05020042 (2) CITY OF CUPERTINOix « ,4yg;£� 'nom .w
Jr •9,
BUILDING DIVISION PERMIT tCUNTRALCT,QRi11VF'UR ATI'Q1Va"
BUILDINGADDRESS: DADDARIO ROOFING III N105020042
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL 440.
(831) 476-9109
ARCHIIECTIENGINEER: `9 /I BUILDINOPERMITINFO
BLDGELECT PLUMB MECH
O
�00 LICENSED CONTRACTOR'S DECLARATION lb Descrip� V.mc
r�(� 1 hby aOlrre that 1 am o
B cesed under provisions of Chapter 9(commencing
with Section 7000)Of Division 3 of the Budnras nM Proresdom Codi.md my license Is \ �V
in full force andeO
t LlcenmClan — Lt..M C. REROOF
y�. Dam rS DECLARATION
4171
A shall b wan DECLARATION
1 wdemand my roti slWl W cooed u public records
sad Liceased Profcuioml
5
OWNER-BUILDER DECLARATION
1 herthy affirm that 1 am"Am
from the Contractor's Licence Law for the
6 m o following rouon.(Section 7031.5.Business and Profussiou Code:My city ne county �A�k)
$ which mq.mes•permit monsu
cuctalmo
, ter,borrow.delish.ne repair my clrucmmrqnn
F2} prim be its ussu4Ke,also requires me applicant fwaneh permit m file a signed Nmmmt
F<
Most heulicensed pumnnitothe provisions offtContractor's Uncrum Law(Chapter 9 Sq. Ft. Floor Area Valuation
6S (commencing with Section 7000)of Divislan 3 of the Bminosamd Prefiess mCodelur
that M is axampt therefrom and the basis for the alleged exemi u n.My vloladon of
Section 7031.5 by my applicant fine a permit mbjcm the applicant in a civil penalty of 3 542MKae10 0 Occas ane e
nm mom than five hundred dolWs(f500). P Y�Yp
❑1,u Owner of tM property,m my mploym withwgu u ftk mte cmnpemdon.
wlllde the work.andtheawcrore is wtmmnded orolrered(Armin(Sec.7044,Beat. Required Inspections
and Profualoas Code:The Convaetore,Licence dm Act dnut apply te an ownu of e q ns p
propenywho builds orimprom thertw,and whodoessuchwork himselfor through his
Own emPh yin,provided that inch Improwmanu tie not intended An offered for sale If,
however.Me Wining ne Improvement is mid within arc year ofcompledan,the owner.
Wilder will have the burden of proving that he did cot build At Improve for purpose of
sale.).
❑1,As owner of the property.am exclusively contracting with licensed mnumtm to
construct the project(Sec.7044,Business and Pmfetdom Code:)The Cmbacluh LL
caro law dm not Apply an an owner Of property who Wilds or improm thereon,and
who mnuacu for much projects with•eonmmmns)licensed puratunt An rhe Conrucmfm
License law.
❑lamexemptunder Sec .9k PCfor thlsmason
Owner Dam
WORKER'S COMPENSATIONDECLARATION -
1 hereby from under penalty of perjury oro Of the following dcclmd=
1 ban and will maintain a Cmdfncam Of CONem in setbimum for WOrkefs Compen.
737M
ion,ss provided fin by Section 37M of the Tabor Code,for me performance of the
rk for which this permit Is Issued.
1 haw and will maintain Wwkces Compensation Immana.u required by Schon
of the Labor Code,f c the pMormance of Me work lm which this permit W homed.
y Workers Compensation mina caner and Policy number art:
rver. Policy No..
CERTIFICA •OF EXEMPTION FROM WORKERS
COMPENSA71ON INSURANCE
(Thu minim used nothecompleted lithe permit Isfneom hum beddm0an($ImH
or ansa)
1 certify mot In the perfomance of the work for which this permit W Issued,I shall not
employ any person in my member an As,he became subject in the Workers'Compcmadw
Laws of CtliromiL Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject m the Workers Compmandon prevision of the IaMr Code,you most
O O forthwith comply with such pmviu0m m this Permit Mall W doomed invoked,
z CONSTRUCTION LENDING AGENCY
F I For which thi Met Vert WaconuuucM 097,Cing agency fne Me perfurmuwte of
Ix Le work ran whim this permit u iasuW(sec.3041.cin.CJ '
W�Q Landers Nurse
OU Lending Mdrtu
Q 1 ceniry Thu I haw mm this application and state that the show inform W un Is
correct 1 atia in comply with all city and county ordinances and sale Wens Misting ng
building cd and!hereby authon
of this city menteupon the
slme nmened propertyfm Inspection
,—,agree-me,indemnifyand
lmcpha
hymn the Cityru against against
wen y Ilabilides,judgments,costs and cape
mm which may in any way mane against aid City
(„)7 in conmguenm of the graining of this mit. Z "
Fl APPLICANT UNDERSTAN WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE
';zly"1or Re-roofs
sic mor ApplicanUConlmctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding occupant close or handle hvudom manna]
As defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 25532M? / All roofs shall be inspected nor to an roofing material beim
cl Y oro 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
It hauNom air cOnumiosnu u de0md by the Bay Area All Quality Management all new materials for inspection.
Dlmict7
❑Yin ❑No
I have mol the bxsardous materials tequirtmenn under Chapter 6.95 of the Calif n.
nia HealthBSafetyCole.Secdmu 25 Sand 25531.1undemani that if the Wilding
dm not cmmnly ho an my mspouihiliry m mdfy Me occupant of Ne
mgmmmcns, ` rw�cOr.ccriri ae roe"pymy� Signature of Applicant Date
0 nc m authoAred agent /!/(/Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
aClOF
Cup 9ertino C 5014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT # Z. 00
2 e � K) 0SO
OWNER'S NAME: jgvder5aL4 PHONE # 41gs --2219
GENERAL CONTRACTOR FAX #
fVj6I1jp% Ca,qfVekCf61/\ V') 4z It.�
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
66 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 I eur- i
Septic Tank
Sheet Metal
Sheet Rock
Tile
LIs I
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I 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 h 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$176.18.,The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: J e�T f I YIt�P✓ ✓i
r
Job Site Address: p
l�b IC tiG✓`I el
Roofing Company Name: �0<1rdP or VIla fp m-Fi(�
k g CG
Applicant's Signature: �il� !/� Date: lQ$
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper _
CITY OF CUPERTINO
arow,
REROOF bCUPEkINO PERMIT APPLICATION FORM
APN# �3 X57 Date:
2 A B5
Building Address:
121-710
ck
Owner's Name: Phone#:
a6_ 2s - 28 29
Contrac Phone#: gg -cn6-g16qj License #:
a &13o -7'3
Contact- Phone#: Cupertino Business License#:
+e0 a a✓ i
410 - 52e-2215
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: } �,�- o FF cow p 'l
Residential qK Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: 15
Cost of Project: Type of Construction: Occupancy group:
6 q0G, o
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
4-137.