09020073 CITY OF CUPERTINO ��
BUILDING DIVISION PERMIT t
PERMIT NO.
BUILDING ADDRESS:21890 D P R E RO . & PERMIT ISSUE DATE
OWNER'S NAME: INC
0—fc A CONTROL NO.
SHO
(4 0 8) 6 26-9320 BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
a 0 o a
u O Z LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3ofthe Business and Profemi` dr.'andmyliccnscis RE-RF RMV EXT 1 LYR WDSHK& INSTL 1/2nCDX
n<a in full force and ✓ )1
DUJz License Class Contractor 30#FLT&LIFETIME CMP, 36SQ CLS A
F p Datc
t AR HrrECTS DEC TI
I un c land my plans all be used as pu rc
m
`o I- Licensed Professional
. OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct.alter,improve,demolish,or repair any structure
a"y prior W its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation
Z< that he is IicenseJ pursuant to the provisions of the Contractor's License Law(Chapter 9
x F$ (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or 15 0 0 0
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500). 32645019 - 00
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(See.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does 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.).
❑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 conracnr(s)licensed pursuant to the Contractor's
License Law. B&P C for this reason
C]I am exempt under Sec
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 Worker's Compen-
on,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is i tied.
My War ee Compensad n Insurance carrier and Polity n her are-
Carrie. � Policy NO.: F' u
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be axnpletcd if the permit is far one 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 Workcrs'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,atter making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
(.�Cn I hereby affirm that there is a construction lending agency for the performance of
(3,> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
a z lender's Address
U I certify that 1 have read this application and state that the above information is
IL" 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
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 anyway accrue against said City
V Z mf sequence of the granting of this permit Date I / D_r
ti APPL NT UNDERSTANDS AND W OMPLY WI ALL ON-POINT Issued t y:
SOUR ONS.
U Re-roof s -
o Applic n Date T of Roof
HAZARDOUS 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
Cole,Section 25532(a)? All root's shall be inspected prior to any roofing material being installed.
❑yes �Tl No
/ - If��.Qo:is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which = -
^t hazardous air contaminants as defined by the Bay Area Air Quality Management,' all new teri ls-for-inspe , n.
uict? f
p Yes No L
� «1 have read the hazardcxhs materials requirements under Chapter 6.95 of the Cali r-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the huildin
ty h�v�at nt,that i. m responsibility to notify the occupant of the Date
req re c' t be m2 o�ytu c f a Ccrtficatc of Oc panty Signature of Appl leant
All roof coverings to be Class" "or better
Owner or authorized agent Date
C); � 3
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN # 4 � Q� Date:
� � G4 � q 411 ��
Building Address: z. 4o,5
'PA I, o S bW '
Owner's Name: MCW�_L
1 Phone#:
HOA: Yes ❑ No M, If yes, provide letter from HOA 9% -
Contractor: '� Phone #:'3 C N SAMXA 1 UWI, i Kf( 4_ 2L _ T5 2
Fax #: 4o� - b4 - 11�
Cupertino Business License #: Contractor 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)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Jv ua/OL UY- \ivoo) Wye l
COAT
Residential Commercial
Green Building: Please complete relevant po;-tion 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:
I Have Rd, Understand and Will Comply with Cupertino's Tear-Off Policy:
Si ture
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CUPEkT1NO FEE SCHEDULE
Number of Fee ID Fee Des,-.ription Fee Permit Type
Squares Group
1REROOFCOM Re-roof(:ommercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis,,ion Fee
1BSEISMICO Seismic Zommercial B
t 1REROOFRES Re-roof:Zesidential B 1SFDWLROOF
p 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
1 Commis Sion Fee
1BSEISMICRE Seismic Residential B
l REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1
1BUSLIC Business; License B
L'�
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 C.ty,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 niaterial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood na:.l inspection and the job is not ready,
you will be charged a re-inspection iee 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 14 "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:
Job Site Address: Zl S Atx �2 ( —
Roofing Co Name:
3,0
Applic is Signat{ir Date:
Greg Casteel
Building Official
Revised 07/30/08