05120099 (2) CITY OF CUPERTINO *BUILDING DIVISION PERMIT ',XONTRACT,ORgNFORMATION R
BUILDINGADDRESS! KEVIN SULLIVAN ROOFING PERNBTNo'05120099
OWNER'S NAME: PERMIT ISSUE DATE
GILLIAN VONBERG 1696 VALLEY 12/15/2005
NE: SANITARY NO. CONTROL NO.
(408) 842-1057
ARCHTECIPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uOp LICENSED CONTRACTOR'S DEsionof hap JobDescri tion
w ON
1 kzeby affirm that 1 am licensed under provision of Chapter 9(commencing p
i� wiNS don7000)ofDiviskn3ofN Buri nd��yf�e�uio/ulCad/c.andd ylieeoxis
nay L eneCi;a'dcrce-- L/S/ REROOF--T/O SHINGLES, INSTALL SHINGLES
j,? License Class Lk.al
e t,o Date Contractor /
q ARATION
RCHRECI'S DECL
usJ1 un remand my plans shall k used as public records yU
,ay LicencedPmfcuional
S OWNER-BUILDER DECLARATION
I herohy affirm that 1 am exempt from tk Contnemfs Licenx law for the
ECO following mason.(Section Yin 1.5,Business and Professions Cale:Any city or county
which mquirea a permit to cmom et.alter,improve,demolish,or repair any coucmm $9000
prior N its issuance.taboo requima the applicant for such Permit to file a signtdstammcm
FFS< that heor licensed purumn,toNoprovisionofthicContractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
ymom (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y N$ that he u exempt therefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty ofOGGU
not mon than 11ww hundred dollars(5300). P Occupancy TYPe
0 1.u awn"of Ute prepcny,o my employees with"gum Ne'v hate compcnvtion.
will do the work end the swcture is not intended or offend for sale(Sec.7044,Business
and Profeviom Code:The Contractor's License Law coca not apply in an awn"of Required Inspections
property who builds oded that such
and who aoeaauchwmk hirtuelfor Wough his
awn employees,provided Nat such improvements are not intended oroffered for sale,r-
however.the building Orden of proving
is hall within ane year or completion.Ne owner-
builder will have Um burden of proving Nat W did not Wild or improve for purpose of
salt.).
❑1,as owner of tit Seen ,.a.B exclusively contracting with licensed Commemrs i.
construct La the es not ,,ply o an Business and Professions Code:)The Contractor's red �{v
cense raw does r supply to an own"of propeny.who Wilds rs improv thereon,and.
whocontractsLacu for such projects with aconuxxr(s)Iiaved pursuant adze Conuactofs
License Law.
❑lam exempt uneer Sec. ,B&PCfor this moon
Owner Dem
WORKER'S COMPENSATION DECLARATION .ae�
1 hereby affirm under perW ty of perjury ore of the following declarations:
1 have and will maintain aCenificate of Consent m self-insure fm Worker's Compen- �r(�
7L171.X)
Co.u provided(o by Section 3700 of the Lamm Code.for due pert...of Um
h for which Nis permit is issued.
and will maintain Workers Compensation Insurance,u required by Section
of the Labor Cods.for Ne perfor ance or Ne work for which this permit is issued.
Warkcfs amPensation lnsvnntt cartitnnd Policy numkram:
ier. Policy No.: "Z
CERTIFICATE O CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mussuction need not W completed if Ne roman is from hundred dollars($101))
M max)
I cemdfy that in Ne performance of the,work for which this Permit is issued.I smll not
employ any perhan in any m u nersa as m Wcomo subject to tbe Workeri Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making this CCniOcam of Exemption,you should
become subject W the Worker's Compeuation provisions of NC labor Code,you most
.JO forthwith Comply with such Provision or NU Permit shall he domtd revoked.
'Z 4CONSTRUCTIONLENDINGAGENCY
Pl hereby alarm Nat alert is a eonaructinn lending agency for the performammc of
a> the work(ser which Nu permit is issued(See 3097,Ci,C.)
QUnder's Namc
0.Z l.eMler's Add.
V Q 1 certify Nat I have reed this application and sure Nat he above bar..it.is
I7. Correa I agree to comply with all city and County ordinances and sum laws misting to
OV Wilding construction,and hereby authorize repmsenmiwa of this city to enter upon Ne
amvwexpolgedproperty fort..,inspection may
F 0.. (We)agree to save,indemnify and keep barmless alt City of Cupcnino again"
f/1 incoimil judgmenhegrantand expenseswhich mayinany way accrue against said City
(J,Z in canrcqucnct of the gaming of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER ULATION
Re-roofs moi!
nature of ApplicanUContracto Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Um applicant o future building=upset store or handle havrdous material
u denied by Ne Cupertino Municipal Code.Chapter 9.12.and tk Hcalth and Safety
Code.Section zss32(.)7 �� All roofs shall be inspected prior to any roofing material being installed.
0 Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
omit haaardous air contaminants as domed by Ne Bay Area Air Quality Management all new materials for inspection.
District?
I haw mad the huardousmseedals requirements undcrC1xptem6.95 of tk Cxlifm.
nia Hua Wt&Salcey Codd,Secuou25505,25533=it 25534,1 understand thatifthe milling
does not currently ham a LCMML that itis my responsibility m notify f occupant of the
require nuwhmhmuvWMCI PdorwlssuaeeofacertifeateaOCgasp Signature of Applicant Date
owner or aathrrvrc agent D,m All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
F"1 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
-5, A) . 0 20Q
OWNER'S NAME: U PHONE #
GENERAL CONTRACTOR 6d&IJ J 3-Z& t FAX # ff¢
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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/C actor Stgnatur�� Date
Community Development Department
Building Division
City of Cupertino
i
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 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: yLo_tA-,J
Job Site Address: ((7i( .S /�C� z 7c,✓U
Roofing Company Name: l�i.� Le,- 5" //i,J !�/:e�s,c�5w
ApplicanYsSignature2g K_Jeezl, �
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
=��� CITY OF CUPERTINO
REROOF
CUPERJINO PERMIT APPLICATION FORM
APN # b 2 Z Z 0 O_ Date: ,
Building Address:
Ow er's Name: Phone#:
Contractor: Phon #: License#:
& 9- . Z A03 cJ�
Contact: Phone-#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
0/Asphalt Shingles O>- Xsphalt Shingles
V❑ }Wood Shakes L1 Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings PZi ❑ Provide I.C.B.O.Report#
U/Fo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:
,"�� Sifi J&Lz-S �.�7�'7116 `' 30(x, 4 z
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
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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