09030041 CITY OF CUPERTINO �vTIA��T Z � t
BUILDINI;DIVISION PERMIT v
UZU
PERMIT NO.
BUILDING ADDRESS:
nal
19735 DRAKE DR TBD - 1 BE D PERMIT ISSUE DATE
OWNER'S NAME:
SA R CONTROL NO.
INE:
BUILDING PERMIT INFO
PARCHrnrECT/ENGlN:FER: BLDG ELECT PLUMB MECH
Z ccLICENSED CONTRACTOR'S DECLARATION Job Description
11UCy affirm that I am licensed under provisions°C Chapter 9(commencing
_ZW000)ofDivision3ofdtcBusincssmdprofcssionsCodc,andmylicenscis RE-ROOF REMOVE WOOD SHAKES INSTALL PLYWOOD &
n-y in full force and effect
�12z Liaenscclaaa�—Contractor ASPHALT SHINGLE & PAPER. 19 SQUARES
3 t-LU Dam ARCHITECT'S DECLARATION
� �
I understand my plans shall be used as public records
m<
�yU
4 O l- Licensed Pmfcssional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
❑O Collowing reason.(Section 7031.5,Business and Professions Code:Any city or county
e which requires a permit to conswct alter,improve,dem°lish,or repair any structure
4 Cn prior to its issuance,also requires the applicant for such permit to file a signed statementF31632037 . 00
Ft.Floor Area Valuation
?< that he is licensed pursuant to the previsions of the Contractor's License Taw(Chapter 9q'
I-$ (commencing with Section 7000)of Division 3 oC the Business and Professions Code)or
000
Y.y .. that he is exempt therefrom and the buffs for the alleged exemption.Any violation ofAPN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more Watt five hundred dollars($5M.
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactoes License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale If,
however.the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.). _
[3.1.as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and•
who contracts for such projects with a cone actor(s)licensed pursuant to the Contractor's
License Law. B&P C for this n
I am exempt un ec.
Owner Date
W RK S N DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for worker's compcn-
..non,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 oC the Labor Code,for the performance of the work for which this permit is issued.
My Worker,,=Code,
Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of rho work for which this permit is issued.I shall not
employ any parson in any man r ore bject to the Workers'Compensation
Laws of Califomiar Rate
Applicant ��11
NOTICE TO AP LIC :If,after making thhs Ccntficate o!Excmpttan,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W ALender's Name
0 z Lendees Address
I certify that 1 have read this application and state that the above information is
LUL 0 correct.1 agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorim representatives of this city to enter upon the
s.
W above-mentioned property for inspection purpose
C)
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
V Zin consequence of the granting of this permit. Date
r, APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued b):
SOUL ULS._
/ I) ( Re-roofs
Signature or Applicant/Cont-actor ate Type
of hoof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or futurebuilding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
C
Yes ° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
:t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
.strict?
OYes Qf
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safety Code,Secdons 25505,25533 and 25534.1 understand that if the building
does not curran have a tenant,that it is my responsibility m notify the Occup t ar the Signator of Applicant Date
require hic must be met r to issuance of a Certificate of cupaucy
All roof coverings to be Classor better
Owner or authorir'ed agent tc
CITY OF CUPERTINO
RE ROOF
OF
CUPEkTINO PERMIT APPLICATION 0<70300q I
APN # 3 2 0 -3-7,66 Date:
Building Address:
Owner's Name: i �� Phone #:
HOA: Yes ❑ No ❑
If es provide leiter from HOA 4D g 3
Contractor:
Phone #: O 30P_ 4
( G 0-Y 00 R04-1 UGC Fax #:
Cupertino tjusiness License #:
Contractor License #: 7 7 67.2 5"
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles � Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
P_-,e — �" —
Job Descri tion:
v s�e -1 �aj l�s S
91
�l `
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation:
I Hav ead, Under and and Will Comply wilh Cupertino's Tear-Off Policy:
Sign e 'INC
cJ S Revised 02/05/09
a(ve
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
CommisE ion Fee
1 BSEISMICO Seismic (commercial B
IREROOFRES Re-roof lzesidential B 1SFDWLR00F
o.
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis,ion Fee
1BSEISMICRE Seismic residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business; License B
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 ag.,ee to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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 nai] 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/i "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 a-b-�ove stated policy on re-roofing.
Homeowner's Name:
Job Site Address: `�]3 ��� �K V _
Roofing Company Name:
Applicant's Signature: Date: — 0
PP �
Greg Casteel
Building Official
Re,.ised 07/30/08