09040055 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � '
BUILDING ADDRESS: PERMIT NO.
22345 MC CLELLAN RD T D ROOTING 09040055
PERMrr ISSUE DATE
OWNER'S NAME:
')NE: SXNWA CONTROL NO.
(408) 892-8872
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0
u p C LICENSED CONTRACTOR'S DECLARATION Job Description
IU 51 hereby affirm that I 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
=y in full force andeffect�q -1 RE-RF 2LYRS INSTL 30YR CMP CLSA 15SQ OSB& 154
License Class Lic.* FLT
ny p Date Contractor
Ul AR HrIEcrs DECLARATI
I m< I understand my plans shall be used as public records
�yU
U.F' Licensed Professional
y OWNER-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
t m Rg which requires a permit to construct,alter-improve,demolish,or repair any structure
Z rA prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
x C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
x t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 more than five hundred dollars(5500). 35705005 . 00
1,as owner of the property,or my employees with wages at 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 Contmctoes 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.).
❑I.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 Contractor's
License Law.
❑I am exempt under Sec B R P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Workees Compcn-
..ton,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I 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.
Ca Workers C tope tion 1 ace cam and Policy number
Cartier. � Polity No.: � 1
CERTIFICAT OF EXEM ON FROM W RKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for ono hundred dollars($100)
or less)
1 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
[~i I hereby affirm that there is a construction lending agency for the performance of
CY+ the work for which this permit is issued(Sec.3097•Civ.C.)
WA Lender's Name
G1t
0� L.endees Address
V O 1 certify that 1 have read this application and state that the above information is
LL►r correct I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon the
s
W above-mentioned property for inspection purpose
a (We)agree to save,indemnify and keep harmless the City oC Cupertino against
liabilities,judgments,costs and expenses which may in any way seems against said City
V Z in th g consequence qqCC ung of this permit Date
l y U
0" APPLICANT STANDS AND WILL COMPLY WITH A L N0 -POINT Issued by:
SOURCE RE L S. C 0
O Re-roofs -
Signature of Applicant/Contracior Date
HAZARDOUS mATtRIALS DISCLOSURE Type of Loof
Will the applicant o future building occupant store or handle hazardous material
as defined by the Cupertin M ct 1 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.
Ya
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
,it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
strict? n
OYa �.
/0 9
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- f ` /
nia Health&Safer Code. dms 25505,25533 anc125534.1 understand that icup building / / G G
docs not curgre tenant dst it is my responsibility to tify occupant of the
reyuiremcnbemelprior uanccoCaCcnific of capon Signature of Applicant Date
OJ O -
All roof verings to be Class"A"or better
Owneroragent D tc
- , CITY OF CUPERTINO 0q 0q 005 5
l � REROOF
CUPEkT1NO PERMIT APPLICATION
APN # Date: / 01
Building Address: cLe- (t Z,
Owner's Name: ,F Phone #:
ci,3
HOA: Yes ❑ No 6 If Yes, provide leiter from HOA C.
dog ) yg � ^ Iggg
Contractor: Phone #:
Cupertino Business License #: ( S; Contractor Liceensp-#:I
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
,)@O Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) Other (Specify) 3 o y 1C n
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
'*Oro be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
cL -4-s 3o 11' �,, p j_�_S4
PS
ResidentCommercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning f
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation: _-
I
I Have Read, U de and and Will Comply witt Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
a,,
CITY OF C UPERTINO
REROOF
CUPEkT]NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Cor:umercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
f l REROOFRES Re-roof Re:idential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissions Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio z Fee
1BSEISMICRE Seismic Re;;idential 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 r,!-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 building inspector. A final inspection and
approval shall be obtained from the b-. lding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ar.y roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off app-oval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood na-1 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 pee 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 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 above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 1113 1 dcUl
-
Roofing Company Name: D JA_
Applicant's Signature: Date: D
Greg Casteel \
Building Official
Revi;ed 07/30/08
u, Community Development
10300 Torre Avenue
4 ;. Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
''UPERTINO
Building Department
JOB 3 �( � 01 C C I e c�n ��-�1 PERMIT # OO Q q 0060"
OWNER'S NAME: S co j a.3 PHONE # v ) g
GENERAL CONTRACTOR: 1 '� FAX #
I am not using any subcontractors: 14,F-7
ignature 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
Owner/Contractor Signature Date