04080096 CITY OF CUPERTINO �`
BUILDING DIVISION PERMIT GOI�i'Cl2A&W NIF RMt TIUN:=s
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BUILDINGDRESS: PERMIT NO,04080096
2264 OAKCREST CT
OWNER'S NAME: PERMIT ISSUE DATE
AL & SHNNON SEID
IFNE: SANITARY NO. CONTROL N0,
ARCHITECTBINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a0o LICENSED CONTRACT'OR'S DECLARATION Job DescPF(NGALED
I
yd u 1 hcroby affirm 1 am Incensed under provision of Chapter Y(Commencinga .
am with Section by of r Dthat I am Rea ed under
Coda e9 cen
pp< in 101, ceaneerzec�. L REROOF
j @ z Ltcemc 1 Lk.0
Dam Cannan CONTRACTOR: FRAGUALIA RO
Q ARCHITECTSD
3 n
Iumlcrsund my plans ohellMwe uM1le cnrG NOV � /004
�6 y. a.
LLQ y Licensed Professional
iS OWNER-BUILDER DECLARATION BUILDING
F I hereby affirm'hat I am exempt room roc Contractor's Lwcnm Law for the
i p O which me mason.(Section 7(1313,Boniness and ove,de oli Codc:Any cityan m county
$-g which tets into a permit m cem,W a alma n t forsu demolish, fi c a sig any twcmm
Flxy prior essiuissnsedpursu mgotheprevision ofWeConnch etoi'mfcause,Lawned
�3100-
EF� (commes licensed pursuant the of Division
of WeConnector'sBusiinces id Profession.
(Chapn9 Sq.Ft.Floor Area VaIU
y Out he ;exemng pt Section]and W basis
r the
WC alleged
exempt on.Any
Cattle)of
� Ne'he u exempt themfmm and the hoes far the alleged eumption.Any violation of
Section 7031.5 by any applicut for a permit subjects We applicant to a civil penalty of APN Number Occupancy Type
not roam than five hundred dOlhts(s500). 34248039 . 00 -
❑I,as owner of the property,or my employees with wages as their sole compensallon,
willdo Omwork,and Wearactum isiotin'ended oro0ered foruk(Sec.70M,Business Required Inspections
and Profesaime Cade:The Comosetors License law dors not apply to e an Owner of 9 P
property who builds or i m provesHereon,and who does such work htmulf sur through his
awn employees.provided Nal such improvements arc notintanded m(IRemd fortis e.If.
however,the building or improvement is sold within one year of completion.We Owner.
builder will has We burden of proving that M did not build or improve for purpose of
sale.).
❑1.a bonnet of the property,am exclusively contracting with licensed convectors in
construe'the project(Sec.70",Business and Profeaions Code:)The Contractor's LL
cove law does not apply in in owner of properly who builds or improves thereon.Ind.
who conmcu for such pmjccm with a contractor(s)licensed pursuant m the Conuactorl
License Law.
0 1 am exempt under Sec. .B&P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hercby,affirm under penalty of perjury one of the following declarations:
❑I hawand will mainuina CenificamofConnnitoulLinsum for Worker's Coepem
senor,o provided for by Section 3700 of We labor Code.far We performance of We
work for which Nis permit is issued.
1 haw:and will maintain Workers Compensation Inmrsum,as required by genion
3 Wo(the Labor Cade,for We performance of We work for which this permit is issued.
My Workers
Compensation Insurance caviar and Policy number am:tG
Cartier'.5 kJE__ rl/ Policy No.Q01/p l9 M— '
CEETIFICC O�Pf10N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hecomplete if the permit is fmronehundrctl dollam( 100)
or less.)
1 certify Nat in the performance of the work for which this permit is Issued.l shell not
employ any person in any insurer m as to Mcome subject to Ne Workers'Compenodon
Laws of California.Dam
Aridteam
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject to Ne Worker's Compensation provisions of We Labor Code,you must
.J O forthwith comply with such pmvistoo or this parent shall be deemed invoked.
zi rn CONSTRUCTION LENDING AGENCY
[r I hereby affirm that Were is a cootmctinn lending agency for the performance or
lli 7 the work fur which this permit is issued(Sec,3097,Civ.C.)
W�Q Lenders Name .
Q z Lenders Address
O Q 1 certify that 1 hove mad this application and aura that the shove Ofomianon ns
(~" coma I agree to comply with all city and county ordinances and auk laws relating to
Q Ubuilding Construction,and hereby motorize rcpmtematives of this city to color upon We
14 shove-mentioned properly for inspection purposes
(We)agree m ova,indemnify and keep harmless the City of Cupertino against
t,i liabilities,judgmcmts,costs and expenses which may to any way acerae against a to City
(„),�{ in�corting ohhis permit.AANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Date
S9�---
f Z Re-roofs -
Sig Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future buildingrecupantsmrc orbandle baramime material Y ��
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ode,Section 25532(Q? All roofs shall be inspected prior to any roofing material being installed.
E]Yes ONO
Wit]the applicant or Imam building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IreDistric,9
oon luxurious air conmm]mnu a defined by We Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑No -_ y
I have mid the harardnusmaterialsmquimmenu underChepter G95ordlo Cubic, /y
eHcaiW&SactyCoe,Seeti s255(I5,35533 sud2S531.l undcrWndthmifthe building / Locs not ement y h I Wel it u my responsibility m notify the aeupam of We
qutmments a nlIPoor innccofaCertificate ofOccu q./f/,� are of Applicant Date
Owm raraclhmzedagent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Z—zo
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: Z Z6 06;t/4,</r) T— /''I1 PERMIT # �
OWNER'S NAME: `' PHONE # �
GENERAL CONTRACTOR: FAX#
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
Owner/Contractor Signature Date
Community Development Department
Building Division
r City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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.
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:
Job Site Address:
Roofing Company Name:
A plicant's Signature: Date.
• Greg teel
Building Official
Revised 1/30/03 '
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF �' �
CUPERINO PERMIT APPLICATION FORM
APN# U Date. �` D
Building Address: /
Z26 y (, B cc l5 cs�e5 T—
Owner's Name: Phone#:
e 9 d tf 514,n 0
Contract Phone#: License#:
(tom 1 _ _ off- — 0 Z3
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: � Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles N�—7 sphalt 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: w
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: lJ
Cost of Project: Typ of Construction: Occupancy group:
Y 54 1V0
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
• Z
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