04040060 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT COINTRACTQ12INkIDRMATION 34;
I BUILDING ADDRESS: PERMIT N004040060
'
• 7 REGNART RE)
OWNER'S NAME: PERMITISSUEDATE
ALAN & SUE KAYSER 04/09/2004
JNE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB METH
�I O p
LICENSED CONTRACTOR'S DECLARATION
w 1 heonhy eror I licensed under provisions of Chapter 9(commencing Job Description
no with$CclIOa]IXX) f I.
Busin sx tWa n six
^O<< in full c nde act. ROOF
�= LiTI Lie. NST OR: HALLMARK ROOFING INC
I Coal 5
q� G ITB -5 MAY 10- 2004
i19 U 1 and stand my plana shali nc used I pu rt, s �•
tog6 ®pAp
Licensed Pmfcasionel ��'�®i1VHA
g OWNER-BUILDER DECLARATION BUILDING
9<x I hereby affirm that I am exempt(rum the Comments License Law for the
ZOO following reason.(Section 71131.5,Business and Po.Prison Code:Any city or munly
$ which reform a Permit 1.construct,aIle,,improve,demolish,or repair any allocation
oor to its issuance,also requires the applicantfor such permit to file a signed statement
that he is licensed Dorsum to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valu,$ipg600
Y (commencing with Section 70100)of Division 3 ofhe Business and Professions Code)or
y hal he is exempt quarter and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant far.permit subjects he applicant to a civil penally of APN Number Occupancy Type
not more than fire hundred Jollara(6500). 3
6646001 . 00 p y YP
❑I,as owner of the property,or my employees with wages as heir sale compensation,
willdohework,and heswcwreis Bol intended ororfered fo...Is(Sec.]W4,Business Required Inspections
and Professions Conde;The Co rman i License Law does not apply man owner of q p
properly who builds or improves thereon,and who doessuch work himself or through his
awn employees,provided that such improvements are nor intended oroRered far wle.If,
however,he building or impravemem is sold within one year of completion,he owner-
builder will have the burden of proving coat he did not build or improve for purpose of
sale.).
❑I,as owner of the properly,am exclusively Manacling with licensed convectors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who Wilds or improves hexon,and
who contracts for such projects with a ornamentals)licensed pursuant to he Coutracals
License Law.
❑I am exempt under Sec. ,B@ P C for this reason
Owner I Dam
WORKER'S COMPENSATION DECLARATION
1 hereby am.(under penally of Perjury one of the following declarations:
_ I ban and will maintain.Certificate of Consent to sel f-insumfor Worker's Compcn-
safe ,as provided for by Section 37M of he labor Code,for the marmmance of the
work for which his Permit is issued.
❑ and 11 mai'ai aWmker's C orientation Insurance,az ayvimd by Senior
37 f Codc or he ,form cc or in rk vhi cot ermil isissueJ.
My Wo r' d c c icr and o ti
Pa'
TIF ATE fN10 OM YORKER,.A
COMPENSATION INSURANCE U V})
Thosectio+ d not McompletN ifma permit is parent,hundred dollars(SI
nr less.)
1 certify coat in he performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as h,hecomc subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:V.afar making this Certificate of Exemption,you should
become subject to the Worker's Compcttsaliam provisions of the Labor Code,you most
,JO forthwiB,comply with such provisions of this Permit shall Thai deemed revoked.
CONSTRUCTION LENDING AGENCY
•N-a Ihereh affirm that hurt is a construction lending[r y g agency for the Performance of
fyi 7 he work fm which this Permit is iuuc0(Sec.309].Civ.C.)
W Q Lender's Name
Da LenderE Address
Q 2
C.)Q 1 ccnee hal 1 have with
this application and arm that the above informationsmisting
is
0 F. corer.1 agree to comply wish all city and county ordinances es aW.lore laws relating e '
QU hu' cramuclloo,end Berea euthanprcprcsclnalivcsof Nis city toenter upon qt,
a live cottoned props.
erly f Its Bea which Tr
clpg o save ndemmi and keep harmless the City of Cupertino against
U fn an
m g n ,ca and ofI sea which Try in any eccmc against said City
U NT If ling of permit. I uedby: Date
ANT N pS W 01 W L N N- INT
REG L
e-roofs
(part T or "Neter lcr mr Dem
HAZARDOUS A RIALS SCLOSURE Type of Roof
Will the applicant or future building oecup store or handle Jonathua material
as defined by the Cupertino Mpnicipal Code.Chapter 9.12,and[be Health and Safely
Cotic,ST❑criasi 25532(¢)? 11 roofs all be inspecte or to any roofing material being installed.
Will the applicen In building occupant use equipment or devices which f a roof is nstalled with tit firs obtaining an inspection,I agree to remove
lith odom air oonmm u dcficed by the Bay Arca Air Quality Management all new e a 5 In eetion.
District
Ycs b
y,
ev rt, ha. mmcanma rials5533 chain r hepar ,thruffhc Califon
or caltoo aft c, Trains 25 itis no 33 7255}4, atic tlthmilcoc huoff
too entry a nag0 it is my his nndly r of he ,
q ct a whi an fsce c of a JTVat9reofApplicantDate
k or authmised agent Dam All roof C verings to e Class"B" or better
CITY OF CUPERTINO a U� o� d
REROOF
CUPEKTINO PERMIT APPLICATION FORM
APN # � �)a Date:
Building Address: I of �/tqr �I11
Ow e: ` I I J.�r 1/
on f r: one License#b�
ahone Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,'I< Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Wood ElWood 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:
OD ri ti _ (Ind 50NM
R sid ntial o erci ❑
d
Are Zone: Yes F-1No ❑ on ed with Planning t. if
re are any r rictions:
Cost ro' ^— Type of Con=i Og p:
+ w
Qt if
A lic ble 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 BUH DING
�3 S• o-U
Community Development
10300 Torre Avenue
' ✓' Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
�UPEI�TINO
Building Dep4pritment
JO E 11T #® O
OWNER'S N PH (J v
GENERAL CONTRACTOR
I am not using any subcontra for
Tign-atuirU Date
Please check applicable subcontractors and complete the follinformation
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 Ro
�Qs�usr C ctor i Fature Date
Community Development Department
Building Division
1, City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
PEI�TINO
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 1/6 " 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 corttpwith the above stated policy o re-roofing.
Homeowner's NameI u
Job Site Address: Y !n r drive
Roofing CSanyNa lall1r0ark�' (nn I
A plicant'
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper