05080154 CITY OF CUPERTINOz�w
BUILDING DIVISION TRACTOR INFORMATIO t
PERMIT C�N - v' :3 8 „ '. :, s A•
BUI LDING ADDRESS: - QUIROZ CONSTRUCTION INC PERMIT N0,05080154
85/87 RQLLTNCRR RT)
NER'S NAME: PERMIT ISSUE DATE
JOSE MORENO 105 N 27TH STREET 08/18/2005
INE: SANITARY NO, CONTROL NO.
(408) 999-0881
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
U00 LICENSED CONTRACTOR'S DECLARATION Job Description
til F 1 hereby afOrm Nat 1 am licensed under provisions of Chapter 9(commencing P
ZW with Section 7")ofDivision 3 ofthe Business and Pro(rssions Coce,and my license is fa0 n n
+« in mufmceande(fect. C y REROOF- --T, O�COMP� INSTALL COMP.
License Cl Lm./ C•/ _ /) ,, 5•
ay tt r
cs Date d--CO lJJ Con V vCOt �yy N d k.,�'y$y,.3
n Fy1 ARCHITECTS DECLARATION
Sc z< 1 understand my plans shall W used as public records
low ��3i- 2005
a o t; Licensed Professional
3 OWNER-BUILDER DECLARATION
0 0 1 hcmny attired Nat 1 am uusin Trent We Contras Co Any c Law co the
[N
fI y ,a�,�
o O which
muoa Permit
i ](13 L5,Business end PnNczvioli Code Any city a county �fLL"-J,ry\/Ill Uy I I 4f 1'
<$ which mquirns s permit w emnsvueL alter,improve,demolish,or repair any svucwm
prior to its iuiance.also mquims the applicant for such permit to file a signed mawment .. .. r �i
s< that w is licensed pursuant to We provisionaOf We Conoawor's License law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section T](a0)of Division 3 of the Business and Professions Code)or 67500
y — that he is exempt thcwfrom and the basis for the alleged exemption.My violation of 4
Section 7031.5 by any appiiesnt for a permit subjects We applicant o a civil penalty of APN NumberOccu ane Type
not mom than five hundred dollars(SS00). P Y YP
❑Luowner of the pmpeny,or my cmployces with wagesuthcir sole compenutlrn,
will do We work and the structure is not intended or offered for sale(Sec.70U,Business
and Professions Codc:The Conmaofs License Law does not apply to an owner of Required Inspections
progeny who builds or improves thereon,and who does such work himself or through his
own employees,pmvided Na such improvements arc not intended an offered for sale.If.
however.We building Or improvement is sold within one Year of completion,the Owner-
builder will have the burden of proving that he did ant build or improve for purpose of
sale.).
El 1,as owner of We property,am exclusively contnaing with licensed contractors to
eonsuuct We project(Sec.71)14.Business and Professions Code:)The Conraaor's Li.
nse Law does not apply to an owner of properly who builds or improves thereon,and
who conuacss for such projects with a contractons)licensed pursuant to the Contractor's
License Lew. '
. ❑I am exempt Under Sec, .B h P C for this reason
137W.fOc
r Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one Of the following dcclaratimu:
ave and will maintain n Ccnirwaw of Consent w self-insum for Worker's Compere
,az provided for by Section]]00 of tM labor Code.for the peRormarme of We _
for whim this permit is issued.nave and will maintain Worker's Compensation jammer,as inquired by Semon
laborCodc,foes Ne performance ofthe work forwhim Nia Pencilis issued.
orker's Compenation Insurance caries and Policy number art:
er f \c!y 1(11 n L Policy No.:
CERTIF�E6 M MON FROM WORKERS'
COMPENSATION INSURANCE
(TTis section need not be completed if the permit is formic hundmd dollars(SI00)
or less)
1 cenifv that in We performance of the work for which this permit or issued,l shall out
cmplry any person in any manner so as m become subject o o Com insure
Laws of Califmrn'• III' yc
Applicant ]3--k `U-1
NOTICE TO APP .Ir,after making this Ccniftute of Exemption.YOU should
become subject to We Worker's Compensation provisions of the Ulcer Codc,you must
O forthwith comply with such provisions or this permit shall he deemed revoked.
? " CONSTRUCTION LENDING AGENCY
I hereby¢Iran that Were is a construction lending agency for We performance of
fY. We work for which this permit is issued(Sec.3097.Civ.C.)
W Q Lender's Name
jz Umbres Address
U C) I certify flat 1 have read this application and sum Nal the Wove information is
W f-' correct.l agree to comply with all city and county oninanes and slow laws relating to
�U building consuUclion.and hereby authorise representatives of do&city to enter upon We
ve-mcntioncd propeny(or inspection purposes.
H y ¢ho (We)agree to Live,indemnify and kap hamilcss We City of Cupertino against
rq liabilities,judgments, .a.and expenses which may in any way accrue against saidCity
U in consequence of We granting of this Permit. _
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
' �•� Re-roofs
Signalufc mama" Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant ser future building occupant store or handle hacamus material ,
az d"T"by the Cupen)?bw Municipal Coca,Chapter 9.12,and We Hcalth and Safety
ode,Scction 25532(¢ `� All roofs shall be inspected prior to an roofing material being
❑Yes lAINr P P Y g g installed.
Wtu the
Beans rr dN Wilding oaa amt r:r equipment rr a.iaa wnirn If a roof is installed without first obtaining an inspection,I agree to remove
PP g v quipmen
VaLl�rcl?
hazardous air emnnminann as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes �/ 1No
I have mail We haxio mamrials requirements under Chapter 6.95 of We Cali for.
iias not Currently
CawaSemhms 255(15, my and 2553a,1 uncaraan We occuremofWe 11 0 'va1L�/
docs not curten0y have a tenant that it u my raponsihility m notify We rccuPant of We
requirements which must W met prior to issuance of a Certifica Occupancy. Sig r&&evf A—p-pTi"Ca nt Date
z � All roof coverings to be Class"B"or better
owneer7Y
r autt Data
sm
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
:UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: LLU[ C0 �, FAX #
I am not using any subcontractors- U -1 U-G-s
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 1 c(
Owner/Contractor Signature Date
Community Development Department
'Q Building Division
City of Cupertino
i 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C O P E IST I N® Fax: (408) 777-3333
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: .___J OA e yy cl im
Job Site Address: /C 6
tE , 2, !5 O d �OJL 0 C/
/�
Roofing Company Name: ( 1 I A I a-1_ &2A 2A C 4 ppnc
Applicants Signature: Date: o_ C 7
Greg Casteel
Building Official
Revised]7/2/04
CITY OF CUPERTINO
tUPamRFROOF
UTTOF
EkTINO PERMIT APPLICATION FORM
APN # c� (� Date: 0o5
Building Address: r
Q �U CICS
Owner's Name: 7 Phone#: -r<O50-5-0 77/z
Contractor: Phone#: Lice se #:
8�fo- y
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
'gr— Other(Specify) p1r�c�. W� _Gr__6ther(Specify) CcMfosi.�lt�
Number of existing covenngs ❑ 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 Polic ❑
Job Description:
E
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: v, Type of Construction: Occupancy group:
Qty. if Fee Grou
A licable Fee ID Fee Description
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energv BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPL CHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
300