08120004 CITY OF CUPERTINO �..... �§
BUIL NG DIVISION PERNUT ` COI RACTORI, F(1RM ATTQN -
BUIIDING RES': PERMfr NO.
9Z,eHYDE AVE TBD - T
OWNER'S NAME: PERMR ISSUE DATE
HAT 6
NE: A 8 CONTROL NO.
ARCHIIECnENGINEER: BUILDING PERMIT INFO
BLDG EIECr PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION Job Description
U F i herby,alarm that l who lisved umMr Provisions of Chapter 9(commencing
with Section 7")ol'Divislon 3oflhe Business and ProfeuVons Code.and my license is
7ohkfull faaeand e ee RE-RF T/O EXTNG TAR&GRAVL &INSTL NEW ROOF BK PER
J)a Z Littnsa Clue "T Lb
nk-
Data 11, cormamer MNFT RQMNTS;CLS A 20SQS
e£ ARCHITECTS DECLARATION
I understand Plans shall be used u w
public rertls
W U
lea
a Licensed Professional
3 OWNER-BUItDER DE CLARAT car
I bear,aRir that 7 1. .Bumps from Ne Cssin. o Ltenm Law for the
p O following ai mama. Peru t 7031.5.Bulinus aM Pofe,duns moor:Any oily or county
S$ white its issuance.su prsmit so Inns i t.alter,impmrs,h Urn it t nr mpoig ed sm rem
r , not he s l eased purse require da aphid O orsuch pemis m ME.incense signed mtment
< nurhacarenwit pursuant to he pro visions of dtecanuacwraucmaal.w(chapmr9 Sq.F[.Floor Area Valuation
'1-0 Z (hat hei ratempth Semon 1000)of basison3of ranged Business aad pton,Any vlCaAe)w
>�$
that W u ewvpr 1hnnlmn and tie baso for the alleged.••^ptioa Any Hmation of 810000
Secalon 7031.5 by any,applicant fora Permit subjccu the applicant In a civil penalty of APN Number Occupancy Type
trot mart than Ove buedrtd dollen('St10}
❑l.uwwsof Wepropeny.wmyennployeuwimwaguutha4.mkmmpte dw. 37539005 . 00
will do profession;
andn- ah Cartrstures Udcdwanc do
forutApply.an Em -IOf Required Inspections
and property won
W Code The Conhacmrs U.Law dao oat aPPIy Ir an caner of - q. P
man employees.
Wildswimprowthimpro means dmsauchcork himselfortgrough M1u
con employees,pfing or dm such impro Old wit arc not arofintended ormfeeed forsale,if.
however,Nebuilding Orden of pmAntsolde did ora Year of Imran sforns,the impose los.). will have rhe burden of proNng Nu he did Out dtik w improve far Puepoae of
tile.).
❑I.u owner of the property.am exclusively canuseting with housed mnvaclms to
construct the pmjm(Sec 1010.Business and Pofemau Cade:)The Couusemrs U.
Geste Law does rot apply to N Manor of property who Wilds or improv thereon.and,
wed ccrusi for such projects with a conuxmr(s)Iicanxd puesunt an the Conuaernr's
Lixue law.
m
I aExempt under See ,B B P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of pedur,aro of the following decluauau:
I ham and will maintain a Certificate of C.m to xlf-incom for Workerscoarpen-
m,u provided for by Section 3700 of the tabor Code.for the Performa a of We
Werk far which this i mnir is issued.
0 1 hate and will maintain worker's Compemasian Insurance,u toquired by Section
31110 of the Lather Code.for the performance of We work for which must Permit is issued.
My Worker's fC'omperea ion Insurance carrier and Policy number ase:
CaetierJ 1 I' .�r.VN.� Policy No.:UO I C�3��
CE FlGTEOF PTION FROM WORKERS'
COMPENSATION INSURANCE
(Tiusxnim reed err W compicoul aft perch is forme hundred do0an($100)
no ICa1)
1 certify that in the perfoemawc of the wart for which out Weak U issued.l shall am
employ any parson in any mannerm u to become subject to the Warlan'Compcnv0on
Laws of California.Date
App
NOTICE TO APPLICANT'If,after making this Cenifmate of Exemption.You should
become subjM an the Worker's Compeaation provisions of the Labor Code,you menu
O z forthwith comply with such provisions or this permit shall be domed row uml.
