05080015 (2) CITY OF CUPERTINO ' fa. ,�;:
BUILDING DIVISION PERMIT CO T_ OTORINF,ORMMI�ON
BUILDING ADDRESS: CONRAD ROOFING SERVICE PERMIT"°.05080015
7965 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
TINA SU 332 PHELAN AVE 08/03/2005
NE: SANITARY NO. CONTROL NO.
(408) 294-76 5
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MECH
O
300 LICENSED CONTRACTOR'S DECLARATION l
!9 I hemby Affirm Inn I atm licensed under petwsiou or chapter 9(commencing Job Desbription
imIth Section7MI)of Division 3 of the Business and Professions Cade.and my license Is
full force Andafect. 2�1bs1 REROOF W/SHINGLESLicle
' Z Da¢ro6;�� 39 Contracter
ARCHITECTS DECLARATION
I I
3
I undc sand my plana shall le C/used As public records G_1V3
Licensed Professional 1005'0
OWNER-BUILDER DECLARATION y_v
ip.2 I hereby n(nrm that 1 exempt from the Canuacm License Law for thef
O O following mama(Stttion]AL1.3,Busmen and PmfeWons Code:My city car county `s
3 " ,°'B:(h
$ which requires A permit m construct eller improve,demolish,or repair any stractum ��`�! �I $14000
prior At its issuance.alW Mquires Lisa applicant for such Permit m file a signed wtement
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Mal Ise Ulicensed pumrantbthe provisions ofMeConuscmYallcannmLaw(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the B usineav and Professions Cade)or
3—
that he is exempt Iherefmm and the buts for the alleged exemption.My violation of
Section 7011.5 by Any applicant for a permit subjects the applicant to a civil penalty of
not mom man live hundred dollars(s500h T Occupancy Type
❑1.as owmer of the property.or my employees with wiles As their sole compensation,
will do the work,and the suuctum Is not intended or offered for sale(See 7044,Business
and ProreWons Code:The Comessines Limue Law,does not Apply In An ower of Required Inspections
properly who bui lds or i m prows thereon.and who doeuuch work himself or thmugh his
awn employees,provided thauuch Improvements arc not intended wonered for sale.B.
however,the building or improvement is weld within ow year or completion.the owner.
builder will Isw the burden of proving ten be did not Wild or improve for purpose of
ulc.).
❑1.As a vier of the Property am exclusively contracting with licensed commus s to
construct the project(Sec.7044,Business and Profession Code:)The Contractor's Lt. .
corse taw docs not apply an an owner of property who Wilds or Impmwa dremon,and,
who contracts for such pmje=with a conuacmr(s)licensed pursuant In Me Contracibes r
License Law.
❑lamexemptundn Sec. ,BAPCrw Wsmason .
Owner Data
73011WORKER'S COMPENSATION DECLARATION
I hereby Athan under Family of perjury one of Me following declarations:
1 haworb will mullWnaCe nmmor ConsentmalfduumforWoeaesCompen-
0
on,u pmvldcd for by Section 3]00 of the labor Code.for Me performance of the
k for which this permit s iatued.
1 haw and will maintain Worker's Compensation insurance,u mquimd by Section
of the labor Cade,for IM performance of the work for which this permit Is Issued.
Worme,Compeuation Insunna artier and Policy number are:
rrier, yt'ar, E,A 4 Policy No.: rf%OO)I ley O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection nW nothe completed Irde rattail Is farm WndrtddoMats(5100)
or leu)
I cenif-v the,in me perrwmarce of the.,it for which this Permit is issued.I Nail raw
employ any person in my manner an As m become subject to Me Worker'Compensalon
Law of Calif..]..Data
Applicant
NOTICE TO APPLICANT:If,a(mr making this Certificate of Exemption,you should
become subject m the Worker's Compeesstion Provisions of M IaMr,Code,you mss
0 z fonhwim comply with such provisiuru or mu permit Nall be deemed cooked.
z O CONSTRUCTION LENDING AGENCY
rN
F Ihereby affirm dust them iss constomflan30 lending agency.) for Mrs performance of
Le work far which Nu permit is Istmd(Sec.3097,Civ.CJ
Q Lender's Name
r7 z Lendefs Address
V O I cenify that I have rad this application and me this the show Information is
Iy!' coney I agree to comply with all city and county ordinances and sum law relating in
building conviction,and hereby Wthorim mpmmnmdm of this city to cnmr upon the
�+W abuve-mentioned Property for mspeNan purposes
[,r Cr (We)agree to mw,indemnity and kttp humlen Me City of Cupertino against
o-y`VV)j Iiabilidn,jWgmeam,cam,endexpemp which may In any my seem Against said City
in APPLICANT UNDERSuence of the TANDS Aof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3—v r
SOURCEREGULATIy}�
�-(✓�� 8-�-0f Re-roofs r
Signature of Applin MContractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant nom or handle bmudou material
u de0ned ray the Cupertino Municipal Code.Chapter 9.12,and the Heal%and Safety
odm.s«tian 25532(.)7 All roofs shall be inspected nor to an roofing material beim
p Yc, � p p - y g g installed.
Will the applicant or future Wilding occupant can equipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
11 baaamous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
7ni,
0Yes Nu
I ham mad the haawrousmateriais mquinnee s underChaperE95 ofMe Califor.
HesW 8 SaielyCade.Seehons 25505.25533 and 25534.1 undemend that if0e building
es not currently haw a mnanr Nat It 4 my mspomibility m nWl'y the occupant of me
ulremen 'ch muss he met prior m Issuance of a Cenilkam of Occopanry6-3—�?— Signature of Applicant Date
ner w amhmcmd agent Data All roof coverings to be Class nBn or better
t Community Development
10300 Torre Avenue
OCIF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
Aov La,-. Qc-, /-S-
OWNER'S NAME: PHONE # 2So— "L-9`( L
GENERAL CONTRACTOR: FAX# "Y— 976/0
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
e -3- OS'
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY�F Telephone: (408)777-3228
U PE�TINO 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.
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-roofing.
Homeowner's Name: ( liv�o Ste`
lob Site Address: o n
Roofing Company Name: Co-. C-r -eon,,
Applicant's Signature: �C"�L/ Date:
Greg Casteel
Building Official
� Revised 11/2/04
Printed on Recycled Paper
allo
CITY OF CUPERTINOREROOFCUO 1, PERMIT APPLICATION FORM
APN# 2- it s Date:
� � � B 3- of-
Building
sBuilding Address:
( /L4i'��OW Fc1C1
Owner's Name: Phone#:
T,ti!4 S+n iso- 3g?-`119y,
Contractor: Phone#: License#:
Contact: I I Phone#: Cupertino Business License#:
-S-0 - Z9Y�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
V Wood Shakes ❑ Wood Shakes
V9 Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings -L- ❑ Provide I.C.B.O.Report#
Qr"To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Co!?!,With Cu ertino's Tear Off Policy:
Job Description: T� ,� . .CF !! .�+ � Jf,lk '7//4" orn J"41y + 30 • t4
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Y Type of Construction: Occupancy group:
IOoa
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