04070019 (2) CITY OF CUPERTINO 7 tea` e° " `�}a,� kry. �+
BUILDING DIVISION PERMIT uO?' TUAC;,TO-R�I,N'VORY ATIO1\•,". e BUILDING ADDRESS: KEITH ROOFING CO INC FERMI INt4070019
. 22106 RAE LN
OWNER'S NAME: PERMITBSUEDATE
FRANK CERVENKA 920 LINCOLN AVE
ONE:
SANITARY NO. CONTROL NO.
408 295-8616
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pp=p iLDnidcaN nae CI LICENSED CONTRACTOR'S
ou DECLARATION
1thereby
n that I em Unsound underprrovisions of Chapter 9(commencing
UOnOthgrad101C)of o3ofbea nPof aenREROOFwmumFIH CV
RCICITE
I nd myplansshad beuseda ubicnr
JUL 1.2+2004
SY
3 C to Licensed Professional
OWNER-BUILDER DECLARATION BUILDING
iS I hereby Rnn that 1 1. exempts an the Conmaara License Law for the
fallop 0 which mquea s a ficecdon llD LS,Business and Pe,tuna.Cade:Any most,
m or county
$ which squirts•permit a cn.wct,pWn improve,dcmmuh,ri e pair any statement poor mslcensed ,dloequina the applicant for suchpemiuo BIeasigned summer9
5�0 thatkis licanscd punuem roto provisions of NC Conlmcmh Limn.Li.(Chapur9 Sq.Ft. Floor Area Valuation
X5� (commencing with SctionIINK)ofDivision 3ofthe Business and PoocssinnsCode)ur
y that le Is exempt thand.a.and the h osis for the alleged eumpilon.Any vialaton of N.
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penally of 15=0 0 Occupancy
not more Nan five hundred dollen ane(5500). P Y Type
❑I,uownerofshepmpmymmyemployeewithwagesudeirsolec==nation, ,
Will do the work and du awctum is nos intended or olfercA outside(Sec.1044,Business
and Proresiona Code:The Contracurs Lowe law does nor apply les an moue,or Required Inspections
ismpeny who bui Ids or i mproventhereon,a nd who does such work himsci f or through his
own employee,provided Chet such improvemenLLase not intaMed or offered for Mls.If,
however.the building or improvement is sold within one year of compktlon,the owner.
builder will have de burden of moving that he did not Wild or improve for purpose of
sale.).
❑1,as owner of the properly,am exclusively contracting with licensed cmuaew,in
conswct the project(Sec.IOM,Business and Profession.Code:)The Conmcurs LL
cense law doe not apply m in owner of property who Wilds or improve demon,and,
who contracts for such projects with a conllSer(s)licensed pursuant to the Cor mnora
License law.
❑1 am exempt under Sec ,B k P C for this reason
1(33100
wner Data
WORKER'S COMPENSATION DECLARATION
I hereby alEm under peaty or perjury ane of Ne fallowing decimations:
I here and will maintain a CeniOata or Consent to elf-insure for Worker's Compere
ion.u pmvidm for by Section 3]00 of the labor Cade,for to performance of the
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Scndon
of the labor Code,far the performance of Ne work fc which this permt is issued.
y Workers Comp9 setian Inmunntt arttcr andPolicynumber emrtier. ��Policc��He
CERTIFIC TEOFEXEMPDON,rROM WORKERS'
COMPENSATION INSll11AAANCE
(Thi,,see int need not W complced if the permit is for one hundred doll($IN))
or less.)
I candy that in the perform ace of the work for which this permit is issued.I shell not
employ any person in any manner so a In become subject to the Workcri Compcnsatlon
Iowa of California.Data
Applicant
NOTICE TO APPLICANT.Ir.after making this Cenificata of Exemption,you should
become subject to the Workers Compensation provisions of the labor CodC,you must
O to=ons comply with such provisions OF thie permit shall W deemed evoked.
„zi"" CONSTRUCTION LENDING AGENCY
[—i��+ I hereby affirm Net Ilam is a convection lending agency for the peif...rec of ,
E
.� the work for which this permit Is issued(Sec.3ty97,Civ.C.)
GQ Lcndcra Name
z Lender's Address
V 0 I cattily that I ham mad this application and stale that the move information Is
ly E' conexi.I ogee to comply with all city and county ordinances and mute laws mladng to
C) building convection,and hereby authodae miummmnbcs ofthis city to Other upon the
Na aWvc-mentioned property for i.0eedon purposes.
(We)agree 10 Mm,indemnify and kccp hamlets the City of Cupertino againsl
«Fi L') Iiabilides.ludgmenla,costs and expenses which may in any way same against Mid City
U io eon north'granting of this permit.
a'^ APP T UNDERSTANDS AND WILL COMPLY WITH A N N.POINT Issued by: Date
R REGUL ONS.
Re-roofs
S of APP Data
1 a.AR000s MATERIALS DISCLOSURE Type of Roof
Wilkie pliant or future building Occupant or handle lmvardeus ramanal
.dented by de Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
We.goodonus33(.r '
❑Ye All roofs shall be inspected prior to any roofing material being installed.
Na
Will the applicant of future wilding occupnl sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havarden air mntsminan dcfmcd by the Bay Area Air Quality Managcmcnl all new rials for inspection.
District?
❑Ys Nu
I have mad On hvvdous maurialsmquirements underCNpur 6.95 of dta Califon-
nuHalth YCodc.Secd=u M.35533ud3353a.lundcnuv ifde Wildi /
doe ally ham a anon,Net it is my expo 'enitry u nodi the occupant of (�
ts which unW nprioruiss ala Ccmr,cae "Iden), re of C ate
-7 Men
m d m Dore
All roof coverings to be Class"B"or better
�. Community Development
1 ,
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Depgtment
JOB ADD RMIT#
;'210 ('0
OWNER'S N PHONE
GENERAL CONTRACTOR: IFAX #
I am not using any subcontra
Signature ate
Please check applicable subcontractors an 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 er
Septic Tank
Sheet Metal
Sheet Rock
-7 4
r/ on or Signature ate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4UPECITY OF Telephone: (408)777-3228
k1 'N 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) 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:
Job Site Address: �a` 6 67,
Roofing Company Name: / r
A plicant s Signa e: Date: G
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
-7 a
Building Address:
12
Owner's Name: Phone#: b
Contractor: License#:5�sy�] �p
p
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 'Xr— Asphalt Shingles
-;,a— 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 Desc *ion: J
Pa✓ c S '/z CSX �n.s Tk 30 Fa �� SD ✓ �� o
Residential Commerc al ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det, if
there are an restrictions: L1
Cost of Project: I ,I Type of Constructi� Occupancy group:
'j � c�
.. . i
able 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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2 f6'