04070028 (2) • CITY OF CUPERTINO - �,.aa,
BuaolNc DIVISION . PERMIT �y,C�UNTRACTQR INF0RMA.TI0N -BUILDING ADDRESS: T D ROOFING PERMIT"904070028
OWNER'S NAME: PERMITISSUEDATE
THOMAS & DENISE LESONDAR 3S40 MARrATF AVP
ONE: SANITARY NO, CONTROL NO,
(408) 892-8872
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
LOO LICENSED CONTRACTOR'S DECLARATION O
I huchy am.Nu 1 am limned under poviums of Chapter 9(mmmcncing Job Description
with Section 7MI)of Division 3 of Nc Business and Professluns Code.and my Because is
in full forte an eine
;'�z Idemseca. 3 L;c,g - fc e21 REROOF W/DURALITE VILLA
n-2 Dale Camrutor
ARCHITECTS DECLARATION'
1210 1 undersand my plans.hafl Wusedas Public mounds
0t; Licensed Pofessonal
-rn OWNER-BUILDER DECLARATION 10,�
I I hereby amrm that 1 am exempt from the ContnOla
aft License w for IM
y00 fallowing moon.(Section 7031.5,Business and Pofusiou Code:Any city or county G
$ which rcqut.a Permit m mm owunaet,slot,improve,dealuh, repair any structure
FZ< prior o its iuuanresequins Num
.al. e mmlifar such permiuo -----
o file a aigocdsumeal- - - - -- -
p 0
that heislicensed rurmanuothe pmvtsiaunfNeComsuoYWanceLaw(Chapor9 Sq.Ft. Floor Area
(commencing y $ (commencing with Section 7000)of Division 3 of the Business and Profusions Crux)or
Nn he is exempt therefore and Ne buds for Ne alleged exemption.Any violation of $14000
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not moue d m five hundred dollen($500). ��9ccupancy Type
❑I.uownuofthepmpeny,ormyemplaycuwithwaguaitheirmleC=Nnaaon, r
will do the work,and the slN9tme ianatimended or offered forst.(Sec.7W.Business
and Pofeuions Code:The Contsuori License Law does not apply o an owner of Required Inspections
property who buildsor improves lherean,and whodoessuch workhimselforthrrugh his
own employee,provided thal such improvemenware oat Intended orolfered farsale If,
however.are building or improvement is into within he year of mmplcuoo,the owmr-
builder will have the burden of proving that he did not build or improve for purlwse of
MI.J.
❑I,u ower of the popeny,am exclusively amonuung with licensed contractors Io
mnswcl the pmject(Sec.7044,Business and Professions Code:)The Cousesto e,LF
cause Law doss nut apply o an no,of property who Wilds or improves thereon,and,
who consncts for such projects with a contracor(q licensed pursuant to the Contractor's
License law.
❑I am exempt under Sec. ,B k PC far N4 mato
Owner Data
WORKER'S COMPENSATION DECLARATION -
1 hereby arm under penalty of perjury one of the fallowing declantiau:
1 have and will maintain a Certificate of Consent to self-insure far Workers Campam
IC11111"
hm,u provided far by Section 37W of the Labor Cade,for Ne perfamrancu of the
t for which this permit is hound.
Co
1 have and will maintain Warkeb Compensation insurance,u ueyuimd by Secuon
W of the labor Cow,(of the performance of one work far which Nis permit is issued.
y Workers Coppen�saiion lnsuranm canicr and Policy number am:
' 1 ss t IaYrtier:. Q\A. -L,.x Policy No.:
CERTIFl ATE FEXEMFnON FROM WORKER— '
COMPENSATION INSURANCE
(This motion reed not W completed If the permit is for one hundred dollen(SI W)
or less)
I certify Net in to perfannanee of the work for which this permit is Issued.I shall not
employ any person in any man rcran H In become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:Ir.afar making this Comfits¢of Emmplirn,you should
become subject to the Worker's Compensation provisions of the Labor Cade,you must
.JO forthwith comply with such pravistau ar this Permit hall be deemed revoked.
Z`Z' CONSTRUCTION LENDING AGENCY
�-+ I hereby amrm that Nem is a construction lending agency for Performance of
> the work for which this permit Is iuucd(Sec.3097,Cih,C.)
WUndoes Name
�Q
5 Z Loader's Address
U 0 1 mnify Nat 1 he.mad this application and sae Nat he above information is
D.F cermet.1 agren to comply with all city and county ordinances and son laws rulating In
D U building construction,and hereby Indurate repeaccuL ws of this City m enter upon the
above-mentioned pmpcny for inspection purposes
gyr (We)49.b ave,indemnify and keep harmless the City of Cupertino against
VI liabilities judgments.costs and expenus which may in any way accme against said City
U 7 in consequence of the granting of this permit.
'^• APPLICANT}IND R ANDS AND WILL COMPLY WITH LL ON-POINT Issued by: Date
SOURCE REGVLA N5.
Signmurt ofApplicanVCamm ar 7 , Dow
_( Re-roofs
HAZARDOUS ADISCLOSURE Type of Roof
Will the applicant or fawn Wilding ashamorhandlchuasdous maorial
u de0ned by de Cupenino Municipal Code.Chawr 9.12,and the Health and Safety
ode,Secuon 25532(¢)? \'
Cres ®Nu All roofs shall be inspected prior to any roofing material being installed.
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
raft haaalow air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes [qNu
I have mad Ne hazardous materials nquinmenu under Chapter 6.95 of den Califon
iia Hexlthh Sxfc% Code,Sectiom25505.25533md25534,lundcr dNatifNe Wilding t /
does not cusfcml h4 ami no.that it u my rc.immililky to notify the ..pant of Ne
rcquiuemcnu whi h' est el paorw iuuancc aft Ccnifoatep fOccu racy.
� ,t �MQ r17 J` Signature of Applicant Date
Owner orInNrrmcdago., Date All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS:�O cl S+ e\) e i1 C„e AL
L� fes. 13 i vd � TT o y bj o o j,9
OWNER'S NAME: d t o ni c,n L asp), A cv\( PRO #
GENERAL CONT OR: T D ho c� 'n F
I am not using any subcontractors: L4fLg.
Signature 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
/Contractor Si a Date
Community Development Department
Building Division
City of Cupertino
! 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U w E kT 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.
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.I
Homeowner's Name: (� I yyl elan e%JU.1-9-
Job Site Address: .2,2 3
Roofing Company Name:
A plicant's Signature: ate: O
_ \A/�1DCX1
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Peper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# 3 Z � Dater
Building Address:
.1A6o9 S') e -A) weej I'5 �vCk
Owner's ame: Phone#:
�(
Contractor: Phone#: License#:
T D :ice i „ q 0 , gqA 8 $ A- 6 6Po .2
Conta t: Phone#: Cupertino Business License#:
es1. e H-occ.w yo$ 5�1J- 88 A
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
pQ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles p I C,
L3 Other(Specify) Other(Specify) 9 UVCJy'`` . V iI I
Number of existing coverings qi( Provide I.C.B.O.Report# J In S ro
1k�t To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: JJ 1_ )I 1, `I
5e.n, OJ` v�QQC, Si \Ctf.L:_ — t-C, C�C-C VJ-i T�,. ,L1 ,'oz: , , l
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni q i
there are anyres ions 'A�
Cost of Project: Type of Constructior� Occupancy gr p
14t o-OO ,ie — o-00 t
Qty. if
ApplicARN 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