09060155 CITY OF CUPERTINO
BUILDING DIVISION PERMIT Va � �`� � �
BUILDING ADDRESS: PERMIT NO.
10411 E ESTATES DR CUPERTINO ROOF INC 09060155
VNER'S NAME: PERMIT ISSUE DATE
qlDAPW JACK 1 3052 KE1134 DR 2999
PHONE: A CONTROL NO.
(408) 973-9427
ARCHITEGT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
90p LICENSED CONTRACTOR'S DECLARATION Job Description
V p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
OU with Section 7000)of Division 3 of the Business and Professions Code.and my license is 1< in full force and eff
RE—RF WO SHKS INSTL 1/2" OSB INSTL 50YR GRND
y ect 6S`�3
juj? License Class C- 3� Lic•ii
=^ DSEQUOIP CLS A 275Q
Date F- ARCHITECTS Contractor DECLARATION
R< 1 understand my plans shall be used as public records
X96
O'a Licensed Professional
y 3 OWNER-BUILDER DECLARATION
I hereby arm that 1 am exempt from the Contractor's License Law for the
t p O affirm
following reason.(Section 7031.5,Business and Professions Code:Any city or county
t which requires a permit to construct alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y t- (commencing with Section 7000)of Division 3 of am Busincts and Professions Code)or $10500
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
net more than five hundred dollars(SM. 36913045 . 00
0 I,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 forsale(Sec.7044,Baaineaa 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.).
0 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.
0 1 am exempt under Sec. B&P C for this reason
vner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 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.
0 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.
My Workers Compensation insurance carrier and Policynumber
Cartier:S!5fg'f'e- r—,h 0 Polity No.:;,17
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certifv 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[�►�-� I hereby affirm that there is a construction lending agency for the performance of
<Y.5 the work for which this permit is issued(Sec.3097,Civ.C.)
WLR.A Lenders Name
r4 Z Lenders Address
U 0 I certify that I have read this application and state that the above information is
IL O" correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
p., liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date 2 C✓
r"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
SO ULA S.
nRe-roofs
nature of Applicant/Conuactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of 1'Loof
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
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Dyer -----dNo
Will If a roof.s installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes B Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
rrently have a t that it is my responsibility to notify the occupant of the
mqu me hich m be et prior to isstrancc of a cen;fic�te of Occupancy. S' tore of Applicant Date
Z �O
ncr All roof coverings to be Class'j ``or better
or authoriacd agent Date
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CIT1f OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: J / �' PERMIT#
OWNER'S NAME: :54 e- fact,K-5' PHONE # -Z S 3-- 4 '91
GENERAL CONTRACTOR: C U Pe iao FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and corn plete 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 �j
Sheet Rock
Tile
Owner/Contractor Signature Date
- , CITY OF CUPERTINO
RE,ROOF
CUPEkTINO PERMIT APPLICATION
APN # 0 �l � ` L' `� Date: Z�_ 6 �
Building Address:
Owner's Name: -S 1P01 r 1 Phone #:
HOA: Yes ❑ Ne--E If Yes, provide letter from HOA
Contractors: Phone #:
Fax #:
Cupertino Business License #: Contractor License #:
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �e Asphalt Shingles
_'--e Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) Z- ' �� ❑ Other (Specify)
Number of existing coverings 4 Z, C.6 ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:--�-,2 a r o Q4-- t( a S 13
V) 5
Resid,� Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applicationpT if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: p v
I- ave Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
_ 'gnature
Revised 02/05/09
CITY OF CUPERTINO
`J RERDOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio z Fee
1BSEISMICO Seismic Commercial B
27 1RER00FRES Re-roof Residential B 1SFDWLR00F
I 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio a Fee
1BSEISMICRE Seismic Re,,,idential B
1
1 REROOFMRES Re-roof WIti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio a Fee
1BSEISMICRE Seismic Re3idential 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 12-ity 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 Cit.�,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 nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new mz.terial 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 can 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 or.the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
s.
Homeowner's Name: ,q C
Job Site Address: /o�I S +��C�'
Roofing Companye:
Applicant's Signature: Date: u f z —v
Greg Casteel
Building Official
Revi.-ed 07/30/08