04090298 (2)CITY OF CUPERTINO • `" ' "- '`�
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... BUILDING DIVISION,, ' .� PERMIT ..'
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Bu1LDINGADDRESS:
SHELTON ROOFING
PE"MITNo04090298
7547
OWNER'S NAME:
PERMIT ISSUE DATE
FRANK NISHIURA
ONE: "
SANITARY NO. CONTROL NO.
(650)961-7699
ARCHOECT/ENGINEER: -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
JOb DeBCri t10
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1 hcmby affirm that 1 am licensed under provisions of Chapter 9 (commencing
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whin SCmu. 7Btplaf Divhsien 3 of dm Basin., it Professions Codo.and my license is
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infug mmeand off n-3,4' I.k Z/ef
License,
REROOF W/SLATE TILE -
DEG l- 2004 -
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ARCH N
- I undcmemd my plans shall he meJ u public ...,its
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BUILDING 1 A ,
.. B U I L DI �F G
Licensed Professional -
OWNEm DECLARATION
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exempt Iron the Cssions is License Law for the
1 hereby affirm 1 exempt f
maso on 1. cu Code: Any city or county
following (Section ]constr Business,aon,ar
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NmC Improve, demolish, or sig any structure
which requires a permit to s w, de
which
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its the e a
the Co
thiartoslcenseCP,aim rtlarequiresIIIC iskinanf for such point( to s Law (Chapter
thathe iLianselaw(Chale)or
ectios 70th)
PSection
Sq. Ft. Floor Area
Valuation ,... ..
menccenmd
of Division, she arsines
of Division 3 of
exempts and
(cat see with Surio
- - - - -
the on. Any ed on
thes he is exempt therefrom and the buts lar Ne dlcgcd exemption. Any violation of
he is an and aged
3 6eNNdkffier0 0
Occupancy Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan five hundred dollars ($5001.
0 I, n ower of the pmpery. or my employcu with wages u their mle compenutlan,
_
Required Inspections -
will dote work, and Nettrunu¢is not intended mothered forsalc(Sec. 7014, Business
and Professions Code: The Contractor's License Law dors not apply M an owner of
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propenywhobuildsorimprovuthemon. and who doessuch work hoselfortNough his
oweemployees,provided Natiuchimprovememsom nmimmndedoroRered formic, If,
however, lie building or improvement is sold white one year ofcompletion, me owner -
builder will have the home. of proving that he did act build or improve for purpose of
-
mth.).
❑ 1, as owner of the property. am exclusively contracting with licensed contractors in
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construct the project (Sec. 7014, Business and Professions Cade:) The Contractor's Lt.
cane Law does not apply he va owner ofpropenywho buildsammpre sthereon. and.
whocumnctsfor such projects with a camnctor(s) Iicensedpnatemlfa Ne Contractor's
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License Law.
❑ I am exempt undo See. Bd PC far this
Owner Dam
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WORKER'S COMPENSATION DECLARATION
I hereby afBsm under penalty of perjury one of the following declandons:-
I have sad will maintain a Certificates of Cannot o sap6iesure for Workers Compen-
sation, as provided for by Secure 3700 of the Labor Code, for the performance of the
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workforwhichthisPermitisissued.
have and will maintain Worker's Compensation Insunncc, as required by Section
300 of the Labor Carlo, for the Performance of the work for which this pemtit is issued.
M Worksorc� afpy�nmtto Insumau carom and Poli number am -
Cr J •/ Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This =ties need not he completed ifthe permit isfaroac hundred dollars ($jEE
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ones=)
1 certify that in the performance of the work for which this permit is issued. l shall not
employ nay person in any manners. as m bosom. subject to she Workers' Compensation
Laws of California. Dam
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Applicant
NOTICE TO APPLICANp:If, after making this Ommimme of Exemption, you should
become subject in the Worker's Compensation previsions of the labor Code, you must
forthwith comply with such provisions or this permit shall he deemed ranked.
CONSTRUCTION LENDING AGENCY
1 hereby alrtrm than there it a construction lending agency for Ne performance of
tim work fur which this p .it is issued (Sce. 3097, Civ. C.)
