07050269 CITY OF CUPERTINO
BUILDING DIVISION PERMIT IMTIUk�,,
PERMIT NO.
BUILOG1KTESLONG DOWN RD FOUR SE1,SONS ROOFING 07050269
PERMIT LSSUE DATE
OWNER'S NAME:
CMS C/O DE ANZA OAKS HOA P 0 BOX 1210 05/29/2007
SANITARY NO. CONTROL NO.
NE:
(408) 27f>-0330
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Zwith Section 7000)of Division3ofthcBusinessandProfessionsCode,andmylicenseis REROOF—REMOVE SHAKE, INSTALL 1/2" CDX PLYWOOD, 30LB
y in full force an ttec 1 Z FELT UNI)ERLAYMENT, 15 SQ, CLASS A GAF FRAND
v�Z
Lice 1 Lic.#
t ip Dao O 15 Contractor
a
ARCHrmCrS DECLARATION DEQUOIA SHINGLES.
;04< 1 understand my plans shall be used as public records
),U
'u.t- Licensed Professional
OWNER-BUILDER DECLARATION
>- 1 hereby affirm that 1 am exempt from the Contractors License Law for the
iin o following reason.(Section 7031.5,Business and Professions Code:Any city or county
e,0, which requites a pertnit to cmnstroc4 alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such perm o file a signed statement Valuation
p '� pP �` g ;�q.Ft.Floor Area
_� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $8000
ah (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
u r 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 of 3424001' .
i 64 Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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 arc 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.).
❑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 thenon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Conuactoes
License Law.
❑I 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
❑I have and will maintain a Certificate of Consent to self-insure for Workces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the tabor Code,for the crformancc of the work for which this permit is issued.
My Worke ompertlon In nee carrier and Policy nthghbe a ;
Cartier. Policy No.: lP� so1
ERTIFI A OF'tXEMFnON FROM WORKERS'
COMPENSATION INSURANCE
(This section teed not be completed if the permit is for ono 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
O forthwith comply with such provisions or this permit shall he deemed revoked_
Z'_ CONSTRUCTION LENDING AGENCY
rA 1 hereby affirm that there is a construction lending agency for the performance of
p!> the work for which this permit is issued(Sec:.3097,Civ.C.)
W A Lender's Name
2 Lender's Address
U C) 1 certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
►+ APPLICANT UNDERSTAND W L COMPLY WITH ALL NON-POINT Issued by:
E TIONS. _
Re-roofs
Signature of Applicant/Convacthr V Dao T of Roof
HAZ CDOUS MATERIALS DISCLOSURE Type
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 ;hall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
p Yes 24.
1 have read the hazardous materials requirements underChaptcr6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not curtenLI have a lona tit is y responsibility o notify the occupant of the
rc which must x m t pri i arta of a Certificate of ca ex Signature of Applicant Date
^ � All roof coverings to be Class"B"or better
wncr or authorixcd age t Date
Community Development Department
Building Division
City of Cupertino
�* 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 buildilg inspector. A final inspection and
approval shall be obtained from the t uilding 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 Ci y, 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 withou`first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be pe:-formed.
IMPORTANT:
1. Flat roofs must have a minimum of Y, " 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 abo-e stated policy on re-roofing.
Homeowner's Name: J Q '.*
Job Site Address: _ 1 �'r ►'� \ `�✓
Roofing Company Name: "'
A plicant's Signature:
Greg teel
Building Official
Revised 1/30/03
Printed,7n Recycled Paper
4
CITY OF CUPERTINO
-aN READOF
cup 11y or O PERMIT APPLICATION FORM
APN# � � ` S Date:
Building Address: C
a& I Y-- -v
Owner's Name: Phone #:
Contractor: License#:
��so�sow y�,m) la
Contact: Cupertino Business License #:
. mss 3 3 c>
Type of hoof Covering.
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles a Asphalt Shingles
W"Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
0 Other(Specify) 0 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 Cupertino's Tear Off Policy:
Job Description: ,.re✓t t�X�S��// t :5-h --- //mac � i rr fi•�// r1 c�✓ � ��J X /`� O1
//y/.�-ry�usv t a.�®/`u�..� �''/yrs /� �f/f ��i�.x c,s. •a �S�l►�•T /Q s
Residential Commercial ❑ 1
Fire Zone: Yes ❑ No [R— Confinned with Planning; Dept. if
there are any restrictions: U
CostofProject: T e of Coo�nstnictio`n: Occupancy gro)ip:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCIJK Plan Cheek Fee BUILDING
BUSLIC Business License BUILDING