06010025 (2) CITY OF CUPERTINOJ." '
BUILDING DIVISION PERMIT tiCONTRACTbR INFORMATION '
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BUILDING ADDRESS: QLD COUNTRY ROOFING PERMIT NO.06010025
1017-4 RIEDET, PT.
OWNER'S NAME: PERMIT ISSUE DATE
Adhi BRUCE MORLEY 125-B GROBRIC CT 01/05/2006
NE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
inp LICENSED CONTRACTORS DECLARATION Job Description
i 1 hereby affirm that I am Iiansed under provisions;of Chi (commencing a i
with Snide.76dIn a Division 3.(On Dueness and Pmfcssim,Cod.,and my lice..is
inBrufemeande � Llea 6221 REROOF--T/O SHAKES, . INSTALL COMP,
_i3= License'�Cl{{sss�s�"
E_ Dam 1 I Cont r 22
SS Y f ams she
N 1 understand my plans¢hall W u u pubic recur s ''..• \ �� �JJ�
>a UY
L'¢enud PnJcasional
5 OWNER-BUILDER DECLARATION
ComanON r�tfj{ VyC
Imasa .(Sinn on I am exempt from um Conmaaors :License Law for my
C o wichfollowingmason.(Section 710 L5.Business and Prove,I.io i Code:An cit r comm 9
�m which ds Issu a Issuance.also
re crumua,alcor,impmm,h Promish,me a signed
any mmcmm 130'0(]�
prior m its ceased puran requires ldovisio s of for sucContin ou's U lc a sLaw(ummcm
FiG thmhe mencig wJ purstion 7 c of Division
of lWConuuess an cemc Law(Chapmr9 Sq.F[.Floor Area Valuation
yF$ (commencing with Section 1000).(Division3 of the Business and Professinna CMle)m
.• out W u exempt therefrarn and the basis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a civil Pen¢hy Of
not more Nan Res hundred dollars(5500). Occupancy Type
❑1,m owner of the pmpeny,m my employco with wages u Noir mlc compensstion,
will do the work and use aweture is not intended or offered farsale(Sec.7044.Bui.e••
and professions Code:The Contractees Liame Law does not apply in an owner of Required Inspections
pmpeny who Wilds or improves thereon,and whoddessuch work himselfor drought his _
own employes,provided that such improvements art not diandc l Proffered for ale.IL
however.me building or improvement is sold within one year of completion.Ne owner
builder will haus the burden of proving than,lis did not Wild or improve for purpose of
sale.).
❑1,As owner of the pmpcny,am eaclusivcly contracting with liaised commuters to
couuum IM project(Sec.7W,Business and professions Code:)The Contractor's Li.
ecru law dos not apply an an owner of property who Wilds or improver demon.W
who contacts for such pmjecu with aeonuacmr(s)Remand pennant o the Conmaetob
LKmt.Law.
❑1 am ewrap,under Sec. ,B&P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby alfrrm under penalty of Perjury one of tic fallowing doclanuatu:
1 haw and will maintain a Certificate of Consent an self-insure for Workers Compere
77M
ioe,es provided for by Seen..37W of dm LaWr Code,for Ne performmrce of Nc
rk for which this permit is issued.
1 have and will maintain WorWa Compeuation Insurance,as required by Section
of Ne labor Code.far dm perfarm,na of the work for which Nu permit is issued.
y Wor e.Compensation Insurance carrier and Policy number am:
me k�FY/hg,ok. Policy Nu: /2—/3P//
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
SITU section aAd not W completed Ilion permit is(coon hundred dollars(SIM)
or less)
I certify that in Ne performance of the work for which this permit is issued,l shall nm
employ any person in any mannerso as to Wrome subject to the Work dr Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,arm,making this C.nifieem of Exemption,you should
become subject an the Worker's Compens.uon previsions of the Lather Code,you must
.J z foMwid,comply with such provisions or this permit shall W deemed marked.
zOCONSTRUCTION LENDING AGENCY
pI hereby affirm mat there is a construction lending agency for the performance of
C' de work for which this permit is issued(Sec.MD,Civ.C.)
W� Q Lenders Name
=z Under'.Add.
C.)C) 1 certify Nat 1 have mad Nis application and Panic that thc a Wm information is
ly Pcmmn.I agree to comply wild All city and county ordinaries and sum laws relating in
0 U building convection,and hereby endocrine Inimsematima of this city to cnmr upon the
,Iy
ahovcme judgments,
pmpcst for expenses lOopwhich ma
H G (We)agree m un indemnify and keep harmless 0.City of Cupertino against
Z incomsNue ce of th,coming expenses may in any way accrue vguuuud City
U z mconsequcncc of the graining of this permit.
^ APPLICA NDERST D D WILL MPL�WITH ALL N- DINT Issued by: Date
SOURCE ULA .(%/ H"'C/ I ���
Re-roofs
Stgnuurt of AppbcanUContracmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding oc nput mart or handle hvardous material
As d.fined by the Cupertino Municipal Code.Chapter 9.13,and Ne HmIth and Safety
ode,S u n 35532(.)?
❑Ye, ON.
All roofs shall be inspected prior to any roofing material being installed.
7ni. If a roof is installed without first obtaining inspection,I
Will the applicant or future Wilding aceupam tau equipment or devices which g an agree to remove p
"�nus air contaminants u defined by Nc Bay Arca Air Quality Management all new materials for inspection.
❑Ycs ❑Nu
I have mad the haraNmrs materials requirements under Chapter 6.95 of the Califon
ealth&Safety Code,Sauom 25505,25533 and 25534.1 understand mer ifdc Wilding
not cu ham a t, ismyresp sibilitymnoutyttcc e issmofthereme hichld u m,au f,cenmeamafOcea ay. Signature of Applicant Date
NOer or amhomed agent Dam All roof coverings to be Class"B" Or better J
Community Development
J
10300
Cupertino
CA 95014
" L R Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:
/ 73 n n / PERMIT #0` o l 00 ,z
OWNER'S NAME: c 'r [ w c.� PHONE # ZS ! - 7 7 6 3
GENERAL CONTRACTOR: Old FAX #
I am not using any subcontractors:0/d &414 6 /,06
i attire 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
Iso l.
er ntractor Si ature Date
Community Development Department
Building Division
City of Cupertino
� 1 10300 Torre Avenue
Telephone: (408)777-3228
OCITY OF Fax: (408) 777-3333
UPEkTINO
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 Y4 " 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: 10173 ' —
Roofing Company Name: �t—
Applicant's Signature:. Date: i VO 6
. Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
: -} REROOF
CITY of
1 CUPERTINO PERMIT APPLICATION FORM
APN# Date: S O b
3 ! >o 2- 1 0 5 �
Building Address/0
] 73 &Vea to(
Owner's Name: f� Phone#:
;�5/ -776-3
Contractor* Phone #: License #: / Z Z ]3
L 7 8'z- -P-30 o (
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 'I. Asphalt Shingles
'g 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 Tann d®Will Comply With Cu ertino's Tear Off Policy:
Job Description:
ResidentiaIN16L Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: aap Type of Construction: Occupancy group:
�3 D UU
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
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