06010100CITY OF CUPERTINO^^bw-+Amu
BUILDING DIVISION pERM7'1'
�CONTRAGT,O.RINFORMAT
ION. '
BUILDING ADDRESS:
T D ROOFING
PERMfr N0.06010100
19741 BIX13Y DR
0-NER'S NAME
PfRMrr ISSUE DATE
YVONNE VAN
3540 MARGATE AVE.
01/19/2006
NE:
SANRARY N0, CONrROI NO.
(408)892-8872
ARCHTf MENGINEER:
BURRING PERMrr INFO
BLDG EIRCT PLUMB MECH
0 0 0
LICENSER CONTRACTORS DECLARATION
Job Description
1 mmby affirm Wo IreuN that I uundOr pmrviou of Chaprcr 9 (mmnxming
p
wlN Scctm ]1M1U)of Div Won of to Boar and Pranvadeode.mdmylkmci,
;oma°' 6 4 S SSI I
REROOF--T/O SHAKE, REPLACE C
Cla�^9°fr�'�
I I `I Lin
Cloud«
Dar r
I uodcARCHME(M DECLARATION
u public
ruand my plans shall m uad rtrnrd,
j
L'aahnd Profmioml
OWNER -BUILDER DECLARATION
1 kmby eRm 0.11 em ucmpi town x Contr W. Licmn Law for not,
following memo. (Section 7031.5, Bovnon and Proresuwn Code: Any city of county
whicb ".imr • pmmit to cuwhucL allot. bnfrorM dm 11M, a u Par any mmtmc
$7000
moor,n its issuaotc. alw mgNrea at.ppl l fOretch fnmit to Ok a dgnod au'mtmn
dw he It liceurtl pant in dt providm, of dx Co.." lJsvx law(L'Wpxt 9
Sq. Ft. Floor Area
Valuation
(commencing with Salim 7000)°( Dlvidm 3 of the Budin., aoM Pmfudau Code) w
Nat h Is e pt ttmfm and the hut, for ten alknd ......ptlan Any rid.ton of
roppli�ntfaapemittabjewthe+,,Bentna�dlp
r
occupancy type
sectionNSiSbyan, Aftyof
non. Oran nK b^ndmd "Ima cssao).
❑ L u ower of tie pmpmty, a my employee wth wage u hheb sok compenvtm,
Required Inspections
will do We wah..M one,uumurt d mrin'mdcd moRaN fm s.k (Sec. "ION. Bosun
Lod Profemwu code: The cat�r af, Lime raw dura notapply n an ownm d
pmpeny who mum m improm Ihemm, and who dons u b work h'vonlfa onmugh bu
owe emplo/ees, prwd onat,uch Impmrmmen% art not inkoded m oBmd fm ulr_ It,
bowoa . tx building or bopror nm u old wlNln oro year or compktea.lin, ownu-
bd1Am will ha.< Inc bwan of proving that he did not mild m Improve fa parpme of
❑ 1. at owns a the pa oy..m eaallsdrxly conu,cting with li m amb,tdon In
mooch the project (sa.7W. Bluinm nod P ntsiorr, cox:) The Canaama s l
nuc Law dw not apply in ao o of Iaapcny wlw mild, or buprom I .and.
who coancu for ,uch pmjcns wiN a amt,cnr(,) l d ptaaaam to the C000rn f,
Lkarc taw.
❑ 1 am ..pi undo Sod. . B h P C for Nis won
no Dale
WORKERS COMPFtlSAT10N DECLARATION
I hueby aR under penalty of perjury ono of the following'-•-- _—
1 ha K.nd will maintain a Ce,rific n of rot to ulf-wine for Wnrkef. emmpm
. u provided for by Smdm 7100 a We Inbar Code, for de pOrfmmanm of the
for which tbi, pnrmi, a issued.
