09030023 CITY OF CUPEO
BUILDING DIVISION RTINPERMIT
PERMIT NO.
BUILDING ADDRESS:
10 1 P1iRhf1T tssvE DwTE
GwNER'S NAME. IMPROVEMENTS
Sp CONTROL NO.
HO
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
RE-ROOF' REMOVE EXISTING D D 0
Hca LICENSEDCONTRACIOR'S DECLARATION SHAKE ROOF, INSTALL ��bl�escription
v I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
lz t with Section 7000)of Division 3.f the Business and Professions Code,and my license is
4 H in full force and f 7i
v�Z Licen Contractor
3 y Date
ARCHITECTS DECLARATION
tt I understand my plans shall be used as public records
D,U
4 O y Lnensed Professional
OWNER-BUILDER DECLARATION
1 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
K m which requires a permit to cnmatruct,alter,improve,demolish,or repair any structure
y"y prior m its issuance.also requires the applicant for such permit to file a signed statement $ Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 q
Ya= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i .. that he is exempt therefrom and the basis
subjects cu ge aaempl to a civil penalty of APN Number Occupancy Type
Section 7031.5 by arty applicant for a pe je PP
not more than five hundred dollars($500)•
I,as owner of the property,or my employees with wagesat their sole compensation,
will do the work and the suWure is not intended or offered for sale(Sec.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 1[,
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.).
C]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-
ccuse 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. B&P C for this reason
1 am exempt under Sec
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for workees Compen-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued•
have and will maintain Worker's Compensadon insurance,as required by Section
3 00 of the labor Code.for the performance of the work for which this permit is issued.
My Worky�s Compean lnsu carticr and Polity number are:
Caries fire I//nf r Ye Policy No.:3LI 21 L Ll Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(f 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,atter making this Certificate of Exemption,you shmuld
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J,Z forthwith comply with such provisions or this permft shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
E-r CA I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendcfs Name
Z
L.endees Address
(certify that I have read this application and state that the above information is
LUL� correct.1 agree to comply with all city and county ordinances and stale laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
>4 WCL
(W to
a to save,indemnify and keep harmless the City of Cupertino against
r-4 to liabilities,ju m nts,costs and expenses which may in anyway accnre against said City
()z in conseq ce Wofthis Date
APPLIC NT COMPL4WIALL/�ON_POINT Issued t y:
sou Re-roof Sig �re ofAppliT of Roof
HAZARDOUS MATERIALS DISCType
will ahs 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)? 0� All rool's shall be inspected prior to any roofing material being installed.
0Yes If a roo-is installed without first obtaining an inspection,I agree to remove
will the applicant or future building occupant use equipment or devices which
emit haiarduus air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes ONo
1 have ad the harardoms materials requirements under Chapter 6.95 of the Califor-
nia Health et Sections 25505,25533 and 75534.1 understand that if the building
docs not a that f ' y responsibility to notify the occupant of the Date
requi in in Lance trance of a Certificate of Occopan Signature of Appl ieant
All roof coverings to be Class'`'or better
ner or authorize ag
Community Development
ose10300 Torre Avenue Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Buildin Deartment
JOB ADDRESS: fp/�4 �".a 4,P,. PERMIT #
OWNER'S NAME: yr e PHONE # q ,o
GENERAL CONTRACTOR: X .7 FAX # qDE' 7v -a 7e)
an ^ �OZe
I am not using y subcontractors:
SVE'Eire to
Please check applicable subcontractors and corn plete 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
FIE Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
�- CITY OF CUPERTINO
k REROOF
CUPEkTINO PERMIT APPLICATION
��o3n�23
APN # Date:
010.110
Building Address:
f7 8K,
Owner's Name: y1ne G2p�e.oev� Phone 1#:
HOA: Yes No If es provide letter from HOA
7G�G�G a
Contractor: cPhone
Fax #: 6616
Cupertino Business License #: Contractor License #:
43IS7-7Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 4 Asphalt Shingles
1Wood 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: �;xis r,� sjaz `4,OZZ fvr s/,,,W 7116 65b, /�� ✓�'Yr� ¢
Residential Commercial
El
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:
1 y4�D
;Have=s a ill Comply with Cupertino's Tear-Off Policy:
ature
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof(,ommercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
-3�3 1RER00FRES R-,roof residential B 1SFDWLROOF
1BCBSC Cal Bld€, Standards B ALL PERMIT TYPES
I Commission Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commi,,sion Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 appLed 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 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: L y
Job Site Address:
Roofing Company Name:
Applicant's Signature:
Date:
Greg Casteel
Building Official
Re Ased 07/30/08