09040142 -7777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � '
BUILDING ADDRESS: PERMIT NO.
848 S STELLING RD SHRULL ROOF
PERMIT ISSUE DATE
OWNER'S NAME: nT TT WT SQ
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A CONTROL NO.
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(408) 84.:7-5090
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
U)= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and P�ons CC-odg,and my license is
e�y in full force and efftt^3 J OOt✓� RE-RF F MV SHK INSTL 7/16 RADNT BARRIER OSB 5 OYR
Z License Class Lic•M
-a Date - -o Contractor S /-(• PRRES :iHNGLS 27SQ CLS A
ARCHITECTS DECLARATION
< I understand my plans shall be used as public records
�yU
Z o In Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
L c O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
E=c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
Y.F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $13000
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 mote than five hundred dollars(S500). 35920025 . 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 q p
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 Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSA71ON 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 Workers Compen-
sation,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 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 Workers Compensation lnsura a carrier and Policy number arc:
Carrier. —t_ F L/-� Policy No.: 7 es— 9 r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis section need not be completed if the permit is for ane hundred dollars($100)
or Icss.)
I 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 O forthwith comply with such provisions or this permit shall be deemed revoked.
Z � CONSTRUCTION LENDING AGENCY
E~•c rte.. I hereby affirm that there is a construction lending agency for the performance of
p(,> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
0 z Lenders Address
V C) I certify that 1 have read this application and state that the above information is
U.� correct.I agree to comply with all city and county ordinances and state laws relating a
Q V building construction,and hereby authorim representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City �/
V Z in consequence of the granting of this permit. Date 1
APPLICANT UN ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGUL TI S.
L7± Re-roof: --
Signature of Appl' t/ContrDate T of Roof
HAZARDOUS MATERIALS DISCLOSURE }/�
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 roof:;shall be inspected prior to any roofing material being installed.
❑Yes
Will a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
.nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new 1 naterials for inspection.
District?
❑Yes ONO
I have toad 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 y
does not cu fly have a tenant,that it is my responsibility a notify the occupant of the
requireme hich must be met prior issuance of a certificate of Occupancy. Signatur' Applicant Date
.1 Date All roof coverings to be Class';."or better
Owner thorixed agent
e,)q011GtLM
CITY OF CUPERTINO
a- 1_0
REROOF
CUPEkTINO PERMIT APPLICATION
APN # h Date:
Building Address:
Owner's Name: �D N L e c%��-,� ',/� uL� Phone #:
9
HOA: Yes ElNo ❑ If Yes, provide leiter from HOA z ss-- (5-_57J)
Contractor: Phone M 5--z) 7v
Fax #: J2 6
Cupertino Business License #: A Contra�ic n e:
CA /��G
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ ,Asphalt Shingles 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: n 7//,;
K C I'►'1 v t s �-vC .� S T/3-/ 1 `I� bi*rrti ul O S$
Residential 3 Commercial
Green Building: Please complete relevant po rtion 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: ?) 3 v 2
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
NREROOF
CUPEkT1NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Z r� Group
1REROOFCOM Re-roof Corunercial B 1COMMLROOF
1BCBSC Cal Bldg Stwidards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
2� 1REROOFRES Re-roof Re,,idential B 1SFDWLR00F
/ 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
Commissio a 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
M 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 appli ed without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the t uilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to arty 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 aprroval.
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 pe:formed.
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 czn 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:
Job Site Address: -
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revi3ed 07/30/08
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
XPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
eye S_ C) rjC-� �1 �-z-
OWNER'S NAME: p 1vN L Q tc ke--jf f,+ U c PHONE # Z 55-
GENERAL CONTRACTOR: j -S hr�t i- u fijFAX #
I am not using any subcontractors:
Si gnature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI14ESS 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 S�r�r• LL
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/Contractor Signature Date