04020062 CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMIT ONT,RACTRINF„OY2MATIO,N,
Bu1LDINGADDRESS: PRESTIGE ROOFING PERMIT No04020062
OWNER'S NAME: PERMIT ISSUE DATE
NE:
SANITARY NO. CONTROL NO.
AR CHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ti00 LICENSED CONTRACTOR'S DECLARATION Job Desc. A
in� I hereby affirm that 1 am licensed;; virions of Chapter 9(co ane-1-g
with
Soti n7 )of Diviaianlof NC Buss and Profrssiam Codc.and myliccnx is
:P yin ren fa deffee a (( REROOF
Licensee Lk.g
Drew _ ax EB 1 3 2004
ARCHITECTS LARATION
W U 1 understand my plans mall be used u Public records
Limbed Pmfcssi...I BUILDING
OWNER-BUILDER DECLARATION
I hatch,affirm Nal I am eumpt from the Contraum's License law for the
0 0 fallowing reason.(Section 703 1.5,Business and Prefessiom Code:Any city or county
a�$ which requires a permit m construct,after.improve.dcmnlieh,or repair any structure
prior m is issuance,also requires tM applicant for such Permit w file a signed nakment
moi$ Net he islianud pursuant totheprovisionsoftheContractor's lJaucLaw(Chapter 9 Sq. Ft. Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and Profeamorn Code)or
.. that be u exempt therefrom and the but for the alleged eumption.Any violation of
Section 7071.5 by try appliant for a Permit subjects rite applicant a civil Nasky of 3 er0 0 Occupancy Type
not more Nan five hundred della.(2500).
0 1.u owner of Hie property,m my employees with wages u their sole compcuatlon,
will do the work.and the structure k wtinuaed ar.RemA rte sale(SCc.?(1 Business Required Inspections
and Pmvior
fes Cade:The Con ractoYs Liam;law does not apply m an owner of q P
prepeny who builds or improves thereon,end who dos such work himself or through his
awn employces,provided that such improwmausu not intended oroRemd intake.If.
however,the Wilding or improvement is said within one Kar of eempledon.the owner-
Wilder will have the Wrden of proving Nat M did ant Wild or improve for purpose of
sale.).
C]1,as owns,of the pmpeny,am aclutively Conweting with licensed com aeho.On
contract the project(Sec.?014,Business and Pmfesslons Cade:)The COMM Clar's Li.
ecme taw does not apply w an owner of property who Wilds or improms thumn,and.
whoommuts for such pmjecu with a eonuactor(s)licensed pursuant m the Contractor's
font law.
I
excmp der Sec. .B&PC far Nu won
owner Date —bL
W CER'S COM ON DECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
I ban and will maintain a Certificate of Consent m self insure far workersCompcn-
sation,u provided for by Section TIDO of the Labor Code,for Ne perrortmace of the
work for which this permit is issued.
0 1 have and will maintain Wortefs Compensation Insurance,u required by Schon
3700 of Ne Lum Code.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sectumt need not be completed if the permit is foronchundmA dollars(5100)
or loss.)
1 unify that in to performance of the work for which this Permit is issued,l shall mu
employany .her say mmner.u m become subject to the Workers Compemation
Laws o'C
Cl
QQpp�fLant
Ilpi'ICETO APPLICANT:IL after ling this Cenificaw of Exemption,you should
a ome subject m the WorkerY Camp uredom provisions of thc labor Coda,you most
forthwith Comply with such provisions or this poordb shall M deemed rented.
Z 0 CONSTRUCTION LENDING AGENCY
[r"' Ihcrehy.farm Nu then iso eoostmttinn lendingagency far dw fulounnme of
a > dw work for which this Permit is issued(Sec.3W7,Co.C.)
[>)Q Lcndee,Name
6r l<Mer's Address
U 0 I certify that 1 have mad this application end sate that Nc man infmmniun is
carlecL I agree to comply with all city and county ordinances and sack laws minting to
D0. Wilding construction,to
and whereby auNoriuepraencless f this of
ruaga the
W above-mentioned property for inspection pmpmes
G (We)agree to save,indemnify and kith harmless Ute City of Cupertino against
N liabilitiu,judgmcnu.cosu and expenses which terpin any way atretic against mid City
U Z in consequence of the grenOng of this permit
d_/1
APPLICANT UNDERSTANDS AND WILL COMPLY WITN ALL NON POINT Issued by: Date
SOURCE E ULATIONS. f
`O Re-roofs
ignawrc ofAppli HAZARDOUS MATERIALS DISCLOSU ontraccor are
Type of Roof
Will Hsu applicant or future Wilding Occupant store or les undorsmamnal
u defined by HI,Corcoran Municipal Code,Chapter 9.12,and the Hcaldh and Safety
Cade,Section 25572(.)? All roofs shall be inspected prior to any roofing material being installed.
Ayes I Na
Will the applicant or forum building occupant sett equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
D'strictl
D Yes MNu
I have mad the hazardousmawrialemquiremenu under Chapter 6.95 ofdw Califon
nia Hmlth&Safny Conic.Salons 25505.25533 and 25531.1 undervand dhatifthc Wilding
dna Out currently haw a tenant that it is my raperandity,W notify stn occupant of the
require ens 'hmuse On met brwi vancc ata Ccnincaic Occapancy. _ Signature of Appant ate
Alloy roof coverings to be Class "B" or better
Ow ser authariza gent Dow
fr Community Development Department
Building Division
City of Cupertino
•;i, "'� 10300 Torre Avenue
Telephone: (408) 777-3228
CIN OF Fax: (408) 777-3333
VUPEkTINO
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:_>� �y G � �(
Job Site Address: X 0A1--n �
Roofing Company Name:/ VC
T YA plicant's Signature: ate: '—
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Community Development
10300 Torre Avenue
�t Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
91PEkTINO .
Building De artment
JOB ADDRESS: PERMIT # Z_
2Z L4
OWNER'S NAME: PHONE # q Z - x
GENERAL CONTRACTOR: } e S9`' 'FAX #
`'
I am not using any subcontractors: �
gnature Date
Please check applicable subcontractors and complete the foil 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 S ovi
Septic Tank
Sheet Metal
%Owner/
ntractor Signature Date
10/28/03
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
-- lo _ o
Building Address: r 'r 1��
Owner's Name: (f e
Contractor: ho #: $jsy G License#:
l7s
v ` CEom' � .� _ �j Ll& l0
Contact: V Phone V �0"2T—W,3 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles
4V 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 Polic
Job Description: 9-6vt. ai c�t"st.143 C" las ,KJ. 1„shall Yvu-c ><
Pst K=I ” Sof h,
Residenti Commercial ❑
Fire Zone: Yes ❑ Noc5kConfirmed with Planning D
Apt. if
there are any rest ' tons:
Cost of Pr w t. ✓yam, Type of Construct[ Occupancy gro
QtY
A ica le 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
ZCan .