09040116 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � REQ � I .
PERMIT NO.
BUILDING ADDRESS:
22050 RE ART MID PEI\INSULA
PERMIT ISSUE DATE
OWNER'S NAME:
A CONTROL NO.
)N
(650) 3-15-7850
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
Mto I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z f, with Section 7000)of Division 3 of the Business and Professions C�,and my license is RE—RF T/0 WD S HK RPL W/1 X 3" DOUG L S FIR& 1/2 C DX
7'y in full force and effect, �1 ,
3MA License Class f� Li ter — (tet n LYWD&FRES TILE CLS A 61SQ
Date
� ARCHITECTS DECLARATION
iti< 1 understand my plans shall be used as public records
DWU
cI' Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
409 which requires a permit to construct.alter,improve,demolish,or repair any structure
y-w prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 832150
y 5 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($500). 3660204:5 . 00
0 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 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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct am 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 contractors
License Law.
0 I 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:
J 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.
IM have and wiB maintain Worker's Compensation Insurance,as required by Section
fft of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compen 'on Insurance carrier and Polity number are:
Cartier Policy NO.: K
C TI CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 certify that in the performance of the work for which this permit is issued,1 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 Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fr rte.. I hereby affirm that there is a construction lending agency for the performance of
fx the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
0 z Lender's Address
1 certify that I have ad this application and state that the above information is
LUre
L correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby authorim representatives of this city to enter upon the
W shove-me . ed property for inspection purposes.
a c) gree to save,indemnify and keep harmless the City of Cupertino against
►F-t liiiZei es,ju ts,casts and expenses which may in any way accrue against said City
U Z in c nseq e e mg of ' rmit Date
►" A LIC STAND AN WILL COMPLY WITH ALL NON-POINT Issued by:
S UR TIONS
( (� Re-roof., -
rgnarure ApplicantJCon or ALS DISCLOSURE Dam Type of Roof
HAZARDOUS M
1 the applicant or future buil ' upant store or handle hazardous material
as define by the Cupertino Municipal ode, aptcr 9.12,and the Health and Safety
code.Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed.
0 building occ ant use equipment or devices which Yes °
Will the applicant orCo. If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or
..tit hazardous air contaminants as defined by t e Bay Area Air Quality Management all new Materials for inspection.
District?
0 Yes
haread the hazardous mate' tremens Chapter 6.95 of the Califor-
nia 11 SafctyCode.Sections 50 2553 d25534.1un dthat ifthe building
d o rmndy have a tenan tha ' i res risibility to no the occupant of the
en w ich be t ortoissuance faCerificat�oc�upanCy. Signature of Applicant Date
a L o All roof coverings to be Class';J"or better NN
Owner o uthorixed agent Date
CITY OF CUPERTINO
RI:ROOF
CITY 0
CUPEkTINO PERMIT APPLICATION
APN # �3 f / Date: .Z n
Building Address:
Owner's Name: LkR\ Phone #:
HOA: Yes ❑ No [iKIf Yes, provide letter from HOA L+U%K _3 (,4 (a T 1 �
Contractor: Phone #: (o-:&D
V vNFax #: l9 Sb -
Cupertino Business License#: Contractor Licen.se #:
931 v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles w"Asphalt Shingles
./ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
NZber of existing coverings '2- ❑ Provide I.C.C.E.S. Report #
sr To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:' t o u)b v `bout, 2 Ca uao
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:
I Have Read, Understand and Will Comply witt. Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
--� CITY OF CUPERTINO
RE ROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B ICOMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis,ion Fee
1BSEISMICO Seismic Commercial B
^' IREROOFRES Re-roof Residential B ISFDWLROOF
l5� I BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis::ion Fee
1BSEISMICRE Seismic :Zesidential B
1REROOFMRES Re-roof IvIulti-Family B IMFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis:;ion Fee
1BSEISMICRE Seismic -,esidential 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 agree 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 applied 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 C ty,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 ne.il inspection is required.
6. Any roofing which is applied withot t first obtaining an inspection,
will require the removal of all new rr aterial 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 csm be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of lii "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be oa the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 1�
Job Site Address: J2� 'z!�7;t
Roofing Company Name
Applicant's Signature• DJ:
Greg Casteel
Building Official
Revi ied 07/30/08