09060143 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
r
ADDRESS:
613 CASTLETON ST R E ROO]NAME: INCN �F.AN—ANTI VAT TT�T( S A CONTROL NO.
INE:
(408) 62,)--9320 BUILDING PERMIT INFO
ARCHTIECTIENGiNEER: BLDG ELECT PLUMB MECH
p zo LICENSED CONTRACTOR'S DECLARATION Job Description
QU I hereby affirm that I am licensed under provisions oC Chapter 9(commencing
z with Section 7000)of Div on 3 of the Business and Professions Codc.and my license is RE—RF R SIV EXTNG 1 LYR WD SHK INSTL 1/2" CDX 30#
a. in full force and effect. Z tel/ Gl
SM Licen lass Lle• FLT& LIPEWEIGHT TILE CLS A 32SQ
3 Date tractor
ARCH S DEC ON
ee a 1 understand my plans shall be records
;yU
Loy Licensed Professional
OWNER-BUILDER DECLARATION
n Y 2 1 hereby alTirm 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
Pi which requires a permit to construct.alter,improve,demolish,or repair any structure Valuation
y'ti prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area
z< that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 $18000 8 O O 0
Y F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
ERE that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(M). 3 5 618 0 E 1 . 00
❑1,az owner of the property,or my employees with wages az their sok 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 dos 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 ace 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.).
❑1,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' B&P C for this reason
C3I am exempt under Sec
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-
,ation,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
3 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 amore:�U
Cartier.
Policy No.:�
CERTIFI COMPENSATION INSURANCEORKERS'
(17tis 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,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
',z forthwith comply with such provisions or this permit shall be deemed revoked.
,J
Z(:) CONSTRUCTION LENDING AGENCY
E.4 I hereby affirm that Utero is a construction lending agency for the performance of
Cd m7 the work for which this permit is issued(Sec.3097.Civ.C.)
W ALender's Name
az Lender's Address
V z I certify that I have read this application and state that the above information is
LL H correct.l agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorim representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way accrue against said City
Ifr ucnce of the granting of this permit Date
C)�+ APPLIC STANDS AND—,WILL COMPLY WiTH A L N -POINT Issued Ey:Re-roof
SOUR S. ; 1�. Zit r---
�
"-I"- Signaluaa Applicant/ConlraCCor °ale T of Roof
._HAZARDOUS MATERIALS DISCLOSURE Type
Will Use applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni!00 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 he applicNe If a roo r is installed without first obtaining an inspection,I agree to remove
Will tor future building.occupant use equipment or devices which
it hazardous air contaminants as cd by the Bay Area Air Quality Management all new materials for inspection. _.
Cl Yes No q =
I have read the hazardous materials requirements under Chapter 6.95that
if the Golding j
nia Health&Safety Code,Sections 15505,25533 and 25534.1 understand that iCthe building l
of curtcndy have a tenant,that it is nt possibility to notify Ute oceupan of the ppticant Date
re c mtiu be ort is oC ficme of Occu ane Signatu Ce o
f All roof coverings to be Class"n"or better
U&auth cd agent Dare
Oq 0 ce
--., CITY OF C.UPERTINO
RE-ROOF
CUPEkTINO PERMIT APPLICATION
APN # U 0 0 Date:
i_�IBuilding Address: 11 i 5 f-
L S�
Owner's Name: L- w Phone #:
HOA: Yes No If es provide letter from HOA
❑
Contractor: Phone #: �Z _ 9 320
'� t►� Ci� .�11�.U/��1� E �� Fax #: `NS` ( 'Z� - 1 (61
Cupertino Business License : Contractor Licen e :
'7 Z I
Type of Ploof 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) 'l
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:jrN,jW %X lk(I LIN OV OY- VVctfV i N STA.
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: ❑
applicablq.,include in plan set & the sheet ine.ex.
Valuatio ' j u n'
I Have Read,-JJRderstap1fd Will Comply with Cupertino's Tear-Off Policy:
Signature -
Revised 02/05/09
i CITY OF C UPERTINO
REROOF
CUPEl�T]NO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BCBSC Cal Bldg Stindards 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
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 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 I uilding 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 Ci-y,the following steps are
required:
1) Pre-inspection and/or tear off apFroval.
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 fE e 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: Li
^r,/
Job Site Address: 2 5-1b 3
l�r
Roofing�inpan Name: U 10� 5 Ccl u�i C
t � _
Applicant's Sign l - Date: -I U�
Greg Casteel
Building Official
Revi ied 07/30/08
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
':UPE�TINO
Building Department
JOB ADDRESS: i PERMIT#
r
I CAMvTuvJ
OWNER'S NAME: ►J PHONE # -( 2(n, -132-0
GENERAL CONTRACTOR: F U U N FAX # 4o (0 2 - -/ 141
I am not using any subcontr ctors: 2 b
S. a 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