09030060 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT � '°
PERMIT NO.
BUILDING ADDRESS:
11000, 11010 , 11020, 11030 , 11040 FUR EA ON
PERMIT ISSUE DATE
OwNMA":SKY SQ
12MI, MANAGEMENT- BOX-4668 S CONTROL NO.
'ONE:
(408) 2; 8-0330
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
0
u O p LICENSED CONTRACTOR'S DECLARATION Job Description
m firm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE-RF '.1000-11040 NO RTH S KY S Q, RMV S HK I N S T L GAF
n a in full Corse and off j TZ�1 Q
� z License Lfc.lt� GRND CItNYN RFSYS &30#FLT UNDRLYMNT CLS A 58SQ
^ Date Contractor
3 F'� RCHITECI'S DECLARATION
understand my plans shall be used u public records
�yU
y Liccnsrd Prufcssional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
Co following reason.(Section 7031.5,Business and Professions Code:Any city or county
which mquims a permit to construct,alter,improve,demolish,or repair any structure
n rn prior to its issuance,also requires the applicant for such permit to file a signed statement ; ,Ft.Floor Area Valuation
G that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 3 q
X F- (commencing with Section 7000)of Division 3 of We Business and Professions Code)or $33000
L .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars(S5W). 316 4 0 01)4 .RF S
❑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(Sec.7044.Business Required Inspections
and Professions Code:The Contractors 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 employers,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.).
❑I,as owner of the property.am exclusively conuacting 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 demon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑1 am exempt under Sec. B&P C for this mason
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 for Workers Compen-
_.tion,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 Workers Compensation Insurance.as required by Section
3700-oT the Labor Code,for the performance of the work for which this permit is issued.
My Worker'yCompensation lAwrance carrier and Policy number am:
�0=51710N
Policy No.: 0466—S2 e:CE IFROM WORKERS'
N INSURANCE
(This section need not be completed 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued(See.3097,Civ.C.)
W A Lenders Name
Z
Lenders Address
U 0 I certify that 1 have read this application and state that the above information is
LL Ecorrect.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against S
cA liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
e-- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N. INT Issued by:
SOURCE REGULATIONS.
Re-roofs -
Signature of ApplicanUCon ate T of P.00f
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino M nicipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes a If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future ']ding occupant use equipment or devices which
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
,strict?
❑Yrs No
1 have read the hazardousmaterialsmquimmcnts under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505.25533 and 75534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must prior to issuance of a Cenificae of OccuSignature of Applicant Date
t'�•--�- - — All roof coverings to be Class"A or better
Owner or authorized agent ae
AA
V,
CITY OF CUPERTINO
z` REROOF
CUPEI �TINO PERMIT A.PPLICA.TION
APN # Date:
, 3 [ k1Pq_D o6q .
Building Address:
Owner's Name: Phone#:
Contractor: Phone gip$
f�(,11_ �c � 1� r� v� Fax #:
Cupertino Business License #: ,� Contractor License #:
�Z 7 ,;�-/0
Type of Roof Covering:
Existing: Proposed:
❑ Built'Up Roof ❑ Built-Up roof
❑ Asphalt Shingles w-Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) ��-��` �- ❑ Other (Specify)
Number of existing coverings _ ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,,.�o,;, C�a �i�'`C ��,�c�,G — -,,,,� -c C ,�'�`✓
Residential Commercial
Green Building: Please complete relevant pc rtion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions:
application or if applicable, include in plan
set & the sheet index.
Valuation,
I Have Read, Understand and Will Comply wi-h Cupertino's Tear-Off Policy:
Signature
CUPERTINO
CITY OF
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
S� 1REROOFMRES Re-roof Nlulti-Family B 1MFDWLROOF
1BSEISMICRE Seismic F_esidential 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 ag.-ee to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be appli E!d 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 Ciiy,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 t 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.
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 cz.n be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/t" 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: a 4,1 L 14
4 �'ry��
job Site Address:
0
Roofing Company Name:
Applicant's Signature: JW
�.ti/� Date: l
Greg Casteel
Building Official
Rei Wised 11/2/04
Community Development
'�•. 10300 Torre Avenue
;;. Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
';UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
O R'S AME: / /� rc'ue%� C� �— PHONE #� � . '
GENERAL CONTRACTOR: FAX # �8�c� "
I am not using any subcontractors: —�'
Signature Date
Please check applicable subcontractors and complete the followinginformation:
ja=SU=BC0NTFRACT0R__BUSIT ESS 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/Contractor Signature Date