03070179 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT -COON?RACTOR INFORMATION:' !,
BUILDING ADDRESS: DZ CONSTRUCTION I'E1MITN003070179
1_11 KRN�PWOOD
DWNERSNAME 5339 PROSPECT RD PERMITISSUEDATE
]ONE: (408) 446-5208 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT IN170
BLDGELT:CT PLUMB MPRH
0 0 0 0
OO LICENSED CONTRACTOR'S DECLARATION
w❑ 1 hereby affirm Into I am licensed under Pmvi.lons nI Chapter 9(commencing Job Description
6y with Section 7("d fDivision Sof the Business and Profcssinns C,dc,and my license is
in full fame and effect �n O
5Sa LmenmiLm.a D U� REROOF;iiUVQ�� O
l- Date Cnmr➢aor U�:.I
AHCHITLCI-S OCCLARq
? U 1understand my plans shall he used as puhlic..oil,
J1 /� 4
'L0011
n Lwo,my,dI fe.inral AN O
OWNER-BUILDER DECLARATION �n
<Y I hereby at Thal 11. exempt from me Cnmrns fir's,:A.,c Law for me
p O following meas,..(Section 7unSo.Business and improve.
do Professions Cnoe:Any oily fir amnty p Q
K m which its isms n perm;)el cars the applicant
i t our Such
h Permit t or mpmg any strudme
Fly thione las ccuana.alsnumLhep visiosofthe Cuntrarmit to file a,I-Sw Aatcmcnt
< thathe isRansd peRn.nll,lnepmv,amns none rnntran,riucersc law lcn.pmr9 Sq. Ft. Floor Area Valuation
6 9 (tt,he iseingw;thicusout and
b hissisonJ,lthe Ord corruption.
Anynns GWe)or
a_ mel he is exempt memo-.,m.,d the naafis tali fila mlegee exernpti,l,,any vmmh,n,r
Section 7031.5 by any apphcenl for.panes,vetoer the applicant In a civil penally fir APN Number Occupancy Type
not more than five hundred dollars($5(10). P Y YP
❑ L u owner .and
pmpcny,om my cmntendes or offered
wages u their role cW,Business
willdomowmk,and meate Contractor's
intended ortls notapply to an Business 305 — FRAME
.fie progeny mea elide:The Cnneecl„a ndwhe Law dent mi apply If an migh is Required Inspections
prnlemwh.qui pruned that such
chimprve who dueewchwded Proffeed moselehis 307 — INSULATION
however,theeuildin orImmmcmint is sod within ne year(if
Me own B- 601 — ROOF TEAR OFF
however,the building or Improvement is sole within oneynr of comPlninn.mcnwner-
rudder will Mee the burden of proving that he did not Wim or imprnvc for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
1,as owner of the property,am exclusively convecting with licensed contractors to 603 — ROOF BATTENS
construct the Project(See 7M4,Business and Professions Cwlc:)The Con"Clor's U. 604 — ROOF IN—PROGRESS
cane Isw docs not apply 1,.,nosier of P,ovedy who W lids or improves rooter,and.
who contracts for such projects with a contnclm(q licensed Pursuant 10 Ire Convector's
Liccnxe Law.
❑ I am escorm under Sec. ,B&PC for this mune
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hercny affirm under Penalty of perjury,one of the following declarations:
I have and will maintain a Certificate of Consent to sell-insure for Worker's Comlem
nation,as provided for by Section TIM of he labor Code,for the pednrmancc of me
irk for which this profit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the tabor Code,for me performance of the work for which this Permit is issued.
My Workecrs Com Pe. )lJan Insurance anicrand Policy)numner am:
Carrier. L �!la�fa` Policy No LF
CERTIFICA OFIXEMPr10NFROM WORK RS
COMPENSATION INSURANCE
(This ueliun need not nc enmplstcd if the Permit is for enc hundred dufars IS100)
,it less.)
I certify Ilial in the Perfnnnnnce of IIIC work for which Ibis Permit is Issued,I shall not
employ any Person in any manner s,as u,become subject to the Workers Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making flits CeniOcam of Exemption,you should
become subject to the Worker's Cio pensa int,movilimes of the Lanny Code,you most
.J z furthwi It comply with such provisions or this permi tthatI he damn revoked.
z O CON STRUM'I ON LENDING AGENCY
F-' I hereby affirm that rete is a Convection lending agency l or the Performance of
the work for which mis permit is issued(Sec.YN7,Civ.C.)
W A Lem.."s Name
lender's Address
Z) z
U 0 1 ecoify that l have read this appliemien and sure that me Steve oformuion is
{y ^F correct.1 agree to comply wit sty ancounty mdimmccs and emu laws ocItfog e
OU building mnvue,ion, reby➢u fir' rcprescnlntivesof his city In enter a pen the
r C ahovomentinpr avny far ins it ngn,us.
(We)a Io se,indemnil keep harmless the City of Cupertino against
V liabilities,' mo ..Cox an
ca hies may in any way eccmc again'said City
Z
in conn tatea cgrnming n( rmlt.
APDL NT e12s'r WILL COMPLY WITH ALL NON POINT Issued by: Date
` SO R
91 rc of pP anti r ra r am Re-roofs
1{gLARDOU. TERIALS DISCLOSURE Type of Roof
Wcepplieam or furore building occupant Hort or handle herardous material
as c d by the Cupenin�Mury CB.1 Code,Chapter 9.12,and the Hcallh and Safety
Co c.SotYe= 25532(')? /�N it All roofs shall be insp ed for to any r o6 trial being installed.
wilthe applicant or Rome building occupy nt use cqui proem or devices wh ich If a roof is installe Itho rst Obtain) g 1 ection,I agree to remove
hara11111us air cnmnminants..a ecfn ry the Bay Arca Air Quality Management al I new maters. for ins C On.
? P
❑Yes It
hcvc a eel ltio 2mri 5533 armcnsun Jer Chapter fi.95 of the Cin n
ninllealme,, YC 'ecdm 2 ,25Imfcmcmil x,,, ,Ch.mn6.9S if do ClIIIh I
does n Iun II Ie it is my responsibility In mums the occumart of the
octio c sons c r;orl,;aaca,a,racer,irca fir eon >' Signa reof4pli an Date
weer or I a,d agent p,e All roof coverings to be Class "B” or better
1 Community Development Department
Building Division
City of Cupertino
...�„ 10300 Torre Avenue
Telephone: (408) 777-3228
CITY 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.
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: ��[ /�B ✓GUsrldDl�
Roofing Company Name: JL
A plicant's Signature: Date:
Grego
Building Official
Revised 1/30/03
Printed on Recycled Paper
a
CITY OF CUPERTINO7
REROOF 03 7
ol CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
�S Oo z a
Building Addres
Owner's Name: Phone#:
Contractor: t Phone#: License#:
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles o0__,Asphah Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
AGNk
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residenti Commercial ❑
Fire Zone: Yes ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of PrcjeqSj0,r 1 Type of Construct Occupancy group:
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