04090013 (2) CITY OF CUPERTINOy h' i��
PERMIT Alto,
BUILDINc DIVISION . . _ ��QR'INI+'U�2�
BUILDING ADDRESS: ROOFCO OF SILICON VALLEY PERMITNO04090013
7733 RAINBOW DR
OWNER'S NAME: - PERMITLSUEDATE
IghJAMES JEIL `
ONE: - SANITARY NO. CONTROL NO.
40 79 -
ARCHiTECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATIONO
'�(Y 1 W.by affirm thm 1 arrIicensW under proviai ns of Chapwr 9(commencing lob DeSCrip
with Smdon]IXg))af Diviaion3ofthe Business an uaiaw Code,andmv
ylicecis
n nlife"'-- 6 9 REROOF W/ MOIRE BLACH
j Z Lieenx CI Lk.p
Cantrmtar SEP 14 2004
reqq ARCHITECTS DEC AT ON
y a 1 undcamo y plans¢hall W used as publi cords
ip BUILDING
o� Licensed Professional
g OWNER-BUILDER DECLARATION
d Q F 1 l..a .(item that 11. exempt from the Contrecmo License Law for the
p C whrollich
.res a perm(Secit to cont. t,altass end Profession h,or re repair
piny m c ante
k$� which requires a permit to.I.the elves improve,demolish,terse Sig any statement
�iy prior.slimnsnce,auu mquircs theapplicantfur ContratoSuch r'm0lcasLaw(Chapt cm
p 0 that heioungwitpursuant70th)ofDiviovofthe eBusinessaLimnuLvw(sCodnr9 Sq.F[. Floor Area Valuation
y $ tht(Comm11 ngwith Section70M)and of basis for
n(Neeged exempt Pfa(eni0vilatae)or
- Sa he is eaempn Nerclrom and Ne bash far be alleged exemption.Any violation of
Section the.5 five
tory applicant for a permit subjects the applicant to a civil penally of 3 GON4`Ii3�t18er0 0 Occupancy e
not mare then Ove hundred dollen(gsao). P YTYP
❑1,as owner of Ne property,m my employees with wages as their sole compensation,
will do thawo&-end on,structure is notinended oroffered foraale(Sm.7044,Business -
and Profession,Com:The Commiserates Liwe owne
aLaw does out apply to an r of Required Inspections
propernywho builds orimpraves thereon,and who doessuchwork himself orthrough his
own employees.provided than such improvereanu arc amounted oroffered for Wa It.
however,the building or improvement is sold within one year o(compledon,the owner.
builder will have the burden of proving that he did cot Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with Ilecnsed amntracmn to
canswcl the project(Sec.7044.Business and Professions Code:)The Contractor's Li.
cave Law docs not apply to an owner of property,who builds or improves thereon,and,
who conmets for such projects with a conuacnor(s)licensed pursuant to the Contractors
License Law.
❑Iamexempnunder Sea ,B&PCfmthlarcvon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pevlty of perjury one of the following declinations:
l have and will maintain a Certificate of Consent to a 1r iesum fm Warkcr'aCompen-
auion,as provided for by Section 37M of dm Labor Code,for the performance of thc
work for which this permit is issued.
011 have and will maintain Workers Compensnion Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Workers an ation l rvpec a cr and Policy roarkr..:
Certje{:C Poliry ON Re 1760
✓✓Yy CERTIFlC O•OF COMPENSATION
INSQ ORKERS'
COMPENSATION INSUR
(Thisaceien need not W completed i(%an permit is laronc hundred dollars($1¢00
,elects.)
1 cantly than in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as to become subject o the Workcri Compcnsalion
Law¢of Calif..!..Data
Anal usunt
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject an the Worker's Compensation previsions of the Labor Code,you must
.JOforthwith comply with such provisions or this permit shall be deemed evoked.
z CONSTRUCTION LENDING AGENCY
[-r I hereby affirm that died,is a construction lending agency for to performance of
qi> the work for which this permit is Wood(Sec.3097.Civ,C.)
GLenders Name
z Leader's Add.
V O 1 certify than 1 have reed this application and soon that the show information is
IT Fcored l agreedinm
to comply with all city and county orces and sun laws relating(a
O building convection,antl hereby authorim nprescma ivv of this city to enter upon the
>ia show-mentioned Property forinspection
which may
(We)agree to save,indemnify and keep harmless the City of Cupertino egeinat
iE"y CA liebilitia.juagmenu,costs and expenses which may in anyway accrue agalnstaeid City
(�,Z in consequence of the granting of this Permit.
^ APP CANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU R L IONS.
Re-roofs
i o(ApplicenUContmctor Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
111 the applicant or future Wilding occupant store or handle barardous material
aaaj'az do recd by the Cupertino Muniripel Code.Chapter 9.13,and Nc Health and Safely
sa,sec den 2ss3z(a)? All roofs shall be inspected prior to an roofing material beim
❑res �r41; p P � Y g g installed.
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
emit hazardous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
District? l
❑Yes I7tm
I have mal the hmaMnus manrialsmyvircmcnts under ChaPnrg.95 of Nc Califoo- q
tie HcmlNASafcny Cadaseedov2550S35533and25534.1undcm.dthssirNc Wilding
docs no urently haw a w 1,Nat it is mY rcspovihilitY m nodfy the accupent of Ne
my ' me sw 1 m etpdorwissuenceotaCcnigcawofOccu m Si tea re ofAppll nt Date
y 3 a All roof coverings to be Class"B"or better
Own auNorizcJ agent t Data
Community Development
f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 77773228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: r PERT #
-2 Z 3 CCt Gl Lo �i
OWNER'S NAME: J re vtI PHONE #
GENERAL CONTRACTOR: d , FAX #
I am not using any subcontractors: �— 3
Signature Date
Please check applicable subcontracto4 ancomplete the following information:
SUBCONTRACTOR USINESS 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 .
/ or Signature "Iz�� D to
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U p C kT I A l0 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: V'�y� C,nr1`�-�j
Job Site Address: -7-73 3 /"L�//f C n) 4..�,jJ
Roofing Company Name: T�GCJ 1'" ��Cy'g f''`//3,1 Gant 4140�000
A plicant's Signature: ..� G.i' Date: 9131a
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO IGqC
000F :> -0
REROOF - ZFD
CUPEkTINO PERMIT APPLICATION FORM 6
APN# o V O! 7 Date:
q-17-
Lee
Gi
Buildin Address:.
Owner's Name: Phone #:
S �t ] n yt/G — Z/Co0
C tract Phone#: License#:
Contact: hone#: Cupertino Business License#:
arvtG
2el 5 3 s v> Z23`/S
Type of Roof Covering:
Existing: Proposed:
❑ ilt-Up Roof ❑ ilt-Up roof
NO" Asphalt Shingles S' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O.Report#
W"—To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
7;-5 "// 30Mol'�ei (cam ZZ -/e
Residential 0 ' Commercial ❑
Fire Zone: Yes ❑ No Confirmed with PI ng Det. if
there are antr1Cti0 , 13
Cost of Pro'ect: Type of Constructi n: Occupancy o
GrU�U�
Qty. if
A tc 1 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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