06010076 CITY OF CUPERTINO p�,��
BUILDING DIVISION PI IUMT ��C�` NTRACTOR INFORMATION.
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BUILDINOADDRESS: R E ROOFING & CONSTRUCTIO P'TNC006010076
T n4"A6 AVFNTT)A TN
NER'S NAME: PERMIT ISSUE DATE
OW
WILLIAM WELLS 15230 CLYDELLE AVE 01/13/2006
NE SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHI'IECT/FNCINEER: BUIIDINO PERMIT INFO
BLDG ELFCr PLUMB MECH
Yo00 LICENSED CONIRACrORs DECLARATION O
Job Descri tion
� 1 hmihY affirm Wt I am liw�d uMcr proviaiom of Cbaircr 9(emmcrcln{ P ✓�WALED
.wsu�roao)a�pyJpwxBu9 « .p�ulmc my . REROOF--T/O SHAKE, INSTALL �O
ja� mfaurmaandirr ll� ( L
Uceac Cl fit.{
[[� Datc ARCHITECTS DECLARAT
'�� t tma«v,m my rltm,Iwl�u><a.r welK,a«,n
o; LiccucdP Msiooal JAN z4, 2006
�y�I 5 OWNER-BUILDER DECLARATION
` lai
C o follnwinglr.r.(SStttimat0311-5Bu�si.And Rollo A..Co@L .U.or nt, �p1
$ which mqubcs a pmmit to samnct,aimr,inflow,dcmol4h,m mrsir my td cum ,y' � �• - �'" :.
prior el it iauimox.Zl A'Wmtbc.pplkntf«wch permitn B4aai{nm L.Ifnwnl .�
<
that Mislk:rnscdpursunttot,ipmvialonsofthe Cmvr.cmr;fiwns,Liw(Clupw9 Sq. Ft. Floor Area ItcValuati -�
�$ (.da,in{wit,Sado-7")4 DfviJon 3 of the Buri.And Prafuslcu Codi)or
Nu k I. pt therefrom am @c h.ais for the allc{m iumpdav Any vbbdoc of
Simios 7031.7 by try applkzu for t pump mbjtw dc.ppticarnl or.civil prauey of
r U U Occupancy Type
.or mai than Leri eaMmd atilt.(swo>.
❑L u owrta of tK laopenY•«my wPlo)m wah w{n u dsL mk caope®tbn,
wrumwiw«Iswo,Tini iunnlmlmeca« veIorts. fsi,WIn.Bo,af Required Inspections
And Fvfuairm,cmc T1s Connaerah LI®ae Vw daa sot apply n an owe of
pttpeny wIn dtllN«Improve merion..m who d«a a«h work eimrdf«tNoa{h bV
twocmployte,Provided pro imp said wtartn«to of
f«alt IL
e iltitr NebullEln{«lingo pone sgtoad within arc)ear of c«opktiuo.the owa
bolder wal have Ble b«drn of proNne dw be ala m ddW«"voprow f«papnae of
u4.)
❑I,as owmcr of the,property,am a+•u,.iwly cant rg with Ileued cssi e on
corunum dm ors a(Sec.7O ,Buy.am FrofC.".Code:)lk Comrctett L:
it.Law doe sa apply n as awmer of popwy.wM Wilda or improve.theran.and
wbo,onmrts for such projccv with a cmvud«(a)li«n.eE pwwanl in the Conua:mis
L'uxna Law.
p lamecmptundc Scc .BhPCf«Jdsrc.ran
Owmer Dere
W ORICER'S COMPENSATION DECLARATION
1 hercby.Rhm mWcr pen.hy of perjury ono of thc lbib in{A�
I e..c.m will maimaio a CmiBam of Cw.cru in self-los im for Worka'tCompcn-
.ation,As provided for by Scotian 37(10 of da,lab«Code,for We Pirformaocc of t,1
www for which it"Permit 4 Woad.
❑1 hue and will maintain Worker,C ampewtlon I...As rtyulmd by S oon
371(10 of the lah«Caro,for the pmfom,•^••of the wort for which this p,rmit is i,wed.
My Warks' compeuatios nn¢c and Policy bcram:��
Camkr. Pol"No..
CT.KI'IFlUTE OF CEMPITON FROM WORKERS'
COMPENSATION INSURANCE
Crhh,cctimnced mthe(impkled lt,ipermlt 4f«rx hummd dotlan(SIW) t or loss.)