z OCONSTRUCTION LENDING AGENCY
[--tom IWrtby affirm i tWrt is.construction lending agency for led performance of
lXi the wart far which this Permit k issued(Sce.309'l,Civ.C.)
y,Q Landers Name
=z Landers Address
U Q 1 cartify that 1 have mad this application and sok WE the halve to[omati.is
I1. cord I agree to empty with all city and county mannas and sok laws aiming to
.c building construction,and hereby anshodre mpmxnatives of this city in Omer upon the
W aWve-mendarm!pmpeny for inspection purposes.
gy (We)agree to sate,indemnify tib keep harmless the City of Cupertino against
Iiabili0ce,)udgwenu,Coss,and cast.which may in any way amuse against said City
U z in couequcnce of the granting of Nu Posit. �j r� L
t-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date U/
SOURCE REG LATI
�-bJ-A!K Re-roofs
'i aurc of pian onteacc Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dor applicant or for=building merpmtaore,orhandlc h rmdous material
u defined by the Cupertino Municipal Cade.Chapter 9.13.and he Health and Safety
Code.Section 155324)? All roofs shall be inspected nor to an roofing material beinginstalled.❑Ym ON.
Will the applicant or future Wilding wev tom use Equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hvaAnu air cmumitan s as defined by the Bay Arta Air Quality Management all new materials for inspection.
uictl
UYu XNo
I haw,mad the haundous materials rtquirtenens,under Chapter6.95ofthe Califon. - t
.is Health&Salaycoln.Section,25505,25533im125534.1 unamand thatfthO Wilding -
dwa trot cumnOY hast a tenon,that it u MY MPonvhility In may da Occupant of Ne
agmamcnuwhichmuabe metpdork Lnummofa Cm Fwakof Occupaay. Signature of Applicant Date
17 " Dow All roof coverings to be Class'%W'or better
er thove0 scam� Dat
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37539005 . 00
DATE ISSUED. . . . . . . : 12/01/2008
RECEIPT # . . . . . . . . . : BS000006711
REFERENCE ID # . . . : 08120004
SITE ADDRESS . . . . . : 920 HYDE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HAL ARRACLOUGH
ADDRESS . . . . . . . . . . : 92,0�YDE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4663
RECEIVED FROM . . . . : JOSE J JIMENEZ
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- ------- -------- ------ ----- -------- ------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1REROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 375 . 00 0 . 00 375 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 375 . 00 MC
---------------
TOTAL RECEIPT 375 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----- ----------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
_ Community Development
t14 10300 Torre Avenue
I ' ,•.'�I' Cupertino CA 95014
1
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEI,TINO
Building Department
JOB ADDRESS: 0 PERMIT # L j�DdO�
OWNER'S NAME: �/ PHONE e15/2 - ZZZ
FAX # Z
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
60 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 az
Septic Tank
Sheet Metal
Sheet Rock
�— Tile
Owner/Contractor Signature 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 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.
S5. 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 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 with the above stated policy on re-roofing.
Homeowner's Names:
Job Site Address: 120 - nnold r, 4y L_ cu P� I
Roofing Company Name: �J r� j!� i 1 N cam.
Applicant's Signature: O 1r�Cl�� Date: 1 -G t Cr
• Greg Casteel
Building Official
Revised 07/30/08
op000
CITY OF CUPERTINO
REROOF
CIT•CUPERTINO PERMIT APPLICATION
_
APN #:27.� o c) ; v Date:
Building Address:
c C
Owner's Name: Phone #:
116X 25"2— 2
Contractor: Phone #: y°yg y 7_ f 7 Z
A Fax #: 37— 6y7Z
Cupertino Business License #: Contractor License #:C-3ci ,g`3`6
Type of Roof Covering:
Existing: Proposed:
a Built-Up Roof. v, Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
41 ❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other(Specify)
Number of existing coverings 2,6 ❑ Provide I.C.B.O. Report #
m To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: j t{� 0 o .J� cX t s 'N�'�+g TttC $
I VS_T4 Lt_ MCyi 0 AX-j< (yam �,,cnu-'ccs.. r zu-1, w s
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: 10r0 G
I Have Read, Unde d and Will Comply with Cupertino's Tear-Off Policy:
Vig—nature
Revised 6/16/08
-� CITY OF CUPERTINO
i -- REROOF
CI OF
CUPEkTINO FEE SCHEDULE •
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
10
' 1RER00FRES ' Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
4
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08