04100147 (2) - CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: z
BUILDING ADDRESS: KEVIN SULLIVAN ROOFING PERMIT Nt4100147
10265 VIRGINIA SWAN PL
OWNER'S NAME: PERMIT ISSUE DATE
GWOHANN GWO 1696 VALLEY OAKS DR. 10/21/2004
ONE: SANITARY N0, CONTROL NO.
(408) 842-1057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+ 00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
U 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Scnion] )of Division 3 of the Busin sand Profcnir,os Code,end my license is
mrmlm coram. REROOF W/COMP. � �
«nxG.an 3 1:�� �e�t
=p Dam Canoe
FF R HITECI'S DEC
jC I understand my plans shall be used as public records
U
3:,H
y Licensed Profcxsionel
DEC / 2004
S
OWNER-BUILDER oexempt
DECLARATION
�<q 1 hereby.(firm that am exempt from the Canons Co License Law for the
p O following mason.(Section]1171.5,Business and Professions Code:Any city or county III MIKIo
K m� which requires a permit m construct,alter,improve,demolish,m repair any.structure $13000
terra prior In its issuance,also equims theapplicant forsuch permil to file asigned Statement
H�s�<
that he is licensed pursuant the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area
Valuation
DI (commencing with Section 701g)or Division 3 of the Business and Podmair,n Cnde)or
to Nat he I.exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of
not more Nrive.e hundred dollars(s50m. e Occupancy Type
❑ 1,as owner of the property,or my employees with wages as heir sole compensation.
will do NC work,and the structure is not intended or offered for sale(Sec.)044,Business
and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections
furiously who builds or improves themon,and who does such work himself or through his
own employees,provided that such improvements arc nut intended or offered for sale.If,
however,the building or improvement is mid within One year of completion,the Owner-
builder will have the burden of proving Nat he did not build or improve for purpose of
salt.).
❑ h as owner Of Ne property,am exclusively contracting with licensed contractors to
construct the project(Sec.70m,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves Ihemon,and
who contracts for such projects with a contracmr(s)licensed pursuant to be COmractors
License taw.
Q l am exempt under Sec. ,B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
I hew and will maintain a Certificate o(Conscm to self-insum for Worker's Compsn-
sauon, provided for by Section 3700 of the labor Code,for Ne performance of the
work whichmispertnitraismod.
1 have and will maintain Worker's COmpenamirn Insurance,as mqulred by Section
37W of the tabor Code,for Ne performance of Ne work for which this permit is issued.
My Worker's Compensation lnsumnce caricr and P ljry oumher ac:
abler STifTe �flN�
Poll*No.: r�cb28f
CERTIFICATE OFEXEM FRAM WORKERS'
COMPENSATION URANCE
Thisscclummcdnotlmcomplcm free permit is for nnc hunerce enll'vs(g11kD
or less.)
1 ccnify Nm in the performance of the work for which this permit is ismcd,1 shall nut
employ any person in any manner.m az In become subject to the Workers Compensation _
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Curti licase or Exemption,you should
become subject to the Worker Com Pc nation provisions of the Labor Cnde,you must
,J ,Z forthwith comply with Rich provision.or this permit shall be deemed revoked.
y iZ)O CONSTRUCTION LENDING AGENCY
I hemby affirm that there is a construction lending agency[or he ampurnmace of
GYi > be work for which Nis permit is issued(Scc.XA7,Out.C.)
!t7 A Lender's Name
= z Lender's Address
V Q 1 certify that I have read this application and sue that be above information ii
Da P-� coned.l agree to comply with all city and county ordinances and mute laws reining IO
V building construction.and hereby budimise represenmtives of this city to enter upon the
a abov-mentioncd property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
iF.ty
liabilities, costs and expenses which may in any way acme against said City
or the granting of
his Permit,
V z AP nICA eUNDERSTANDSt11 WW _ LY_ IT .ALL-NON-P01 Issued by: Date
UR GULATIO
Re-roofs
Jim re of A,litmistroutruchor 1 m r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will be applicam Lir fuwrc builJing acupem score nr henJic haeaNuus memrial
as defined by the Calendar,Municup 'Code.Chapter 9.12.and the Hcallh and Safety
Code,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
1Ycs
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
emir hosarmons air cnnuminanu as cllncd by the Bay Arca Air Quality Management all new materials inspection.
District?
E]Y., r
I have mad the haiwithirs materials requirements under Chaper 6,95 of the Cal for,
ria HcalNffiSafcly .Sections 25NI5,2 33 vn do eNatif Nc huilJing /�
Ja: ort curt t(y ha a tenant Nat_it y.r. IY r IY.Ihe ne.pant of
m4cimucnt— hmb m`apoor ism i rroeedlamcy. Sign t o DDI
Date
o oma rrisedagemt `1�, All roof coverings to be Class "B" or better
Community Development
aClOF
10300 Torre Avenue
iCupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS/: - C f� PERMIT # 4/?OWNER'S NAME: M M i� PHONE # 56 GENERAL CONTRA OR v FAX # Y� c�
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 6
Septic Tank
Sheet Metal
Sheet Rock
' Owne Contractor ignature Date
Community Development Department
Building Division
City of Cupertino
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,
' ,AU 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:
Job Site Address:
/a'e�N t- .Sup c7v,,FaJ
Roofing Company Name: ZIP-✓ .e✓ eS
!Greg
licant's Signatur Date: I. /
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
•
aC10FRERooFCUkINO PERMIT APPLICATION FORM
APN# � ( / � / d Date:
Building Address: 0 (�
Owner's Name: Pho e#:
CJ o 8 s68-s�Yd
Con actor, (� �Ke✓iNE_.Sat/, � ne #: -¢OBJ License#:
t9 �2 ✓ icG�7/�/G &eviee5 L —/ S
Contact:,.�,,,y ES Phone#: Cecc# -f0? Cupertino Business License#:
9_- 3z a �38io
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles /< Asphalt Shingles Q�2 eS./
/) Wood Shakes ❑ Wood Shakes
L5 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 Polic :
Job Description: 7 d �.r>/e 2 Wo UP R��5� J,t1 STftGG i L11 feGT.
C MP e
Residential Commercial ❑
Fire Zone: , Yes ❑ No Confirmed with Plann'
are any res � ons:
Cost of Proje t: MO. 20Uf
Type of Construction: /� ccup cy p:
13, � Q�
Qty. if
A lica 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
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