04100081 CrrY Or CUI"ERTIN0 N >
BUILDING DIVISION PERMIT WNTM" -TOR INFORMATION >'� -
BUILDING ADDRESS: I INC PERMITN
0923 CANYON VISTA DR
OWNER'S NAME: PERMIT ISSUE DATE
al RANCHO EEP CLIFF HOA 605 COMMERCIAL ST 10/13/2004
ION[: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCH ECT/ENGINEER: BUILDING PERMIT INFO
BLOC ELF.CI' PLUMB MECH
G� 0
M
0 o LICENSED CONTRACTOR'S DECLARATION
j.r I fete Y af0rm that 1 am lian.¢d nJca pmvisions of Chapter 9(commencing Job Description
zw with qof Division 3ofm B 0 eats and Profcssinn.0 a�andmyliccnscis p� o�r . !S !d% �7
in full eand C �U REROOF W/ DURA LASTy�
�= Licen laza
n=m Datat�ract!f%,
-A} ,ITECTS S ATION
Or
na �,l my pM1js s1 N: .cd rpanhe caste° AI'iZ `Z-� 2005
sa License, r^fessional \ `
�0� OWNER BUILDER DECLARATION 1�
M
i 1 hereby affirm on am exempt from he Contractor
:An,a Law tits he B RU�L®I� A
Cc o following reason.(Section]113 L5,Business an,PnJeszinns a's L Any city w county pNtlA�r ��VJVpI
is,.,� which requires a permit to construct,alter,improve,demolish,or repair any stmeture $10100
F2i prions its issuance.also requires the applicant for such permit to file a signed.stalcmem
-xthat he is licensed pursuant to the provisions of the contractnh uecnsc Law(Chapter 9 Sq. Ft. Floor Area Valuation
'i-0 (comma acing with Section70f0)or Division 3 of the Business and Professions code)it
n 3 Nat he is exempt merafrom and the Buis for ma alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty of 11C Occupancy Type
not marc man f farcical dollars($50)). P y. Yp
O 1,ax owner of the property,or my employees with wages as than sora compensation.
will do me work.and alta awaum is not intended or offered for sale(Sec.70UI.Business
and Pmfcasionx Cade:The Condoners License Law dues not apply to an owner or Required Inspections
property who Edi Ids or improves thereon,and who does such work him actor through his
own cmployccs,provided that such improvements arc not intended or offered for sale.If.
however.me building or improvement is sold within ane year of completion.Ne owner-
builder will have he burden of proving mat he did not Moi to or improve for purpose of
sale.).
❑1.as r of but tonicity,am exclusively contracting with licensed contractors to
commaCt the project(See.TMs,Business and Professions Code:)The Contractor's Li-
se Law does not apply to an owner of property who builds or improves Ihemon,and.
who contracts for such projects with a contractri licensed pursuant to the Contractor's
Lice a.Law.
❑l am exempt under Sec. .B&P C for this roman
Own Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm ands,penahy of perjury one of me fallowing declarations:
U I have and will maintain a CenifeamofConsentto self-insure for Worker'sCom,en-
satian,mprovided for by Section J]W of me Labor Coale.for he per(onmanec of he
work for which Cris permit is issued.
❑1 have and will maintain Worker's Compensation Insinuate,u mq^imd by Section
3]00 of he"he,Calc.fur the perfurmanec of the work hof which his permit is Issued.
My GkeTrs-C mperuatVynxunn and Policy no
aniet✓IfA����- ill-o Nu.: ram:Olf 7-0-
CERTIFICATE OF F.XEM FI'IONF WORKERS' `I
COMPENSATION INSURANCE
(This section mail not be tmmpleted fair permit is for unc hundred dollars($100)
r less.)
I ecNfy that in the performance of the work for which this Permit is issued.I shall not
employ anyperaten in any ma azto Mcoor is el to thcworkcai Compensation
LawaafClii m
nnnhcam
bcC6 E- L0J .after making this Cep nits or the aemption,you should
bt�subject to with
rhat's
pro Compensation previsions of the deemed
Codc.you must
z
forthwith comply with such provisions or this Permit he dccmcJ revoked.
z'O CONSTRUCTION LENDING AGENCY
rte. I hereby affirm mat mere is a construction lending agency for the parfmmance of
"1 me work fur which this permit is issued(Sec.3097,Co,C.)
W Q Lender's Name
Lender's Address
� z
U O 1 Carry mat 1 have read this application and state that the above information is
W im^ Correct.1 agree to comply with all city and county ordinances and state laws relating to
Q U building construction,and hereby moisture representatives of his city to enter upon the
C above-(We) d I.rain far impaction pumices.
(We)agree m case,iodcratif,expenses
and keep harmless me City of Cupcnmo against
UN incoities.judaof thetosuandef this pswhich may in any way aecrvc against xaial City
U r7. in APPLICANT
urtbt granting of this permit.
^ APPLICANT UNDERSTAN ND WILL COMPLY WITH ALL NON-POINT Issued by: . Date
SOUR EGULA ONS.
Re-roofs
atone of Applicamucontraaor Date
HAZARDOUS MATERIALS DISC �URE Type of Roof
Will he applicant Lir fuwm building uceupanrnwebr handle hvafduus material
az defined by the Cupenion Municipal Code.Chapter 9.12,and the Health and Safety
Code.section zss3z(ay All roofs shall be inspected prior to an roofing material being❑tierNa P P Y g g installed.
Will he applicant or into.huiliing oaupant use cyuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haiardoux air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District'
u
❑Vcs
I have read the hxsallous materials requirements under Chapter 6.95 of the Cali for
aid Hcalm&Safety Code.Seeuum 8515.15533 and 25534.1 undersand mat if the building In _I , f
hes nm curre ml hmc a t t,th I it rs my rerpunsibildy m notily the,scupanr nI tet /
rayuirnu c mart tpmumissusnccOra CcnrBcu` Opun13�v�
Signature of App (cant Date
own anmorind agent Data All roof coverings to be Class "B" or better
• Community Development
r 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPERTINO
Building De artment
JOB ADDRESS: 1 I d y 2 3 Ca �o vt ts� a 2A PERMIT # /O�,9
c u
OWNER'S NAME: S C7 C PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: °
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
Owner/Contractor Sign e, Date
I Community Development Department
Building Division
i City of Cupertino
10300 Torre Avenue
OCITY�f Telephone: (408)777-3228
��'�O 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.
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.
HomeownersName:
10G A_� Ccs nvt
Job Site Address: e_p�
Roofing Company Nance: �Y o(.e�u e 0 v"' -
A plicanYs Signatg:\ lc�� �L - Date: 10-) 3 ��
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
GCS- REROO)F
CUPEkTINO PERMIT APPLICATION FORM
APN# 3S"/ Date:
(� ° `� - t o
Building Address:
Owner's Name: CowtQGSs v�,k mo,�rPhone#:
Contractor: Phone #: License#:
1s� 31,, 010 '7 (, 10
Contac . Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
ElAsphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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:
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: (5
CqsJ of Project: Type of Construction: Occupancy group:
00
Qty. if/. '
A lic,i � 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