05110028 (2) F
ITY OF CUPERTINO 95✓y�te�ry•.w.sp`��.y�'{�* � {'�' (�1�T
BUILDING DIVISION PERMIT ik Vlo,it r,"GTQ�w^It�FO
LDING ADDRESS: ROOF ROOFING emoair N0.05110028
rT,FNVTRW All
OW HER'S NAME: PERMIT ISSUE DATE
RUSS VIERRO 77 VAREAR DR
CONTROL NO.
NE: S1ANITARY NO.
408) 265-9270
ARCHITELTIENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
3o'd
LICENSED CONIMAC1ORSDECLARATION JobDescription
£ 1 money affirm that I an Ikea under Provisions of Chapter 9(Commencing
with Section 70M)ofDiviaion 3oflim Business and Professions Code,and my licens is
+pp'�
it,full 5 REROOF--T/O COMP. /INSTALL COMP.
i Z Lkenm lis It N
y Dee - Conlruser_ Roo.—�ob
e ARCHRECTSO ION
C i understand my Plana dull h used u public rtcards
au.
Licensed Professional
ora Oat I am exempt
from
we ContTION
a S 1 hereby atiim that 1 1. exempt from tiro Contractors :Any law for tie �
l O following uirou;newsom.(Suction 70715.Buaieeu sod improve.
dcu il Code:Any only of Coumy
39 Whkb itsi papmasl reCMWtim.lite haplr su hpemitt or Rpur ed lm meat
tprior Mhathecome 87000
Misased c.posmrequire thcappnsofdfor amhperrlm Okow Lsw moment
�< (commrcing cJ purmanl mlhe pmviaians3 offt mrxbrand Proclsiw(Coule) 9 Sq.FI. FIOOC Area Valuation
O that Wisen{wtNSerefram and
basis for
oftheeWCosandumfMyvi Code)arm
IMI io e 313 b thesUmm and or Wim it Ibe arlo{ou emmant M AnY l PeNm of
Section thews n any rullkanl for a remit subjects rhe applicant th a civil Penalty of r Occupancy Type
ml mart dun lw buodmd dollars(SSW4
0 1,an owner of we Property,or my employees with"Sea u their sok compensation,
will do the work,and the structure,is not bonded or offered for sale(Sec.7041•Buaircaa I
and Professions Cade The Camrannrs Llmu ce Law dam Cot apply b wo owner of CLI I ss,
Property who build&aimproves,thereon,and who does such wok himss)f or through hu
own mnplayea,provided the such improvements art notklended arofferod forsale.If. /A
howenr,she Wilding or Improvement is mid within one yefeomPlesion.the owneJM
Cancer- .93
burner will haw W beraw of proving that he did not build or Improve for purpose of C U
sale.),
❑1.uowneroftheproperty,.B ernes woy PmmsMg with:)meedommnces U.
Consima the Project(Sec.TON.Business mod Rofasaiau Code:)The an themer&Li•
.he raw dons not apply man owns ofinenc nyaM beam of WPro Wedemon.ad, DUE
Cha e e Law.for such roomers with acanmacmr(q licensed pununt m the Convutsl
License Law.
❑lam caempl roses See ,BQPCfor bb moon
Ower Due
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under thermally of perjury rn of IM following declumdau:
thaveandwilleunWn aCeN wofCauentmsof-insertforVVa ICempun
salon,u provided for by Seodon 370D or the labor Cade,for the pwifcmuaz of Ilr
wart par which this permit is issued.
❑1 ban and will maintain Workers Compensation Inamorata,u required by Secdm
7700 of the Labor Cade,for the prfamauee of the work forwhich the permit is Issued
MY Warker&,Cam Ilan Nmrame'"and Policynumber am:
carrier. S�- - o PolkyNm�2go�ilgiS Loot
CEAPIR7E0 PXEMPION MOM WORKERS*
COMPENSA71ON INSURANCE
(This maim weed Curiae Completion lbe permit(more Mammo dollars($1011)
Mmry)
1 cutely that In the performance of the work fa which this remit is issued.I snail ora
employ any person in my summer an as be become subject b that Workma'Compensation
Laws of California,Dau
Applicant
NOTICE TO APPLICANT:If.&hr matin{this Certificate of Eaempti m.you s mew
accurate¬al to the Worker Compensation pmv W=of the Labe Coda you must
0 Z forthwith comply with such Provisions a the peril"I be deemed rtwked.
z O CONSTRUCTION LENDING AGENCY
t--t Iherwhichir the Jon (Sm.
307.Cin.agency forth pa(ureae of
6Yv�>••� de work Na which this remit ts issued(Ss,.J09'1,CN.G
0 Lanaurs Name
�z tenaeraAaaresa
t.)Q 1 cenify that I ban reod this application and mule the the show Information is
if.E correct.I agree u &a
e to=reply with all city and county ordinances; e laws missing to
Q rVbuilding cmmuctim•and hereby mthodm repruenuWu of the city to cntaupem new
{27 ahn-meotioued Property for Inspection Purposes.
{y (We)agrte to sat,indemnify and keep harmless the Clly of Cupertino against
In liabilities,judgments.cents and expenses which may In any my mare s,{alnaimid City
V 7 bePLICANTeofthegSTANDf the Pcrll. / r—
�+ APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG /
5� Re-roofs
ofApplici n,Co Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Om applicant or Nuue Wilding accupa LMM or handle lammkw material
u dented by the Cupenino Municipal ,Chapter 9.12.and the Hearth and Safety
ode,Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu a
Will the&pp0man arm Comoro hilar,occupant mm equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit huumw.all cmumrnanu u m: by the Bay Amo Air Quality Management all new materials for inspection.
Due m7
❑Yes
No
I ban man the huudtw nuerala requirements under Chapter 695 of the Califs- // O
rus Health S SafetyCode,Sections 25505.25 malt 25534.I understood that lfda building `- S
Java mt cummly have a e nL a my responsibility b nedfY me 4YYPM of
!g alrema hi iss..facutificeyr Signature ofAti:Tplicant Date
/ d
Owner unuthorind agent Dee All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDR SS: PERMIT #
OWNER'S NAME: o PHONE #
GENERAL CONTRACTOR:-T,>, T-Z,,..%:A FAX #
I am not using any subcontractor �( -Dj
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
IP Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
f
f l� ,ar
Owner/ ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
� TFax: (408)777-3333
UPER. INO
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:
Job Site Address t ott y 1
Roofing Company Name: :000r �d %-
Applicant's Signatur : Date: ��
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
o I
Owner's Name: Phone#:
Zv5 S 40v• '3 A- 33 s
Contractor: Phone#: License#:
Z +off Loo �'., r 26r gti p (ar) S6 Ir
Contac : Phone#: Cupertino Business License#:
P. `lmw- bRo • S -7 / 2
Type of Roof Covering: z G 7)
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
'` Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu ber of existing coverings 2 ❑ 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:
Job Description:
a 70 [gc�
Residential Coqrunercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning DMt. if
there are any restrictions: LJ
Cost of Project: dr' Type of Construction: �ccupancy group:
-16+x0 C e,
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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