09030177 CITY OF CUPERTINO PERMIT
erg.
BUILDING DIVISION PERNIIT
PERMIT NO.
BUILDING ADDRESS:
21891 HERMOSA AVE JIM FEF-KEL ROOFING 09030177
OWNER'S NAME. C ONTRAC'TOR PERMIT ISSUE DATE
C
SXNIYA CONTROL NO.
'ONE:
(408) 3; 0-3436
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
Q p LICENSED CONTRACTOR'S DECLARATION Job Description
m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is RE—RF T/O RF SHEAT OSB 3 0 LB FLT 3 0 YR DIM SNL RF
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in full force and cet
'ass [ic.8 21SQ 4/ 12 CLS A - CONTRACTOR RNWD BUS LIC 3/24/9
G D8e f Contractor
ARCHITECTS DECLARATION
a< 1 undersand my plans shall be used as public records
�yU
L O y Licensed Professional
y 3 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
Cp o following reason.(Section 7(131.5,Business and Professions Code:Any city or county
c.9 which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance.also requires the applicant for such permit to file a signed statement Valuation
P Ft.Floor Area
_ that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq
t✓ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $11000
y 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 APN Number Occupancy Type
not more than five hundred dollars(5500). 357160"4 . 00
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactoes License Law docs not apply to an owner or
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 contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure forworkees compen-
. iron,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation In nce carrier and Policy numberam.
Cartier. , PolicyNo:
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be compleed if the permit is for 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 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z"" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
tx the work for which this permit is issued(Ser:.3097,Civ.C.)
W Q Lender's Name
r7 z Lender's Address
U O 1 certify that 1 have read this application and safe that the above information is
LL►-4 correct.I agree to comply with all city and county ordinances and sate laws relating to
O[.4 building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
Q, (We)agree to save,indcmni and keep harmless the City of Cupertino against
,E"y V) linconquenceofthegrantin
dgments•PWMPLY
in any way acme against said City
U Z L� ��fT UNDEWITH ALL NON-POINT Issued by: Date t
EQU
Re-roof:, -
7d.flincd
mofApplicanVComractor Dae T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed.
C3Yes -
Will aroof is installed without first obtaining an inspection,I agree to remove
ill the applicant or future building occupant use equipment or devices which
it hazardous air contaminants as defined by the Bay Area Air Quality Management all ne materials for inspection.
.strict?
❑Yes Nu
1 have read the haz s materials requirements under Chapter 6.95 of the Califor-
nia Hcal &Safety Code ons 25505,25533 and 25534.1 understand that if the building G
does no urmndy have ant.that i ' m nsibility to notify the occupant of the
requi is which m met pri u of a Certificate of occupan Signa I e of Applicant Date
All roof coverings to be Class'i4."or better
Owner o authorized agent Dae _
CITY OF CUPERTINO
a� �
REROOF
CUPEkTINO PERMIT APPLICATION
APN Ll . Dat —
J
Building Address:
Owner's Name:�j7�(J,s_- Zj 0 Phone#:
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: Phone#:Z+0
Lr � Fax
Cupertino Business License #: Contractor License #:
�Q 6
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ A phalt Shingles asphalt Shingles
d Shakes ❑ Wood Shakes
Y Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings Z_ _ ❑ Provide I.C.C.E.S. Report #
x'fo be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
y
Residential Commercial ❑
Green Building: Please complete relevant pa rtion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the :application or if there are any restrictions: ❑
applicable, i clude in plan set & the sheet index.
Valuation:
I Have Re d, Understand d Will Comply with Cupertino's Tear-Off Policy:
S' nature
Revised 02/05/09
-- CITY OFCUPERTINO
RI�ROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1 REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES
Commis sion Fee
1BSEISMICO Seismic Commercial B
2 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commi,,Sion Fee
' 1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bld;; Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
1IS Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS:2 /eg/ PERMIT () 3 l
OWNER'S NAME: L,"(> PHONE #3?0 C(
GENERAL CONTRACTOR: F-0
I am not using any subcontractors:
Signature Date
Please check applicable subcontrL Zand 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/ ontractor 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 a,;ree 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 app lied 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 ap::)roval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood n ail 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 na:.l 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 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: -_4!5;r94 L` G•/ C�
Job Site Address: / �"�� / �C��iD �l/�•
Roofing Company Name:
Applicant's Signatur Date-;
Greg Casteel
Building Offici
ReNised 07/30/08