05040170 (2)CITYOFCUPERTINO
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BUILDING DIVISION PERMIT
CO1VaTRAGTUR
BUILDING ADDRESS:
ALLIANCE ROOFING
PERMIT NO.
05040170
OWNER'S NAME:
PERMIT ISSUE DATE,
ftONE: SANITARY 0. OL NO.
CHI7ECT SNGINEER:
BUILDING PERMIT INFO
BLDO ELECT PLUMB MITCH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 bewby affirm mat 1 am Hawed under pmvi+iom of Chapter 9 (rommencin6
e
withSection IWO) Divl,IN3of a Busineuand Professions Coda.md.,licensB
in ren face andel _ �� Cie. 4s}Oen.
Licenw I
REROOF W/DENSDECK & FIBERTITLE OVER (E)
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Dem Contractor 4 rArA
ARCHITECTS DECDECLARATION w
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1 underuand my plena shall be used as public records
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Licensed Pwfesommal
DECLARATION
OW NEon
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1 hereby exempt License for RIC
that 11. exempt Item the Cnsitocs COAL•:
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city O
m6bR feecmM 71DL5, and detiew o Any ally nr county
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Impansu demnlhh, or mush
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whichfollowing t.LLlot, ve.
which requires s permit re rnnatmeL alar,
lensed c. tes;he do applicant for such permit toiecomle 4 ed statement
ConitwmsandPraUonsCodo9
Sq. Ft. Floor Area
Va uadon
<
aw(Chmmenl
thiormiu
pursuant to of
thalheencingwdputwantutheprovivision3of
$
nal Code) of
Section 7000) ofth
pth
IneisofrI allegac ed exemption.
Nat k ts exempt Unrefrom and the buss for Ole altered eaempdan. AnY Nolallan O(
that he exempt
31AM1409100
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to arnil Penalty of
not mom than five hundred dollars ($500).
❑ I, as Owner of the property, or my employes with wegal u thok sale cempensadm.
aired Inspections
will do the work and me+wcumtsml intended or offered formle(Sec. Triad. BusinessRe
and Professional Code: The Cesuaoo or+ License law clue, napply m an owner er
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property who bui Ida or im prom+ thereon, and who does each work himself or through his
own employes, provided that such i m prowmanu tee not Intended or a@red for ante. IL
however, the building or improvement is mid within one year of completion. the awner-
bullder. will have W burden of proving that be did am Wild or Improve for purpose of
sale.).
0 I. as Owner of the property, am exeluively connecting with licensed conuwmrs In
comlruct the project (Sec. 7014, Business and Professions Code:) The Conmcmh U.
cense law does not apply to an owner of properly who Wilds Or Improves themes, and,
who contracts for such projects with a comrwtar(s) licensed pursumt to the Conumtors
License law.
❑ I an, exempt under Sm .B k PC for this resen
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 bemby a Tm under penalty of Petiury One of the following declarations:
I hems and will maintain a CeNOmte of Consent or self-insum for WorkeesCompen-
mdon, as provided fm by Section 3700 of the labor Code, for the performance of the
work for which this Permit is laved.
❑ 1 have and will maintain Workers Compensation Laurance. as numbed by Section
37W of me labor Code, for the perfomamxof six work for which this permit is Issued.
pnPolicy No.:&Z— OIL 3s)O_)2r 6
CMayrtWieer kek4 p�e1�snm carrier and Policy number an: -
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CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(lhlssectim need mnNeumpleted Ifthe Permit Is Intone hundred dollars (SIM)
nr less)
1 certify that in the performance of the, work for which this permit is issued, l mall not
employ any person In my manner w as u become subject to the Worked Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after making this cer incate Of Exemption, you mould
become subject m the Workers Compensation provisions of Om labor Cade, you muss
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forthwith comply with such provisions or this Permll shall be deemed revoked.
C
CONSTRUCTION LENDING AGENCY14
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1 hereby a0'um that dart B a construction lending agency for the performance of
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the wish fur which this permit is issued (Sec. 3097. Civ. C.)
Gj
Lenders Name
Lender's Address
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1 certify that 1 ban mad %is application and sum that the soon information Is
corm I epee to comply with all city and county ordinances and sole laws relating to
building construction, and hereby authorize reprcwaumes of this city to enter upon the
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show -mentioned property for inspection purposes
WIiebiliti
less the City of against
(We) agree m save, indemnify and keep harmCupertino
fn againsl send City
ser and I xpcmes which may my way aarne
i nsequence0 the ofthis Permit.
LICANT U DE A S AND WILL COMPLY WITH ALL ON -P INT
Issued by: Date
SO EG
4 as a
Re -roofs
Slgnose ofAPp,..,Co..0 Date
at
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding mupani pow Or handle huardons material
defined by the COP'MineMunicipal Cade, Chapter 9.IZ and do Health and Safety
alk, Sed25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes PNo
If a roof is installed without firs[ obtaining an inspection, I agree to remove
WIII the applicant or future building Occupant use equipment o devices which
emit ha'rudnu air contaminants u defined by the Bay Amo Air Quality Management
all new materials for inspection.
District?
❑Yes t$NO
I hive mW the hazardous materials requirements under Chapter 6.95 of the Califor.
nu 'au 25505.2SS33md25534.I undereunA thatifdm Wilding
not cum ly ha a 4 that it my responsibility m ratify tbe up of the
Immentsw' metpal aroissuanceofaCcrtiBcateofOcc they.
Signature of Applicant Date
'7,D a
"B"
All roof coverings to be Class or better
Owner or autharixe0 agent Dale
C,
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
OCITY OF
UPEkTINO,
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Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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:
Job Site Address:-sa"?, D4 F V i7W ' 61,'t r -
Roofing Company N i Arl
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Date: 4 -_2z� - Q 5 -
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CITY OF CUPERTINO
REROOF
livol
CUPEkTINO PERMIT APPLICATION FORM
APN # l U 01� O T?
Bldg Permit Fees
Date:
BENERGY
Energy
BUILDING
Building Address:
/0
Seismic Fee Res
55 5
049 V1646o4ce;
Owner's Name: // '' �
fd#14i-E T ALG ACD
Phone #:
oi4l-�dr��i
Contractor: nn
/V LL1ArIGS�
�> ir�
License #: ))''
TR�0.26L
Contact:Cupertino
Business License
Business License #:
✓� AGI—
Type of Roof Covering:
Existing:
Proposed:
18 Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
O Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
13Other(Specify)
❑ Wood Shingles
.0 Other(Specify) t'46 TO f€ 1�4bd f L,
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: =,,Isf�LL
4 c
" fBusDaeA, AJ0 r,g,,,er,rd' ctfe(Z Bx 7-, J4
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act+ o Lei T7-�/L
Residential E]
Commercial
Fire Zone: Yes ❑ No ❑
Confirmed with Planning De t. if
there are any restrictions:
Cost of Project:
Type of Construction: Occupancy group:
4-48 Duo
Qty. if
Applicable
Fee ID
Fee Description
2 ITTM,
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