04010147 (2) CITY OF CUPER'rlNO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BU ILDING ADDRESS: R J BEAN ROOFING PERMIT NO 04010147
OWNER'S NAME: PERMIT ISSUE DATE
04
ONE: SANITARY NO. CONTROL NO.
(408) 358-4028
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 Lm that I LICENSEDCONTRACTORS
unOR'S DECLARATION Job Description
wF 1 Sectio'
affirm that I am licenxd undo provisions or Chapter 9lrommcnse is p
�it`$ with Serio^]ocv�of Di isitnJofNC Bu�rM Prrfcssimnx Cock.and my license is p�ppggp �t
in mu rnroeRr t. 3 Z REROOF - ��p��q,��®
j i Licenm Clan v 3 Lic.
F p Date Co.,, to!.
ARCHITECTS O RAT
�w uaandmyPhnsldr.7nsdapubbereen,da FEB 1 0 2004
;o ff Liccnscd Prorcssmi al
I OWNER-BUILDERus, RATION BUILDING$ 1 hereby alfirm that 1 am exempt frood m ms Contactoh LicenseLaw for the
p o following moon.(Secuun 71D IS,Business and Professions Code:Any city or county
m which m,minea a Permit to conmum,alter.impmvc,demolish,fir repair any structure
prior to its issuance.also requires she applicant for such Permit to file a signed statement
fro
that he islieenudpursuant tothe provislonsufthe Contractor's License Law(Chapter 9 Sq. FL Floor Area Valuation
rot- (commencing with Section 7")of Division]of the Business and Professions CNc)or
y`<$
that he is exempt therefrom and the hats for me alleged exemption.Any violation of
Section 7031.5 by any applicant fon permit subjects the applicant o a civil penalty of
nut 359P14'4llLtber00 Occupancy Type
more man five hundred dollars(5500). P Y YP
0 1,m owner of the property,or my employees with wages m disco axle compensation,
will do the work and the structure is not intended or offend for sale(Sec.Twq Business
and Professions Code:The Contractor's Licenu Law does not apply in an owner of Required Inspections
papery who builds Or improsss themon.and who docs mah work hionm f o through his
own employees,provided that such improvements are not intended or offered for gale.IL
however,me building or improvement is mid within ore year of completion,the awrcr-
builder will hale the burden of proving that he did not build or improve for purpose of
sale)
0 1,as owner of the propeny,am exclusively contracting with licensed convammrs to
convect the project(Sec.7044,Business and Profusions Code)The Contractor's Li.
come law does not apply to an owner of progeny who builds or improves thereon.and
who contacts for such Prorcta with a conoacou(s)licensed pursuant to the Convacmr's
Licenu Law.
0 1 am exempt under Sec. B&P C for this mason
Owen Date
WORKER'S COMPENSATION DECLARATION
1 hereby air,.mot penalty of perjury one of the following declarations:
1 have and will maintain a Certificate pfCoaent to sel6iaure for Workar a Compcn.
ution,u Provided for by Section 3]00 of Bic Latin,Code,for me performance of me
work for which this permit is turned.
0 1 bate and will maintain Worker's Compensation Laurance,as mquimd by Section
3700 of the labor Code.for the performanee orlhe work fm which this pcmrit is issued.
My Work.,',Compensation Insurance artier and Policy number are:
Carie'.. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cr is rectum need no tacomptowd if the Permit!arm one handmA do11m($101)
or Ica.)
I certify tha th perrormance of the work for which this Permit u issued,1 shall not
employ any�pL�g�prnany manneLrstasto fico c subject to the Workeri Compensation
gc'-i'To
fCa f 4 — k�
AP IC :1L after making this Cenirica¢of Exemption,you should
suhjcnmme orkcriCompcaetion provisions ofthc LithoCode,you must
Oth comply wire such Provisions Or this famit shall be dccmed rooked.
Z �;! CONSTRUCTION LENDING AGENCY
ce l hereby aRrm mat mere is a eonsuupion lending agency for the Performance of
(Yi the work fur which this gamut is issued(Sec.3091,Civ.C.)
W Q Undoes Name
z Lender's Address
U C) 1 certify that I bass read this application and sate that But above information is
ly P CORPLI.l agree m Comply with all city and county ordinances and sure laws mlating to
0U building convection.and hereby authoslae repreunmives of this city to enter upon m,
1 show-mcmitmed Property for inmection purpose&
(We)agree to save,indemnify and keep harmless lie City of Cupertino against s
F N
liabilities.judgments.costs and expenses which may in any way accrue against mid City
(„) Z in con eque^ec of flue granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOUR TIONS. _ —
gnawre of plicantlConuaztor Dare Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant ser future building uccupanutore or handle haaandous material
u defined by Ibe Cupenino Municipal Code.Chapter 9.13,and the Health and Safety
Code, C)Y.
23532(,)? All roofs shall be inspected prior to an roofing material beim
❑Yes +u P P Y g g installed.
Will the applicant of future building occupant use equipment at device,which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air con aminsma as defined by the Bay Area Air Quality Management all new materials for inspection.
isuia?
❑Yea ja<
shave roti me hvallousmamrials myvimrrrenaunder Chapterti.YS of mr WildingASignature
tel/✓✓ ` ^ ,a
ria Hrslm&e Ocand Codc,Sttumu]5505,35 idirtm.u.nd rCh.,uO6.95 flth Calif., J\C/, /fyC}.11i
nes not cumemly haw a tenant.mat it d my ,responsibility tyn�me occupant or the
're whi uaIxtMCIphororiarnenceofaCenir:atc`0 occupancy. Applicant Date
I-3o o�F
Owner or am 'rod agent D„P All roof coverings to be Class "B”or better
Community Development Department
Building Division
ji City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
4UPEkTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997UBC 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:
�/ c
Job Site Address: / 1 t -OV
JLRoofing Company Name: v✓ 1
A plicant's Signature: - - Date: /—�i0—Oq
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
a REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 2--[ ' o ' I Date: _3 -O`{
Building Address: �1 Lb/ T�
1 hl Qw- K
Owner's Name: Phone#:
Contract Phone#: License#-
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Li-`Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings \ ❑ Provide I.C.B.O.Report#
.2'To be Removed ❑ Provide Mfgr. Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 9—
Job Description: FiKU� ��
O v Q�� wa✓ G0 �,��a o ik
Residenti B-� Comfnercial ❑ "y
F Zone: Yes No ❑ Confirmed with Plann' e t. if
there are any restri tons:
Cost of Project: T e o Constructio Occupancy gro
Qty.
Applko e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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