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05120148 (2)
CITY OF CUPERTINO .�r Fda., BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: DONE RIGHT INC PERMIT NO.05120148 OWNER'S NAME: PERMITISUEDATE TRYFOROS JAMES M AND OLGA 1129 LONG FELLOW 12/23/2005 INE: SANITARY NO, CONTROL NO. (408) 377-8777 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ig LICENSED CONIAd under DECLARATION w 1 hereby arrim,deo I am tree-sea ander pmmdons of Chapter v(commencing Job Description i� wide SecMm7(IOU)ofDoiaian3o(iWBus asandP uin Code.andmylimmeen a« is ullfoceandc REMOVE EXISTING SHAKE ROOF INSTALL 30 POUND FEL � i LDiac�nu Cl s Constitute, a G CLASS C SHAKES ^�4 ARCHITECTS DECLARATION �y odI undersand my plans shall he used As public records Dyu ;'y Licensed Profeuionel 5 OWNER-BUILDER DECLARATION <F I hereby off=that I am exempt from the Ccerai mr's License Law portion C c O following moon.(Smdon 7(D L5,Business and Prou feasioCock:Any cit,or county B which requires a permit ti cnutrox,alter,improve,demolish,or repair any structure prior it)its issuance.also requires the applicant for such Permit to rile a signed statement LSC that he is licensed pursuant m the PmviS MS or the Contractor's Liceme Law(chapter 9 Sq. Ft. Floor Area Valu 16 8 6 7 '~a (commencing with Section 7")of Division 3 aline Busincssand Prof isions Code)m .. that he u exempt therefrom and Ne basis for dee alleged exemption.Any violation of Sation 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more man live hundred dollars(M). 35913057 . 00 P Y Ty� ❑I,as owner Afore property,or my employees with wages as their sole compensation, will do the work,and the structure is net intended or offered foaale(Sec.70".Butlers• Add Pmfeasiou code:The Contractors License law does trot apply m an owner of Requir spections property who buildswded Mascsthereon,and who Amnsuchwork oroffearthmugh his Own employ=.Me building improvansuch ement ements old whore not intended mpletinA for Meownr. builder ..me building or improvement is hold within one year of completion,pu owner. builder will have the burden of proving that M did not build or improve far puryoee of v/A tile.), ryas' ❑I,u ewer of ct Sec.pr.,n,..704.B exclusivelynd convecting with Tire ed mortars s. 'Y-- constructmLa IM==nota apply to an Business and Partray who Wi Cade:)The Con hereon.U. 0,I��6 score law dew not applyje is owner of property who sed p or improves Omrton,and who consncu for such projects WiN aconuxmr(h)licensed pursant to dee Conveners 0 lamam exe exempt under See ar this reason Date Owner Date WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of the fallowing declarations: I ham and will maintain a Certificates of Consent to wit-insure for Worturs Camper. Orion.in provided for by Section 3700 of the labor Code,for the performance of me work for which this permit is issued. ❑1 have and will maintain Workers Compamdon Insurance,As rcquimd by Section 3700afolm abor Code.formeper,,fpP(mance of the weir for which thupermit is issuW. My Worker' C p resell.". c.rriennd Palicy nnu^um__ber ) ,/_ Carrier. r Policy No.:�_ C RTI ICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Croon section need not be completed if the Permit is foronc hundred dollars($IBID or Mss.) I cemfv 0.11.the perfmmenee of me work for which this permit is issued.I shall not employ any posed-in any mannersu As In bacome subject Id dee Warkcri Com=motion Lawa of California.Dam Applicant NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption,you should become subject an me Worker's Compeuation previsions of We labor Code,you muss .J z forthwith comply wide such provisions or this p.it shall be deemed revoked. ZO CONSIRUCf10N LENDING AGENCY [—� Ihereby affirm mat More is a mnstructina lending agency for me performance of fY ru7 me work(tar which this permit is issued(Sec.3097.Civ.C.) CV A Landers Name z Undere Add^ V Q I minify mar 1 haw rW this appliauon and sum that me above Infamous.is t" cancel.I agree m comply with all city and county ordinances and sure laws relating to 0CJ building cmutrucron.and hembyaumwire rtpcamisdraofdox,it,soen¢rapnn me 1. ahoac-mentioned propmy for inspection purposes. Fr a (we)agree,m save,indemnlf)'and keep horralers the City of eapenina agalKt IV)Z in of and extensu WhlCM1 may In any Way ensue ageius did City fJ z in consequence of the graining of this permia Issued b '-" APPLICAf �1NDER A SAND WILL COMPLY WITH ALL ON-POINT •Z.Z3- SOUR CUL e /�O j� y; Date a E— /!" Re-roofs Signaniffeof AWCAMIContrimunr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Jon applicant or future building occupant store or handle huardous material u defined by the Cupertino Municipal Cade.Chapter 9.12,and dm Ncalm and Safety Code. 0Yesection zss3z(o? All roofs shall be inspected nor to an roofing material beim ❑Yes .e''� P P Y 8 g installed. Will the applicant or future Wilding'mcupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I,herardn A ear canuminams u defined by the Bay Area Air Quality Management all new materials for inspection. via? ❑Yea �Dv� 1 have read me hma`rdnus materialsreyvimamms under Chapter6.95 of the Califon ria Health A Safety Coo,Sad 5.25533 ua1255N.l umkssumd des don building docs Ives correct I it is my nspauihililY m notify IM occupant of the require ch must priortoissuanceofaceneramafocayanay. Signature of Applicant Date G radthmeredagent roto All roof coverings to be Class"B"or better Community Development J 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building De utment JOB ADDRESS: PERMIT # s© 660 6 OWNER'S NAME: Q - PHONE # GENERAL CONTRACTOR: ' eI FAX # I am not using any subcontractors: 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 T' er/Contractor Signature Date Community Development Department Building Division City of Cupertino (�. 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 CUPEkTINO 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$176.18. The re-inspection fee must be paid before another inspection can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I I understand and will comply with the above stated policy on re-roofing. Homeowner's Name:t/d''fCd f'�/ 6 Job Site Address: Roofing Company Name: Applicant's Signatu Dat/P 3 Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO 051"01014$ a REROOF CITY OF CUPERTINO PERMIT APPLICATION FORM APN # 3sq �2� D�� Date: J J Building Address: 0'6 1680 iif - Owner's Name: � Phone#:mos Contracto Phone#: License #: a 3�7�7�� Contact: Phone#. O Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles .or'Wood Shakes _-O'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 and Will Comply With Cu ertino's Tear Off Policy: Job Description: �oUe �� _ 6 (/ f (T Residential Com ercial ❑ Fire Zone: Yeso No Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: 15 967/ 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