08110037 CITY OF CUPERTINO Wi� �^ '
BUILDING DIVISION PERMIT nfkCyONCRA R*T1YU,,RIVIA.TIO
BUILDING ADDRESS: PERMIT NO.
21852 OAKVTEW LN TBD — TO 13E
OWNER'S NAME: PERMIT ISSUE DATE
NE: kttA 0. 8 CONTROL NO.
ARCHIIECf/ENGINEFER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� l� L� 0
up0 LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby affirm Nat 1 am licanaed under previsions of CMpser 9(commencing P
<f..l with Section 7")of Division 3 ofthe Business and Profession Code,and my littmeu
+�„ in fullromeandeff �7 2 RE—RF RMV OLD RF INSTL NEW 30LB PAPRS,NEW 40YR
'0� L1cneC C'�' 311 Lk.a ELKS SHNGLS CLS A 185
1'p Dow CLOS DELLA Q
As"I be
DECLARATION
�$av awmaundmypkNwlb tied. pnhlkmomd H D ROOFING CO. PD FOR BUS LIC 11/10/8 $110 . 00
g Licensed Prof. i..I
3OWNER-BUILDER DECLARATION
1 hertby aRm Nal 1 am attempt from the ConuamaYs License Law for the
OO following meson(Section 701.5.Basmas and Profession Code:Any city of county
C
S me which on uirm•Permit in mommet,akr.improve.dcmoluh.or repair any suumum
seat} prlorbils;YuanR.alW req for such permit m flea signed Wlement
< thamkRronedw�rottotheprovisionsoftheconnrt.raua�Law(chapter9 Sq.Ft.Floor Area Valuation
Fs0
15 (commes exem iN Smiocan and of t;vu;on 5 o(dm Budxasand Prafc y viola en of $7000
y�$ Nat he"Is exempt Nutfom and the Wsis for the aikgm evmptian Roy violation of
Section703IJ by any applicant for.permit abjrou the apPlkarn m.civil pe..BY of APN Number Occupancy Type
not mare Nov fist hundred dollars(SSW),
t.uowmrafthe r vm«av; roes o< 32619108 . 00
❑ properry,arm w I Mw uNe'v sok core wdon.
will do Nestor"and the a Com s adn's Lndede I..do f .1 apply 70M,ous.of Required Inspections
,lid Pnty wh obu Code The Co dermu s lid who Law dm rot apply lf roe,stern is q P
ow ern whobuildsmed mal such impa,.lidwho dnaouchworkhimselfedthrouN his
own employees,lding.fJur sets imps mid wait are not yeau,ofc mplcdm0plaM fuxme
weerxlx -
however,the building ammprovemron u midwithindid one yeti of romPktioa the owner-
milewilt have Id,humen of moving that h<did rot laden n improve for purpose of
um.).
❑L as owKr of Ne popmy.w exclusively contracting with licensed ronmctars m
romtma Ne momma(Sec 7044,Business and professions Cade:)The Contractor',U.
cane Law does not apply m an emmer of property who builds or improm Nemon,,nd,
who comma for such projects with a rontrxmr(s)licerued pursuant in the,Contrimme.
L;cene law.
❑I mo except undo See ,B&P C for this rtsan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby a1Rm under penalty of perjury orc of the following declarations
1 bast and will maintain aCeNfimu of Consent in elf-imam for wmkefo Compen-
.'on.as provided for by Scenes 37M pf Ne labor Code,for the Performance of do
work for which this permit;s isswd
❑I Bare and will maintain Worked,Compensation Imuran¢,as required by Section
3700 of the labor Coda fn the pedminso a of the wort for which Nu permit is issued.
My Warted Co pe adon Insurance curter and Policy number am:
Carrier. TE Policy No.: /
CERTIFlC OFEXEMPRONFROM ORKER '
COMPENSATION INSURANCE
Crus section need amt be com pleved lithe Permit is for em,hundred dollen(51010
lir less)
1 cenlh thm in Ne performance of the work for which this permit is issued,l Nail not
employ any person in try manner an as W become abject in the Women'Campemation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after mating this Cmmfcam of Exemption.you should
bemome subject m the Worked Compensation pmvisiom or the labor Coda you most
0 O forthwith comply with such pmvisiom or this permit shall m dermad mrokcd.
z` Riat CONSTRUCTION LENDING AGENCY
E I hereby arm thNem is a comwction koding agency,ror Nm
e perfuance,of
P:�>„ the wmk for which this Permit Is issued(Sec.3097,Civ.C.)
Lendee.Name
,z Lendees Address
U Q 1 crnify that 1 have read Ws appli,men and sum Nu the above information I.
j F coma 1 agree,m comply with ail city and county ominames and sum laws relating m
0U Wilding construction.and hcrthy aothodm reprmcmatim of that city m enter upon use
W alma-mentioned property for Inspection purposes.
(Wm)aroma to era,indemnify and trap harmless the City of Cupcaino agaiml
y liabilities judgments,tests and expense which may In any way acme gaimt saidCity /7
U z uncane{mace of me ung of Nu Permit
^ APPLICA DE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER G
Il—/o—og Re-roofs
siz.amumbfAmAM.L65difiractior Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will W applicant.,for.building occupaetaom m handle harardam mamns]
as exultant by the Cupertino Municipal Code.Chapter 9.12.ad the Health and Safety
code.seaian 25532(a)7 ""masa
❑Ye All roofs shall be inspected prior to any roofing material being installed.
wtil
the applicant or future building ocropam use equipment n&A.which If a roof is installed without first obtaining an inspection,I agree to remove
:it haramom err co can i,unts as dcfncd by the Bay Arca Air Qua.hy Managcmcnt all new materials for inspection.
i ct7
❑Yes y
I have rtad Ne hassmommateriaumqu;m ones trod,,Chapter 6.93ofNe Califon
.is Health&SafetyCede.Seeman 25505.25533and 25534.1 understand maifNe Wilding — // ✓ /O —(J
doesetc ti .eamnan.wtit u my mmom;b;lity m mury dm meopme or dm
mgnin map he met prior in issuumc of.Ceruflea,or OcaPumy. SignatureO Applicant Date
�!O_0 All roof coverings to be Class'%¢"or better
Owmrar,mt e, ,gem Dam
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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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$176.18. The re-inspection fee must
be Raid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 1512W//`l W RQ�JG/N
Job Site Address: I QHS 2 - oRX h,l-- / LN
Roofing Company Name: PJ
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO
Zan-
REROOF
:CUPEIIiTINO PERMIT APPLICATION
APN # Date:
Building Address:
21595-9 f K it IN
Owner's Name: Phone #:
w; W BaoW/✓ Wed - 5�q - ,S4`d$
Contractor: Phone #: y lS-cdSO -3 h 6g
gAMl'17ow ,n//{ Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑/ Built-Up roof
Asphalt Shingles �f Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
umber of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
yle-MoUE 010 &,If Nrw ;oft prgpcas / 11, ST411 N,w �o��,�aS elk
Ll yrs / - yHN lr5
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: o
s
I Have Re , Understand and Will Comply with Cupertino's Tear-Off Policy:
SigAatur
Revised 6/16/08
allCITY OF CUPERTINO
REROOF
CUPEI,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08