09040112 CITY OF CUPERTINO �
BUILDING DIVISION PERNUT
PERMIT NO.
BUILDING ADDRESS:
20163 2017 2 0213 F01 EA
PERMIT ISSUE DATE
OwNWA"CREST SQ
SANEAleyN671 CONTROL NO.
jNE:
(4 )8) 278-0330
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
0 o a a
p ZO LICENSED CONTRACTOR'S DECLARATION Job DCSCnptlOn
v I hereby affirm that i am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Profons Code,and my license is
RE-RF R PLC EXT RF SY S W/NEW GAF GRNDCNYN
a H in full force and eff, ?
j z License CI I Lrc'* C,�--- — AS PHLT RF
E,p Dare L' Contraclo
u� ARCHITECTS DECLARATION SY
C-a 1 understand my plans shall be used as public records
rresn.d CL3 A
W y Licensed Ptufcssional
o g OWNER-BUILDER DECLARATION 7 2 SQ;2 016 3 , 2 017 3, 2 018 3, 2 019 3, 2 0 2 0 3, 2 0 213
2<2 1 hereby affirm that I 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
K$ improve.demolish,or repair any structure
Fi which requires a permit to construct.alter.
structure
n^y prior to its issuance,also requires the applicant for such permit to file a signed statement 3q.Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
s m (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $42000
i .. 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(5500). 31637001 .20163
❑I,as owner of the property.or my employees with wages as their sale compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractors License Law docs 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 U-
.
cerise 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 Contractors
License Law.
❑1 am exempt under Sec. B&P C for this reason
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 Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
eco for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section A
3 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Co pe n I e carrier and Policy num S'I/ C ' l
Cartier. Polity No.:
CERTIFICATE O EXEMPTION FROM WORKERS'
COM ENSA710N 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 Workces Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z hA CONSTRUCTION LENDING AGENCY
(.-r r�-i 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.)
W Lenders Name
az Lenders Address
V 0 I certify that I have read this application and state that the above information is
LI.1-. correct 1 agree to comply with all city and county ordinances and state laws relating to
OVbuilding convection,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments.costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
0114 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
SOURCE REGULATIONS.
Re-roofs -
Signature of Applicant/Contractor Dare T of Roof
MATERIALS DISCLOSURE Type
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.
❑Yes No
Will the applicant r Cuturc wilding occupant use equipment or devices which
If a roof .s installed without first obtaining an inspection,I agree to remove
Mil.hazardous air contaminan defined by the Bay Area Air Quality Management all new r,iaterials for inspection.
District?
❑Yes ❑ o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building ____ _Z .L J
does not currently have a tenant,that it is my responsibility to notify the!20-L a the
.Qu;re, hT%z .mt r issuanceoCaCcrtficatcofOcf cr. Signature;of Applicant Date
—�__ All roof coverings to be Class'%."or better
Owner or authorized agent are
CITY OF CUPERTINO
RER.00F
CITY OF
CUI'EkTINO PERMIT APPLICATION
APN # / o t :3 -1 � � DateZ
l 5� z l
Building Address:
Owner's Name: (�7 �, �u�y ,s.rG-tom`} Phone #: CIVbV
373y
HOA: Yes No ❑ If yes, provide lettc r from HOA
Contractor: Phone #: ((-(o's) __�2 k �= �
'+ u r S�a6o" !; 4CD Fax#: 0!?e3
Cupertino Business License #: Contractor License M
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
X Other (Specify) � � Li Other (Specify)
X
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
� To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: /ut C'�eysfii�� ✓'v��- .-.w r� �, /1G�-t-' G�~.a'�
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: � -2 ��� e►` 7,22
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
a REROOF
OF
JPERT1NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Sta:ldards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Corrmercial B
1 REROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
Z 1 REROOFMRES Re-roof Mul:i-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC 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 agrae 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 apphE d without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the bt gilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ani roofing installation.
4. To receive a final sign off from the Cite,the following steps are
required: r
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 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 cart be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 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:: IV /?a,3 e,.- , f-
�
Job Site Address: 0/6 3 20 2- `> A)0'.*' 1Cf.0 --
Roofing Company Name: s .
Applicant's Signature: ''�� -'..1— -- Date: Z 0
Greg Casteel
Building Official
Revised 07/30/08