09040145 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
11646 CEDAR SPRING CT CASTILLO' S ROOFING 09040145
OWNER'S NAME: PERMIT ISSUE DA'L'E
AwgARF
)NE: S A 9 9 9 CONTROL NO.
(408) 251-3565
ARCHITEC IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION
u P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Scction 7000)of Division 3 of the Business and Professions Codc,and my license is
H in full force and effect J) RE-RF T/0 EXT WDSHK APPLY#3 0 LB FLT GAF GRND
v�Z License CI Lic•# l
F Date Contractor CANYN
ARCHITECTS DEC N
< I understand my plans shall be used as public records S HNG L S CLS A 2 0 S Q
DaU
a in Licensed Professional
n y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
C p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m Fd which requires a permit to construct.alter.improve.demolish,or repair any structure
y Z prior to its issuance,also requires the applicant for such permit to file a signed statement
s o that he is licensed pursuant to the pmvisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yt— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 9 5 0 0
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 mere than fire hundred dollars($500). 36654060 . 00
❑I,as owner of the property,or my employees with wages as their sok compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements am 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 leaden 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 docs 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.
❑1 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 for Worker's Compen-
sation,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 Insu4EXPTION
'r and Policy number are: Q
Carrier Policy No.: 02 3 0100`19
CERTIFICATE FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is far one hundred dollars($100)
Of ICas,)
I cenifv 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
[~—t rA I hereby affirm that there is a construction lending agency for the performance of
a+> the work for which this permit is issued(Sec.3097,Civ.C.)
a0 Lenders Name
z Lenders Address
fJ 0 1 certify that I have read this application and state that the above information is
LL "' correct I agree to comply with all city and county ordinances and state laws relating to
O V building construction.and hereby authorizs representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
r�r rA liabilities,judgments,costs and expenses which may in any way accrue against said City L77
U Z in consequence of the granting of this permit. .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by: Date
SOUR ERE LA770 ,!
- T �7 d`� Re-roofs
nates of Applicant/Contractor atc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
til the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municip Code,Chapter 9.12,and the Health and Safety
Cede,Section 25532(x)? All roofs ;hall be inspected prior to any roofing material being installed.
❑Yea o
If a roof i:;installed without first obtaining an inspection,I agree to remove
Will the applicant or future builgitrg occupant use equipment or devices which
..,nit hazardous air contaminants as rued by the Bay Area Air Quality Management all new materials for inspection.
District?
El Yes 0 N
1 have read the hazardous materials requirements under Chapter 6.95 of the Calif L C }
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the buildin
does not currently have a tenant,that it is my responsibility to notify the occupant of the
re_quirements hichm mel prior to issuance ofaCcrtificatcf �� Signaturyf Applicant Date
7.1
O ner ora orized agent Da
All roof coverings to be Class'��"or better
i
D9 (DL4
,, CITY OF CUPERTINO
V RF;ROOF
CUPEkTINO PERMIT APPLICATION
APN # Date:
�P�_e 4 ') �,c7 . 00 4 hiLo0)
Building Address: I l (Pqb r
I `
Owner's Name: Sh;Zv kA Phone #: qv�- q4q . 2 f
HOA: Yes ❑ No ❑ If yes, provide It tter from HOA
Contractor: Phone #: .4bg ,25)olb� bs Fax #: 4D$_ Z!51_5 5&5_
Cupertino Business License #: Contractoricense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 4/Asphalt Shingles
VWood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings _ ❑ Provide I.C.C.E.S. Report#
VTo be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: lir 2Xi ,�6, pp)"I J�
J
Residential Commercial Lj
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-,$ q 1 -
5C)C). C)o
I Have Read, U derstand and Will Comply with Cupertino's Tear-Off Policy:
t
Signator
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 Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Ri:sidential B 1SFDWLR00F
1 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic R,-sidential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic R-Isidential 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 agr ae 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 appliE 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 Citi,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: )f you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fe a of$176.18. The re-inspection fee must
be paid before another insyection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be oil the job site at the time on inspection.
I understand and will comply with the abol,e stated policy on re-roofing.
Homeowner's Name: 6 h , -z-L,) k
Job Site Address:
1,��(o C'P� r
Roofing Company Name: &AiR)S
Applicant's Sign Date:
Greg Casteel
Building Official
Revised 07/30/08
Community Development
.F 10300 Torre Avenue
fl- Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
„UPEkTINO
Building Department
JOB ADDRESS: Ce&r Sor n�- PERMIT # Oct Q) _
OWNER'S NAME: Sh i 2 Prvva r . PHONE # LOW-2,5)-35&,S-
GENERAL
S-2,51-3s&.rGENERAL CONTRACTOR: FAX # 4C)9-25)-3S&5'
I am not using any subcontracto 14'27
Signature Date
Please check applicable subcontractors and com lete 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
qb-716
D to
Owner/Contractor Signature