09040160 CITY OF CUPERTINO 40
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10796 LINDA VISTA DR QUALITY FIRST
OWNER'S NAME. IMPROVEMENTS PERMIT ISSUE DATE
660 n I "M '2999
A CONTROL NO.
'1NE:
(916) 788-2921
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION Job Description
v I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code,an my license is
o
In
in full force and t RE—RF RMV&DISPS WDSHK& RPLC W/30YR TIMBRLN COMPRF
; z LicenscClass Lice /7/160SB RPLC ALL VNTJKS FLSHNG&DRPEDG CLSA 34SQ
C F-C Dam Contractor
LQ ARCHITECT'S 9ECLA A
I understand my plans shall be used as public re rds
�yU
y Licensed Professional
y S OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
co following reason.(Section 7031.5,Business and Professions Code:Any city or county
R m V which requires a permit to construct,alter.improve,demolish,or repair any structure
a—rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
s C that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 q.Ft.Floor Area
X H$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3 3 3 48
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). 35608003 . 00
❑1,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.).
.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 Contractofs
License Law.
❑I am mpt under Sec B&P C for this reason
Owner fk_tj�lowing declarations
I have and will maintain a Certificate of Consent to self-insure Cor 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 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 Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone 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►-r CONSTRUCTION LENDING AGENCY
(~r rA 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 L.endces Name
z Lcndees Address
V 0 I certify that I have read this application and state that the above information is
IL H correct.1 agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
>"a (We)agree to save.indemnify and keep harmless the City of Cupertino against
p.4 to liabilities,judgments,costs and expenses which may in any way accrue against said City
V z in consequence of the granting of this pe Date
", APPLICANT UNDERSTANDS A WIL COMPLY WITH ALL NON-POINT Issued by:
SOURC EGULATIONS.
li Re-roofs -
Sign ur'Y.Ilf
pplicant/Co for Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
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
Cole.Section 25532(a)? � All roofs E hall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminaLs asdcfincd by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building —"`� 7 j
does not currently have a tenant,that it is my responsibility to notify the occupant of titc
require which must be met . to issuance of a Certificate of Occupancy. SlgnatiCe Applicant Date
�� L� All roof coverings to be Class'"or better
Owner o u orhred agent Date
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION
APN # Date:
t
Building Address: lo4ello 4-,
Owner's Name: Phone#:
1� e,1u;
HOA: Yes ❑ No If yes, provide letter from HOA
Contractor: Phone#:
Fax #:
Cupertino Business License #: C 8ptractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ phalt Shingles ❑ Asphalt Shingles
ood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ;al Other (Specify) 12,0 jr
Number of existing coverings ❑ Provide I.C.C.E.S. R port#__�_
9. To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 2YY1DU,e i sP&r"e O ' w006, gh(t ke 916d_�. R(2 Pla&e_ W
30 y ear ?m bier 1,>)'e, d4m ;q ova w y to OS Ck6
-PA 1-,,-q 6'r�P 249' 'p-,
v'p- 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 index.
Valuation: #33 ,3q8-. ao
I Have Read, Understand and Will Comply wits. Cupertino's Tear-Off Policy:
Sign e
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCIREDULE
Number of Fee ID Fee Descrip tion Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Conunercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Res:.dential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg StEndards B ALL PERMIT TYPES
Commission 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 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 buildvig 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 withou: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 1/ "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 abo�re stated policy on re-roofing.
Homeowner's Name: -)'t-1 Q e\C(/1'\_
Job Site Address: �imf_ Uy
Roofing Company Name: ' �" ?n
Applicant's Signature: � ate: �� �
Greg Casteel —01
Building Official
Revived 07/30/08
Community Development
" , 10300 Torre Avenue
aim:; Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
'UPEkTINO
Buildi�7,1je ar"I
JOB ADDRESS: PERMIT # ( �o
OWNER'S NAME:
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: C1
Signature Date
Please check applicable subcontractors and 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
er/Contractor i tore Date