Under', Nines
Landei s Address
I certify dual 1 have read this application and stare that the above information is
correct. 1 agree to comply with all city and county ordinances and sure laws mlefing to
building coutrunhon, and hereby autitorim representatives of this city to enter upon the
above-mentioned property for inspection purposes
(WC) agree to save, indemnify and keep harmless the City of Cupertino against
limililtax,jYdgna att. Costs andeapenses which may to any way aCLNe against$alit City
in tonuquenea Rhe granting a( armif.
APPLICA NI¢RST WILL MPL1gWITHALGL/ON-POINT
_
Issuedbyi --Date -!
SOU CE U i Nk6'_
Re -roofs
Signature of ApplicaDam
US MATERIALS DISCLOSURE
HAZARDOUS
Type of Roof
Will unit applicant buildingeaupvnurore2. ad us material
CartomfMuni
Health
ss defined by the Cupertino Municipal Code, Chapter 9.11, and tho Health and Safety
"
Cade. Section 25531(a)?�
C3 Yes
All roofs shall be inspected prior to any roofing material being installed.
"If a roof is installed without first obtaining an inspection, I agree to remove _
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Distrin?
❑ Ycs
iremcnts under Chapmrfr.95 the Calicine
1 have mad the haumuuns
ria if
Cade,Sxtrau 15505, understand ifthc building
2550S.V53
7
roxcurrent
Docs not current w a moan the y respon ility mrnuly thc axes ant of Nc
yubt
_
Signature of Applicant Date
mquiremcnts ch on, I or tuuanu Car arae
;04v
'" All roof coverings to be Class "B" or better
Owner or authorized agent Dam.
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CUPEkTINO
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OW24I)erelopeteat
10300 Tare Avenue
upmtme CA 93014
ass (408) 7773228
Fu (409) 7773333
+/ Mai MlxL L+\,. fai aiilGia� '
>t J * OBADDRES& p
r;ve:. 0 09(529
i OWNBR'S NAME: c &A I"em PHONE
GENERAL CONTRACTOR FAX M
!t I am not using any subcontractors:
Signature Date
Plea" cheek annheable .t..
SUBCONTRACTOR
BUSINESS NAME
B;USINEOS LICENSE #
Cabinets & KUwork
Cem"t Ybdahimi
mectrieal
Excavation
Fencitt
Flooring Carpeting
Linoleum / Wood
j
Glass / Glazing
Heating
Insulation
Landsca
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masoLathing
Y
OrrwmenW Sheet Metal
i
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Paing / PaP� Wall
Paving
i
Plastering
In
RSeptic
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Z
Tank
Sheet Metal
Shea Rack
Tile
r
L0 30vd >Hl SailI'1V03I
X
Date
LBLEBESBSS BL�6L bONL/LL/60
1711
*CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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.
Homeowner's Name:° vLw
Job Site Address: 754
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Roofing Company Name: C_
A plicant's Signature:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date:
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CITY OF
CUPERTINO
CITY OF CUPERTINO z ��
REROOF v `�
PERMIT APPLICATION FORM
APN #36/ 6" 17
D �Sr
Date: q o�H
l�
Building Address:
-7 S z-/ 7
L,4) al
Owner's Name: Q
BSEISMICRE
Phone #:
BUILDING
BSEISMICOM
956-U59 0
Contract
Phone #:
License #:
BUILDING
c. 650 96 -7G
2 G
Contact:
Phone #: p
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
pC Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
* Other (Specify) T
Number of existing coverings ❑ Provide I.C.B.O. Report # S:(225
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Desc iption:
71 s 6, add 4 ,A..� d LL" ELt tom-'-
Q_X,-,Z .
&1�1".-U.<.1 O s s"
Residential
Commercial ❑
Fire Zone: Yes ❑ No
❑ Confirmed with Planning Dept. if
there are anyrestrictions: LJ
Cost of Project:
Type of Construction: Occupancy group:
a /. 40g• n
/6t
Y.ifD,
Annlicabl FPr m
FiPP TiPCl�1-�Tflnn
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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