04090062CITY OF CUPERTINO
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BUILDING DIVISIONPERMIT
COl�LRACTOR INF0i2MATION
BUILDING ADDRESS:
PERMIT NO.
04090062
R AMPREENEEAF BR
PERMIT LS$UE DATE
ONE:
SANITARY OL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG EIPCT PLUMB MECH
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p LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 Mrcby affirm Mat I am licensed under p viaiaxs of Chapter 9 (commencing
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wiMScii 70)IBai'Division3of MCBusinev 11 Pullmans Code. and my licevc is
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REROOF W/COMP.
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Dalc =1 Conlnclor
ARCHITECTSDECLANAfION
CONTRACTOR: SNOWDEN ROOF SYSTEM
I understand my plans shall he used as public records
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In Licensed Profcssianal
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OW NER-BUILDER DECLARATION
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1 hereby mGnn that I am exempt from Me Contractors License Law for the
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following amort. section ID3 L5, Business and oli Cmc: Any city county
w, de any structure
Which q re cnnswct, improve, demolish. s
iss s a pea
y
ea(commncing
fie a sig
its leo applicant Such Contranniuoflese, Lawmitemem
pat Inc its censedeehant to ms
ilio of the Comrsewrsnd
life")
Sq. Ft. Floor Area
Valua[iL1n890
rdpurstnm7pre
POeelaw(Chapte9
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of Diviomnr
iM Section7")nd7 of Division of the Bmineuand Cmle)or
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-Mat
r on. Anyone
he u exempt therefrom and the buil for the alleged exemption. Any violation of
Mat M s exempt
APN Number
q;� Occas ane
P Y Type
Section 7031.5 by any applicant for a permit subjects to applicant w a civil penalty of
not moa Man five hundred donor ($500).
0 1, as owner of the pmpwy, or my employees with wages as Meir sale compensation.
32630175.00
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Required Inspections
will do the work and the swcture is not intended or offered for sale (Sec. 7044, Business
and Profession Code: The Contractors Liaise law does ma apply in an owner of
property who builds or impmvu Merron. and whodoessochwork himself or through his
own employees, provided that uch improvements are not intended oroffered forsak, If.
however, Me building or impmvement is sold within one year of completion, the owner.
builder will ban Me burden of proving Mai he did not build or improve for purpose of
sale.).
0 I, as owner of the property, am exclusively contracting with licensed comacwn to
construct We Limpet (Sec. 7044. Business and Rafeasio a Code:) The Contractor's U.
came law dors not apply to an owner of propery who builds or improsrs Memon, and
who contracts for such projects wit a conlaactor(s) licensed pursuant o the Contractors
License Law.
O l Me exempt under Sec. , B A, P C for Mis reason
Owner Dat
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane mrtbe fallowing declarations:
1 have and will maintain a Cci iOnt of Consent to self-insure for WorkeraCompcn-
tion, as provided for by Section 3700 of Me labor Code, for We Performance of Me
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance, as required by Section
37W of Me Labor Code. rot Me pceformenee of the work for which this Permit is issued.
My Worker's compensation Insumncc carrier em"Iicy number am:
Carrier.�/ Polty aZ7_2 /9Oj- 2c:aW
CETICTONK
TMOnONRO:WO
AN INSURANCE
mill section need not he completed irthe pensi t is for one hundred dollars ($IOB7
or lcas.)
1 certify Mat in the performance of Me work for which this permit is issued, I shall not
employ any person in any manncrso as to WCane Sanest to the Workers' Compensation
laws of coliform.. Dat
APPlicam
NOTICE TO APPLICANT: V. ager making this Certificate of Exemption. you should
become subject to Me Worker's Compensation provisions of Me labor Code, you must
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forthwith comply with such provisions or this Permit shall be deemed evoked.
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CONSTRUCTION LENDING AGENCY
I hereby Nrm Mat Were is a construction lending agency far Me performance of
the work for which this Peron is issued (Sec. 3097. Civ. C.)
Lender's Name
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builder's Address
1 certify Mat I haw Lead this applismon and Mute that Me about let ...Men is
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carries. 1 agree of comply with all city and county ordinances and mile laws relating to
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and hemhyaudtonpurpo exnuti.res of this city menu upon We
ahpve-memiuned property foriupection pugroas.
a1mwngconstruction,tone
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(We) agree in un, indemnity and keep harmless Me City of Cupertino against
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liabRities,judgments.eosts and expenses which may in any way accrue against Mid City
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in consequence of Me granting of this permit.
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APPLICANT UNDERSTAND$ AND WILL COMPLY WIT ALL NON-POINT
Issued by: Date -
eRRCvvRREEGULATIONNS.
Re-roofs
Type of Roof
CEE
Signu cof pPlicanV�-:n-1.r Dat
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Of future building Occupant store or handle hmndoas material
u defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
cmc, Stttion:ss3z(a)7
All roofs shall be inspected to any roofing material being installed.
❑rut .�Nu
prior
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
mit havardoes air contaminants as dc0ncd by the Bay Area Air Quality Management
all new materials for inspection.
Dmsvicl7
DYcs JR-Nu
Ihave mail Me Wire ciusmawialsmquimmcntsunder Chapwr6.95ofde Califon
v
ria Health&Sarcty Cadc,SccMmaM505.25533 xmInS34. Iundcrsmnd thalifthc Wilding
docs haw Nat it
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not curcmly a knank i /u pmnsihility m nwMy the Occupant of Me
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ic'Mrxmcts which must he metpnort tf cearaceniraale of OccPpeney'
Signature of Appl' ant 1 Date
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All roof coverings to be Class "B" or better
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ownerner
o ugcn� Date
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
aILI-5EW
PERMIT #
OWNER'S NAME:
PHONE # -,q
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors: �/ wL a �/� _ g - /?—ey
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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 Signature
Date
'NUi
CITY OF
UPEQ INO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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.
is 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: %r ccie (e,7 7 eykz
Job Site Address: .2-0-22e) (7/1 EEN A4
Roofing Company Name: Yt Cr
A plicant's Signature: Date: <7 -/3 `� y
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
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CITY or
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
BUILDING
BSEISMICOM
Owner's Name:
S-02a✓E
Phone #:
Plan Check Fee
BUILDING
BUSLIC
Contractor:
Pho #:
License #:
01
ontact:
Phone #:
Cupertino Business License #:
-J O G — G Z
Type of Roof Covering: .
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
® Asphalt Shingles
9- 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: EL
Job Description:
Residential ®
Commercial ❑
Fire Zone: Yes ❑
No ❑ Conti ed with Planning Det. if
the e any restrictions: / ,
ject:
Cost of Project:
Type of Cons tfpCn_ O cupanc �ii
I
91y. rf
able Fee ID Fee De.-crintinn
Fre (7rnnn
\ 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