07090017 CITY OF CUPERTINO
BUILDING DIVISIbN PERMIT � � I ( '
PERMIT NO.
BUILDING ADDRESS:
20635 NANCY CT T D ROOFING 07090017
PERMIT ISSUE DATE
OWNER'S NAME:
MR AND MS CASTEJON 675 TULGY RD 09/05/2007
SANITARY NO. CONTROL NO.
VE:
(408) 892-8872
BUILDING PERMIT INFO
ARCHITE(IIENGINEER:
BLDG ELECT PLUMB MECH
p C LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE ROOD SHAKE & INSTALL EAGLE LITE/MAL I BU
1`40- in full force and a t� C
;n? License Class � s— Lic•# �y � I CONCRETE TIL; 5 .7 LAB PER SQ FT, CLASS A.
eZ Date Contractor
ARCHITECT'S DECLARAT
i C< 1 understand my plans shall he used as public me rds
>yU
U.y Licensed Professional
O< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
.00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
!i which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq $15000
t=O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 ofA��1 Number Occupancy Type
not more than five hundred dollars(5500). 35915025
. V V
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law dors not apply to an Owner of
property who builds or improves 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 of
sale.).
0 1,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractoes Li-
cense taw docs 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 Conuacmrs
License law.
0 I am exempt under Sec. B&P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(]I 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.
CIAlovc and will maintain Worker's Compensation Insurance,as required by Section
:PWof the Labor Cook,for the performance of the work for which this permit is issued.
My Worker's Com `onurance carrier and Policy number are: _
Cartier. �– J 1 Policy No.: 3
CERTIFICATE OF EXEMP IC- 1 ROM ORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the perfo the work for w 'h this permit is issued,I shall not
employ any person in an c jest to the Workers'Compensation
Laws of California D
Applicant
NOTICE TO APPLI ANT:If,after making this Ccrti r Exemption,you should
become subject to the Worker's Compensation provisio a c Labor Code,you must
Oforthwith comply with such provisions or this permit 11 be emed revoked.
Z" CONSTRUCTION LENDING AGENCY
(.+rte.. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0 z Lenders Address
U C) I certify that I have read this application and state that the above information is
[L a correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
13r (We
) ee to save,indemnify and keep harmless the City of Cupertino against
liabilities, c sand expenses which may in anyway accmc against said City
U 2 in consequf ranting of this permitDaleAPPLICAN STANDS AN LL COMPLY WITH ALL NON-POINT Issued by:
SOURCEIO f
C S Re-roofs
Signatu of Appicant/Contractor Da T of Roof
HAZARDOUS M ALS DISCLOSURE Type
Will the applicant or future builds g occupant store or handle hazardous material
as defined by the Cupertino Munici al 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.
0 Yes N
If a roof .s 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 tncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
0Yes u
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safetyode, ti 25505,25533 and 25534.1 understand that iCthc building __'' / rI
does not currently dave a fnait.that it is my responsibility to no ly the ott ant of the
requirements whic in nor i ccofaCertificate rga�np cy' Signatur(.ofApplicant Date
Owner or auth tzcd agent
D.4All roof coverings to be Class"B"or better
C0O1 -
CITY OF C'UPERTINO
CUPEkTENO PERMIT APPLICATION F®IM
o V Date: 9 -�
Building Address:
Owner's Nan e Phone#:
Contractor_ License
i D f� v o � Y)
Contact: e S ► 1-� u r,�� Cupertino Business License #:
'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) � C, C
u nber of existing coverings Ll Provide I.C.B.O. Report (�
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu3ertino's Tear Off Policy: ❑
Job Description: ji�Lcl I L `
Residential Commercial ❑ l I g
C(
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost of Project: Type of Constru,;tion: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE ;,31dg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408) 777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino
i. Prior to permit issuaru_c, jou m"Ist agree tO comp[, wily i O97, Siriid,irds
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildinp 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 apprcval.
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 f.rst 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 understand and will comply withtheabove stated policy on re-roofing.
Homeowner's Name:
5
Job Site Address: J �� 1 I 1
Roofing Company Name: Cl _T
Applicant's �
's Si ature: i Date: C�
PP
Greg Casteel
Building Official
Revisec 111/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`;UPEkTIN0
Buildin De artment
JOB ADDRESS: PERMIT #
,2o cc 35 (-,)-70 �?b d ( 7
OWNER'S NAME: o ' PHONE #
GENERAL CONTRACTOR: T D Va 07 A C' FAX#
%1 Sr
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
Tile
Owner/Contractor Signature Date