09040039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS: ,
T D ROOFING
7465 DUMAS DR 09040039
PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
'ONE:
(408) 892-8872
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG EO PLUM 0
Q p C LICENSED CONTRACTOR'S DECLARATION Job Description
inI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Seorceande)ecDivision3oftreBusirhessand ProfessionsCode,a �license is RE-RF RMV 2LYR WDSHK INSTL 7/160SB 15LBS FLT 30YR
c D y in full form and effect Lle A �(a
j rn Z License s
.-� D„� Contraetor. tD.�aa�"`�G SHNGLS& NEW GUTR CLS A 2 SQ
ARCHITECTS DECLARATION
I a< 1 understand my plans shall be used as public records
D,U
W y Licensed Professional
n yOWNER-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
m alter,improve,demolish,or repair any structureV6 which requires a permit to construct,
rn prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
Yo=-C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10000
i 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). 35924040 . 01
❑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 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.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 U.
ccnse 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.
❑1 am exempt under Sec B&P C for this mason
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-
-.tion,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workees Qomp nsa on Insursnc carrier and Policy number am: r�
� �,,��) Jt k—
Carrie"
Policy No.: c z z 1/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed 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 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`j,,, forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
F.r r-r 1 hereby affirm that Were is a construction lending agency for the performance of
Q!h7 the work for which this permit is issued(Sec.3097,Civ.C.)
WA Lender's Name
]
Z
Lender's Address
V C 1 certify that I have read this application and state that the above information is
[L HcorrecL I agree to comply with all city and county ordinances and state laws relating to
V building construction.and hereby authorize representatives of this city to enter upon the
Wabove-mentioned property for inspection purposes.
CL (We)agree to save indemnify and keep harmless the City of Cupertino against
Hto liabilities,judgments and�xpenses which may in anyway accrue against said City (��JW /
V Z in consequence oC c ti of this permit Date
►� APPLICANT RS NDS AND WILL COMPLY WITH;777a;
Issued ty:
SOURCE TI S.
Re-roof
Signatu Applicant/Contractor arc Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yp
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
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
C-]Yes LJ No
Will If a Too:
ll the applicant or future building occupant use equipment or devices which is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminantssfined by the Bay Area Air Quality Management all new mate ' r inspection.
strict?
❑Yes ❑No /
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,WAMY3 25505,25533 and 25534.1 understand that if the building
does not currently h tic L it is my responsibility m notify the occupant of the Date
requirements wh' m m or to issuance of a Certificate of Occu S ignatu a of Applicant
U y All roof coverings to be Class'. or better
Owner or authorized agent Date
C�' CIO a9
CITY OF CUPERTINO
u RFROOF
CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address:
7 `/(oS' DLA&nas
Owner's Name: t Phone #:
HOA: Yes ❑ No ❑ If yes, provide letter from HOA Ya6'/ - ;25�q6
Contractor: Phone #: 416,l-- 6,2-S=dvt, (--
Fax #:Z/L)�- Z* .3 — 9/742"
Cupertino Business License #: Contractor License #:
S-Z/"-c/
Type of Aoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles u, 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: 2 L -• wo c�c s ct -� h S !f `�
v✓ �,h� �`e_ S
Residential Commercial ❑
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 in lex.
Valuation: a -
I Have Read, Un and Will Comply with Cupertino's Tear-Off Policy:
Signa
Revised 02/05/09
-� CITY OF CUPERTINO
(t`,._ R.ERDOF
CUPEkT1NO 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
Commissio 1 Fee
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
i--
i 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business L,cense 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 ie-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 buildvtg 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 Ci-y,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 nai:.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 In "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: K%vxfY1
Job Site Address: 7 q L- 5-- L)
Roofing Company Name: '
X0
Applicant's �
's Si ature: Date:.,, -7,0
Greg Casteel
Building Official
Revised 07/30/08