07010090 CITY OF CUPERTINO
BUILDING DIVISION PERMITe�1� lG C)P I:�1Ft? 1 1�
BUILDING ADDRESS: PERMIT NO.
22090 RAE LA WOODS RI
PERMTT I85UE DATE
OWNER'S NAME:
CUPERTINO HILLS SWIM AND 2179 STONE AVENUE STE 22 01/17/2007
SANITARY NO. CONTROL NO.
` (831) 63r -5576
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
i F I hereby affirm that I am licensed under provisions of Chapter 9(commencing REROOF POOL HOUSE- TEAR OFF EXISTING BUR, REPLACE
=Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
Dni i�elnseCla�and efret•,t--G �* 4 % WITH 4 LAYERS 1 BASE 1 CAP 2 PLY, HOT MOPPED WITH
3 t-1 Date
/ ( ContractorTAR. C L'.S S A
ARCHITECTS DECLA ATION
2.14a
U l understand my plans shall be used as public records
LH Licensed Professional
n y 3
OWNER-BUILDER DECLARATION
<2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
i
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
,a rL which requires a permit to concoct,alter,improve,demolish,or repair any structure
u Z r prior hi its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area $7900 Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 7 9 Q Q
%�$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3560702'' . Number Occupancy Type
not mote than five hundred dollars(5500)
0 1,as owner of the property or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or imprnves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose or
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
ve and will maintain Worker's Compensation]ttmrance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workceees Compensauo uran carrier and Policy number are:
Carrier.J1J:J2 olicy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption•you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�zr forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
(.t 4 1 hereby affirm that there is a construction lending agency for the performance of
(Z t7 the work for which this permit is issued(Sec.3097.Civ.C.)
W Q Lender's Name
0,z L.cndees Address
U C) I certify that I have read this application and state that the above information is
LL" corect.1 agree to comply with all city and county ordinances and state laws relating to
�Ubuilding concoction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,cuss and expenses which may in any way accrue against said City
U z in consequence of the granting of this permit. Date
�. APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU C EGULATI S.
Re-roofs
Signature of Applieam/Contraetor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Loof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? , All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant r forum building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove
Will the applicant er
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Q Yes
1 have read the by ous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade, ctions 25505,25533 and 25534.1 understand that if tftc building
does currently have a tenant,that it is my responsibility to notify the occupant of the
reqs ts i h must be met prior to issuance of a Certificate of Occupancy. Signaturt of Applicant Date
1✓r 7 e>— All roof coverings to be Class"B"or better
Owner or authorize a Date
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 i irst 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 he 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: Z Z 0 9 0
Roofing Company Name:
J
Applicant's Signature: Date: 1-17-
V
'17" vT
Greg Casteel
Building Official
Revise 311/2/04
ADI oogO
CITY OF CUPERTINO
RE ROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: -P do L l0 USE
Owner's Name: Sw Phone#:
V414 CIUL $/fly es
Contractor: License#:
Contact: Cupertino Business License#:
North Bay Permit§9X9 Type of Roof Covering:
Existing: Proposed:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ 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 Cit ertino's Tear Off Policy: ❑
Job Description: n / clap
esidential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dfft. if
there are any restrictions:
Cost of Project: s� Type of Constniction: Occupancy group:
1 7V00
f Fee Group
i
Qty.ty.
Applicable le Fee ID Fee Description
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