04080031 (2) CITY OF CUPERTINO '° °� '® « "`"` °�� B, 4�'.
BUILDING DIVISION PERMIT 'CI);1�I`T.Rr�.CT!LR;IN 'ORMAT7( 1�I-
BUILDING ADDRESS: PERMR NO.
ROOFCO OF SILICON VALLEY 04080031
OWNER'S NAME: PERMIT ISSUE DATE
NE: My 900 HOG 844B EARLE AVE SANITARY OL NO.
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
B ELECT PLUMB MECH
0 0
you LICENSED CONTRACTOR'S DECLARATION lob Description ��
mF 1 bereby affirm that 1 am licmued under provisions Of Chapter 9(commencing
Z2a`j with Section 10r)(0)of Division 3 of Ne Businessland Professions Code,and my license is
in full force antl.1. .
jai Lieensc cissa et - 3q Lot.x 31 REROOF W/ASPHALT SHINGLES_ �j' �C
ZF,p Date p^ T—rY ARCHITECTS 11CLARAIIABBI
a I undersand my plans shall W used as public records
Dau
3 0H Licensed Pndessional
g OWNER-BUILDER DECLARATION
1 hereby affirm Out 1 am Exempt from the Contractor's License Law for the
00 following moon.(Section 71131.5,Business and Professions Code:Any city or county
m tai which requires a Permit In construct,.Itea improve,demolish,or repair any someone
prior Or im amares'.110 requires the Applicant for such permit to rile a signed statement
Ext that he is licensed pursuant to the pmvisiomofOnConractor',License Law(Chapter 9 Sq.Ft.Floor Area Valu tion
6th (commencing with Section 7")of Division 3 of the Business and Professions Code)or
3 Out he as exam o Ncsefrom and Ne baso for On alleged exemption.Any vi.lOGon of
Section 7031.5 by any applicant far a permit aubj.cu Ne applicant to a civil penalty of 3..W.A7.N... 1`00 Occupancy Type
not more Nan five hundred dollars($500). - 6L'�'411'B7
❑Lo the work.the the muy,m is cmntendes with A.).(See
044,8 sin.
will Pr thework.ands: he Con s terct intended or offered rs no,apply to An manor
Required Inspections
and ertywhiobu builds or
The Contchummdon.License Law da.a oat apply lf an owner of 9 P
progenywho buildsorimprovesch improvements
who doessuchwoe himselfed form[ his
own employees,provided that such improvements are not ear of completion,m eared for sale 1L
however,Ne building or den of pmcnt is sold within ane yild or or the Ow r.
of
builder will have the burden of paving that he did not build or improve for purpose of
sale J.
0 I,as owner of Ne praparty,am exclusively contracting with licensed contractors e
construct the project(Sec.7W,Basin.and Profusions Cale:)The Cmdracmh U.
come Law does not apply to an owner of property who Wilds or improves Orman.antl,
who contracts for such pmjecm with a contracor(s)licensed pursuant a the Consramor's
License Law.
❑I am uempt under Sec. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I have and will maintain a Certificate or Consent to self-insum for Worker's Compete
sadon,v pmvided for by Section 3700 of the labor Code,for Ne performance of due
f work for which mus permit is issued.
I have and will maintain Worker's Compensation Insurance,u required by Section
37M of Ne labor Code,for the performance of Ne work per which this permit is issued
My Worker's Comp[nsatian Insurance c micr up olicy number ase:
Cartier: Policy No.: 17 b 0 1??-7
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mans section need not W completed if the permit is loran.hundred dollars($100)
or less.)
1 certify Nat in the performance of the work for which thia permit is issues.I shall not
employ anypcman in any mannerm oto cmmmesubjeauatbo Warkcrs'Campensation ..
Laws of California.On ti
Applicant
NOTICE TO APPLICIf,after akin,Nis CcNOxe
cato of Emption,you mould
become subject to Nc or er's Compensation provisions of Nc Labor Cade,you must
O Z forthwith comply with such provisions or this permit shall W deemed invoked.
zO CONSiRUCfION LENDING AGENCY
'r IhembyafErm that there is a ieuwctlon lending agency for the performance of .
tri 4> On work for which this permit is issued(Sec.3(97,Civ.C.)
W A Lenticls Name
z lenders Addems
U 0 1 certify that I haus read Nis application and sale that the above information is
Iy N corm.I agree to comply with all city and county ordinances and sate laws relating to
0U building construction,and hereby aodamen repmeenatives of Nis city to enter upon the
;+W above-mentioned praperty for inspection purposes. /J
G
(We)agree to save,indemnify and keep harmless the City or CupcninA againstrF.t fA Iiabilioles,pegmcna.costs and espens.s which may in anyway memo against said City
U Z in consequence of the gm rain,of Nis permit
w. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s REC TIONS. ,p
S"S Ofd Re-roofs
Sigurc ApplicantoContractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill thm applicant or future building Occupant store or handle hamadous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cala,Section 25532(ap
Yes t� All roofs shall be inspected prior to any roofing material being installed.
❑
1 Will the applicant or future building Occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardom air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
inrid?
kf J ❑Yes �11�
4ria Ho.1I have mad thc hmardous maerlalssequircmcnm under Chapter 6.95 of the Calier.
O&SafetyCode,Se=dans 25505,35533 and 25534.1 undersand Not if Nc building
Jas not currently have a to gp4 Na it is my easponsihility ur notify the Ocupm,of W,
f rc tee cna bet tpoor uissuanccofaCertificate oftop ars Si aveofApplicant Ditto
0 nor r amhori'rcJ a,cns All roof coverings to be Class "B"or better
Community Development
cy 10300 Torre Avenue
I Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS PERMIT #
96.9 ) W 0 �o 0
OWNER'S N PHONE 9 333 J�
GENERAL CONTRACTOR: FAX#
'I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTORBUSINESS 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
er ontractor tune v/ Date
1 •
Community Development Department
a Building Division
5- City of Cupertino
10300 Torre Avenue
'k
CITY OF Telephone: (408)777-3228
UPE"'INO Fax: (408)777-3333
r
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 1/4" 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:
_ "G�7
Job Site Address: 21? J/ rJ,04,6�Aifl
44AZ
Roofing Company Name: 1E//a 04 1 t LOIR 40
At' Signature: Date: /��/
.re
g eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO
REROOF
CITY OF
CUPERT'INO PERMIT APPLICATION FORM
APN# 02,
2 ZJ Date-
Building Address:
Owner's Name: Phone#:
t �o low X353
Contrac/tp'/r: ��77 Phone#: License #:
Roe
Cont ct: hone#: Cupertino Business License#:
CjA
Type of Roof Covering:
Existing: ---- -- ... _. .. Proposgd:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles OV Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nypnber of existing coverings Z ❑ Provide I.C.B.O.Report#
W To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zone: e/ No, Confirmed with a n g t. if
there area restrictions
Cost of roject: Type of Con ction: Occup c roup
rcx
Qt
A li ab e 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