1 certify Nt in thi performarce of th work for which this pttmlt 4 imed,l.hall nor
cmptry.ny, Noon In any mamtor an as n biemc subject to the Workas'C«opermatlm
Law of California.Due
Applinru
NOTICE TO APPLICANT.-V.afwr matin{this CcnNnti of Eicmption.you Cmuld
bsbmt,aubjw in the Wort«Y Com,miadan prnvislons of thc lah«Cmc Lau mus
.JO rmthwrh empty with lute prav4bos or Nis Norilt"Ibi damW M
of
'Z�'� CObtMUCDON LENDING AOENCY
rc•i= Ihmrby affirm
dial them 4.m on 4min{.{tory for do lcrramiIria of
iz 7 the w«k f«which this pctmit 4 iau:d(Soca W.Co.C.)
{e1 Q tomo',Nami
z L ocv's arta.
U O 1«Nfy dw 1 haw red W4"lkadon td sum that thi.bow orotmtilurt 4
IL ^ carcM I.&.W comply withdl chy.na county orttltwnre..na awc law,rt Win{in
O building conswctlan.and bi,mby authnrim mpmenwiv or Nit city An err urns too
LL1 .bvvc rncntimm NORny for inspstios p«m...
L1. (We)29=to ave,imcmoity And Fecp humus the City of CuNnion.{aimt
rn li.bRitlea.JmgmAinu,costa tud eapeme whi MAY 4 any wy twat against aid City
traddo
V z APPLIC N ERST n{S of AND WILL COMPLY WIT(H LL NON-POINr Issued by: Dale -(JI
/OU U
1{muss_ AppliunUCanuacini Du< Re-roots
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIIltheappBont«future hu ga¢vpant earn«Itamkbawdau,mawW
u aflncd by t,i Cupcnlno Mu 'C Codc,czw 9.11.tad 0c Health and Slay
semimt 9ss32i.)r All roofs shall be inspected prior to an roofing material being❑m No Pe P Y g g installed.
Will do apples nt«r I an{n errant t goimoirl or m!h' If a roof is installed without first obtaining an inspection,I agree to remove
.nit huardm,.11 etuunitwu dc0rcd by th Bay Arta Air Qoailly Manaommitu a Is for inspection.
D4B m7
❑Ya No
I bux rad d,o lb uao ,mak:rials rtgmmmitu tmdcr ClupmrQ97 ofdr lar- I
n4 d(Wmy Cadc.Ss11«a 23503.23513 atl]5511.1 Wcrsam thant,l ha 4.
not tly ltivxaamu th.tlt4myies,,,rim h)nmtiry the ac ado
mqueitrya.. cwkW1 , 'O� Signatute-o[Applicant Date
ow�2rm�ia't�oved, mom' mm All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Its Cupertino CA 95014
Telephone(408) 777-3228
CRY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
D k L�
6 D/ D 0 7
OWNER'S NAME: Wl l_L AM 1. PHONE# 44)&- 926 — 353
GENERAL CONTRACTOR 12, C --�,uu¢,N FAX #
C�/
I am not using any subcontractors:
Signature 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
310
--�n6rrContrhctqr Sigilatlyre Date
Now
Community Development Department
Building Division
f City of Cupertino
10300 Torre Avenue
Telephone:
OCITY OF Fax: (408)777-3333
UPEkTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 City, 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 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 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 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: ` `�i j'i � �-L-I A MQ V��1 C1,US LA)
,j
Site Address: ` o 13 �9 Z 1 U� N � DA- L i ,j
L 1 s C�,(S i R wc.�
Roofing Company �'��
Applicant's Stature' _.Date:
1 l I
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
mav- cs d 7C
Ak CUPEkTINO PERMIT APPLICATION FORM
APN # 3 3 Date:
Building Address:
Owner's Name: Phone#:
�lt,U Wk �UIti�S sok Ml - 3.139
Contractor:,-�
Phone#: License #:
Contact:/ Phone#: Cupertino Business License#:
�b�l� �R� ToI� SqM� 2-6 15
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles AAsphalt Shingles
X, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:'�M6C CNlW,kj(f l l,�(` 6'L (/l�- WON S--k �NSfYI,L 1,1W 112" CDX
0 # 7M 'r LA 3-o- R .
Residential Commercial ❑ CON e
Fire Zone: Yes ❑ No XX Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of ProjectI2 ylj Type of Construction: Occupancy group:
(A i 1
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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