACTOR INFORMA.TIONa
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BUILDING ADDRESS: EASTMAN CONTRACTING, INC PERMIT NO.03100114
OWNER'S NAME: 1418 DOUGLAS ST PERMITISSUEDATE
INE: (408) 971-9000 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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O o LICENSED CONTRACTOR'S DECLARATION
I u C 1 hereby affirm the,I am licensed under provisions or Chapter (commencing Job Description
w with Section 707 of the,
3 of the Business and Professions Code,and my license is
a in full force and effect. ,V,i,l�
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jq� License clads see.« REROOF Fr
1Cr� Date Contractor
ARCHITECTS DECLARATION
i s Iunderstandmyplans shallWroci spuhimmoords MAY 17 2004
U
a o Licensed Professional
a OWNER-BUILDER DECLARATION
Conti ON /'�
:0 0 I hereby.(firm that I am exempt from the Contractor's Code:Any c Law for the BUILDING
.2 O following requires
reason.Permian 703 1.5,Business and Professions h,oAny tiny s county
Z Bi which requires a peals,to carbon,alter,improve,demolish,Fi repair any structure
poor m its issuance,also requires the applicant for such permit m File a signed statement
< IhmhcisliccnscJPursuanuothcpnwisiomofmeCOmracmr'sLicenulaw(CM1epmr9 Sq.Ft. Floor Area Valuation
2�G (commencing with Section 7")of Division 3 of the Business and Professions Crude)or
that he is exempt therefrom and Be basis for We alleged exemption.Any violation or 35709070 . 00
Section 7031.5 by any applicant for a Permit subjects me applicant to acivil Penalty of APN Number Occupancy Type
not more man five hundred dollar,F1500). P y YP
❑1,as owner of the progeny.M my employees with wages u their solo compensation,
will do to work,and the structure is non intended or offered for sale(Sec.7094,Business
and Professions Cods:The Coolum oz's License Law docs not apply to ea owner of Required Inspections
properly who builds or improves thereon,and who does such work himself or through his
Own employees,provided that such improvemena are not intended or offered for sale.If,
however,Ne building or improvement is sold within one year of completion,be owner-
builder will have me burden of proving Nat he did not build or improve for purpose of
sale.).
X I,as owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.7094,Business and Professions Code:)The Convectors Li.
cense law does not apply to an owner of property who builds or improves menton,and
who contracts for such projects with a common r(s)licensed purmanuo me Comment's
License Law.
l am exempt under Sec. B&P C for this burden
own2 40014 /5L<��,/ /S O
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following declarations:
1 have and will maintain a Cer ifieme of Consent to self-mance for Workers Compete
Ilykin,u provided for by Section 37M Of me labor Codc,far sur Wfilmm mix,M the
k for which this permit is issued.
1 have and will maintain Wurkera Compensation Insurance,as required by Section
0 of the labor Coda,for me performance of me work fnr which this permit is issued.Worker's Compensation Insurance carrier and Policy number art:nicr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need no,hecomplered if the permit is fnr one hundmd dollars(5101))
fir less.)
1 certify that in the performance of the work for which this permit is issued,)shall not
employ any person in any manner am in in become subject to the Workers'Compensation
Law,of California.Dare
Applicant `
NOTICE TO APPLICANT:IL after making this Couricau of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed mvoked.
ti y CONSTRUCTION LENDING AGENCY
1 hereby affirm mat mere is a construction lending agency fnr the Performance of
Y. > me work for which this fermi,I,issued(See.3097,Civ.C.)
YA Lender's Name ,
Z Lit dekd Addmss
J 0 1 certify that I have read this application and sate met to above information is
camel.I agree to comply with all city and county ordinances and state laws relating to
V. building convection,and hereby eumoria rcpreseneddiois of this city to enter upon the
Uabove-mentioned properly for inspection purpose,.
(we)agree to save,indemnify and keep harmless me City of Cupertino against
rG liabilities,judgments.coax antl..peau,which may in any way accrue against said City /O r,
in consequence of the ranting of this permit I/ s\_J
APPLICANT UN STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREG TIONS. - %O//S
Re-roofs
ignanubc reaHAZARDOUS MATERIALS DISCLOSURE ter Dam Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Code, 2ss3xa)7
C3y. KNo All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the 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 haxardous air contaminants as deoned by the Bay Area Air Quality Management all new mater als for Inspection.
is riot] y
❑Yes ISN.
Ihave read the arardomi materials mquiremenx under Chapter 6.95 of the Califno-build
nis Hcsna,Safety ,Secti1/o ons 25505,25533 and 25534.I undersand met if sur ing 0
Jas not curzen ave a tenant mat i,is my responsibility to nod ly the occupant of be
octuircureamAr5hmostnometpnormissuanceof0CcmocamofOccupancy. Ignal Of Applicant Date
io ys n3
thmixed O,',Q Dau All roof coverings to be Class "B"or better
S
Community Development Department
Building Division
City of Cupertino
" 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U��^—'�O 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) h1-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 L eo 4 /5t`rZAQ
Job Site Address ,/ 2 22 O 6 QV/'If p4er�D CV, 52�,�7� �� 5
Roofing Company Name; / �a '" ti fie¢ J
A plicant's/Signature. Date/ �S/ koo3
�W'�✓WJE/v ��
• Greg
9t el
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 3 1 c> 0 l l
REROOF
II;
CUPETINO PERMIT APPLICATION FORM
APN# G Date:
Building Address: 22 2
Owner's Name: ,f(' GeO K p Phone#: i 4b� 1 �� ^g 3?c�
Contractor: / c Phone#: License#f:
(Zrog) 91/ 9000 SZ oST
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
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: n2w�.9Vf i,6k� � �t w1C�/��c{ �l� e0ty fby
Residential Comme cial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D t. if
there are anrestrictio )
Cost of Projec 7
/ .—��Oyyoe of Con cti : Occupancy group:
ty. if
App c file 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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