and! will maintain Worker, Complion lmoomco. u mqubW by ScNm
a a a
t , it i,
a ab rr cox, for ton PmfamR nnOf tx work for whichwlnmr
we
Eh,
tynu orv t n Ll VL`Iro1kY No.: • L-1
CE MONFROMWORKEl1S
COMPENSATION INSURANCE
(Thu acctm reed Atm mwmpkrcl I(hm Rnvt V fa me hWrtd dollen (5100)
m ku)
1 cutify that In Im'If... a the work Jr. which onH pemlr I, ....n, I ab.)] na
employ any Penin In any minor an u n bewmc mbjecl In the warkm' Campewtan
laws of cmtforma. Date
A,Ii
NOTICE TO APPLICANT: If. aMr making this Ccnifin e of Enmptm, you should
bamte , )oct to ten Worker's Coro a ton pawifioru a one "aha Cock, yen moa
rw Widh comply with nth providau Of Ni, pmmit mail m 1xmM mwked
CONSTRUCTION LENDINGkodinGFNCY
1lwy.mm Thu hero i,. c koding agcxy fa Nc perfartuna of
d (S=.rkn
tc doh for whkh Ihl, pemlt B iumd lSa. 3097. Civ C.)
1 LxMCS Name
I1Mefs Adtlmsa
j I u fy that 1)tare read on applkmW mil ,uac that Nc a Xt a infomadm Lr
.
' Cama l .gmc to comply with ail city and emrlty oTdirwema and ante laws m W ing b
Wilding onry on. mJ mmby authodae«Pournntims of this city In onto upon ten
l shave-hnontoad ProprnY fa iupcmim puryona
(we),Z= n taw. iodmtaify.w kap hamlesa the city a cupmim .gaitr o
j li.bibaajodgm, .aolcalrouuwhichmay inmyway uauc.gaut$aidcty
in CmnGlleMe of Mnng aW, Patron.
' APPLICANT t1N STANDS AND WILL COMPLY WI ALL QN- INT
�1p,,
/// /f
Issued by: Date 7 - �j
SOURCE REI /
dW t �� "
Re -roofs fzC
Sipwun ApplicmVC°mrclm Daic
of
HAZARDOUS MA is DISCLOSURE
Type of Roof
Wit theapplicantor forum milling macctmtdk h,rhnallou,
u xm lmby the Cupenim Intl Code..O.Cbtfone HeilN Safi)
xv 9.1I, W .oq slay
Odin. Sat. 25531(+)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
If a roof is installed without first obtaining an inspection, I agree to remove
Will onc.pplkent a fuuvc building occupam tae egvipmrnt Of &Y4=1 which
it hvuduu air cm. u xhnod by the Bay Am Air Qtmity Mnngcmcnt
all new materials for Inspection.
07
Y. Nu
1 have mad tic harndousmakdaia nquimmew under Chaptr 695 done Califa-
nia sarnycode, .25533 aod255,4. I und:rumd that iftlm mining
s11xa rot ctnmmly hart I It u my hrapowbility b y tc I pf tc
myulmmenuwhkh o n' F.ccnim
6
Signature of Applicant Date
r at
All roof coverings to be Class "B" or better
Owxr a authorired agent Dam
Community Development
' �' 10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
y Fax (408) 777-3333
UPEf�TINO
Building Department
JOB ADDRESS:
", 41 �ik
PERMIT #
O 6 Z,,a0
OWNER'S NAME: vc,»
PHONE X10$ 51, 3.2Aq
GENERAL CONTRACTOR T D 1' 119
FAX #
I am not using any subcontractors: LE WAV /\' ' 19 I 0 �O
Signature Date
Please check applicable subcontractors and complete the following information
(Ci o
Date
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
(Ci o
Date
lima
1 i
l4
CITY OF
UPEkTINO
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 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: J o�N)'\e V0.»
r— I(
job Site Address: I d ¢ I
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
finned m Recycled Pepw
' aC10F
CUPERTINO
IN
F__
L
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
06�-7�``_�
APN # 3 6q 09
b
BUILDING
Date: I I l
I o (o
Building Address:
BSEISMICRE
Owner's Name: !
BUILDING
BSEISMICOM
Phone #:
SIOd
d O 1\ \'1-e V
BPLANCHK
Plan Check Fee
BUILDING
Contractor:
no o �\
Phone #:
�l 8 8 .�
License #:
34- 5 5 9 1
T D
y oS
02
Contact: I
Phone #:
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
X Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
of existing coverings
❑ Provide I.C.B.O. Report #
Number
To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Description:1
j� ��\ ov e yv ooc S
h 0- e
` tk 3o y C t \� l
)Le ci c� \nJ ,
Residential Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning D_pt. if
there are any restrictions: [
Cost of Project:
Type of Construction:( Occupancy group:
u7L,37L,3 T -
T"D
Qty. if
Annl i cabl e
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
�3�66
��37. 86