05060088ITY OF CUPERTINOBUILDING
DIVISION PERMIT1LDINGADDRESS:
FO
WESTERN ROOFING COMPANY
""MITNG05080088
70 LILY A
NER'S NAME:
PERMIT ISSUE DATE
EMI NAKAHARA
2174 DIANA PL
08/12/2005
ONE:
SANITARY NO. CONTROL NO.
(408)258-7749
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION .--
Job Description
1 Wrcby afOrm that L am licemed Antler previsions of Chapter 9 (commencing
P
with Section 70[0) AID Burinevatb PmfeasiuisCade, M licenseis
to
nmufa a^.arca 7
REROOF-T/O SHAKES, INSTALL LIT. WEIGHT
LieA s LIe.M
Dam Convumr
EAGE LITE
CHITECTS DEC RATION
I uneemund my plana shall M used As public record
Licensed Pndcainnel
OWNER-BUILDER DECLARATION
I h.(firm Nal 1exempt from the Contractor's License Low Law for I
reason. Profession Cole: My city or county
fallowing reaan. (Section F131.1. 3, Business andimprove.
which rtyusma a Permit m emmrthe eller, improv, de sir'myi,md auucmm
former permit A fl c a a hapten l
prim m s l issuance, alas m On the she applicant Oc Copermit w is e a eLaw (Chapter
tathe purwant Nth) Nc
Sq. Ft, Floor Area Val❑ 3b6900
menciansed
of Dialomof
Code) or
(commencing with Section? of viCnJe)of
e0 usinessand Professions
of toeged
basis f3
exemption.Any
Nat he b exempt Ihcrtfrom and iK bub for Ne Alleged emmption. Any violNun of
tend
APN Number Occupancy Type
Sallon 1031.5 by any applicant for • permit mbjecu the applicant Io a civil penally of
not mote than Ow hundred dollars ($500).
35903035.00
t"awn" of tW property, or my employees with wages u their sole compensation,
V
Required Inspections
w..h.vmW`.nd Ne structure is not lnlesWed or offered for sale sm 7060, Business
and Professions Cade: The Cormucmr's Luaum law d"a not apply H an Owner of
q P
prepcny w ho bui lds or improves Hereon, and who does sue h work himself or through his
own employees, provided Hat such Improvements Am not intended araffered 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
sala.).
❑ 1. As owner of to property, em exclusively contracting with licamed rontmemm to
construct He pmjcct (See. 7044, Business and Professions Code:) 71. Conuacmr's U.
cense law does not apply to an owner of property who Wilda or Improves Lemon, and,
who conmacts for such projects with a contmenor(s) licensed pursuant H the Cantor's
L' Law.
l em..Cmp n er See B & PSC for this recon
Owner I Dem n -�
RFRSMPENS DECLARATION
1 hereby than unhr pemlty of p ' ry one of the folloom dedaatiom:
1 haw and will maintain a Certificate of Consenuo self-imam for Worker', Compen.
"Amn, as provided for by Section 3700 of the Labor Code. for the Performance of the
-
work, for which this Permit is issued.
❑ 1 have afW will maintain Workefs Compensation Insurance, As mquirtd by Section
3700 of the labor Code. for the Performs"ofth) work for which this Permit is iaued.
'
My Workees Campemation Insurance varier and Polity number am:
Cartier. SThfCC^I ./AMID Policy Na.:[� —O U�
CERTIFI TEOF EMPIONFRO V RULERS'
COMPENSATION INSURANCE
(This section hoed.this) completed if the permit is for enc hundred dol .0100)
"Imo.)
I car ify that In the perf 'mance of Ne w"k fm which Nis permit b Toned. I shall not
-
employanyp"soni n mann b m ubjutm the WorkegCampmsadon
Laws of Celifamia. e
Applinnt
NOTICE TO Ale PLICANT: IL eller mak ng thisenl0ca of Exemption, you should
become subject to Ne Waher'a Campewtian pe iaiore of me lath" Cade. you most
foMwit comply with such provisinm"ibis permit Nall be doomed mated.
CONSTRUCTION LENDING AGENCY
I herebym that there is a construction lending agency I'nr Ne performance of
the work for which this permit is issued (Sec 3097, Civ. C.)
Lender's Name
Lender's Add.
I cenify that 1 have mad this application and state that the show information is
cmmcl. I agree N comply with all city and county ordinances and sum laws relating on
building construction, and hereby autharim mPreunudves of this city in enter upon me
above-mentioned property for impccdon purposes
(We) agree to a... indemnify and keep harmless the City of Cupertino against
liabilities, judgmcnu, casts and ex emsee which may in my way accrue against said Cayin
,
s Permit.
APPLICANTDS
)UNDER5TANOf LW granting Of tAND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type of Roof
Signature of ApplicaDate
HAZARDOUS MATERIALS DISCLOSURE
HAZARDOUS
WIII theapplicant or factum building LLomor handle h
ealdowmatedai
a dented by the no Municipal Code. Chapter 9.11, and the Health anJ Safety
e. Char
catl), n eaus3:(a)7
32(.)?
❑Ye, Na
All roofs shall be inspected prior to an roofing material beim
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use cquipmem at Jevims which
mit herardnos air contaminants As defined by the Bay Area Air Quality Management
all new materials for inspection.
DisuictT
E] yea "'
I have mad the hvarduus material rtq.im=ms.ndcrChApmr6.95of to Califon
r
is Health &Safety Coale, Sodom 75505,25533 and] 15534.1 understand that iflhe Wilding
Jam not cuadBy ham, A An"�J at' ts my remorabilisy m notify me occupant of the
f e—
rcqul'cm ew ch must be pEI to O.uanmaf a ceru0cate of occupancy.
Signature of Applicant Date
` (
2-sJ'-- All roof coverings to be Class "B” or better
Owner -
,..Ih.rWid agcn D„)
Please check avvhcable subcontractors and comvlete the following information
r
Owner/Contr 'to Signature
Od'-/2'd1
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
r
Owner/Contr 'to Signature
Od'-/2'd1
Date
u
CITY OF
CUPERTINO
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.
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.
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: LVA' UA14AA&2=&
Job Site Address:
Roofing Company Name:
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Onn�nA nn Onn.nlaA Daner
Date: �[2
:CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # / 0 3 D � rte– Date:
Buildin Ad� ss:
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING
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Owner's Name:
Phone #: /j� 2-3
4 0 77
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-Contractor:-
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Phone Cicense#_
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W (W1gR
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upertino Business License #:
Phone #:/'
Contact:
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Type of Roof Covering:
Existing:
Proposed:
Li Built -Up roof
❑ Built -Up Roof
❑ Asphalt Shingles
El Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
L3Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
❑ Provide I.C.B.O. Report #
Number of existing coverings
6-'�To be Removed
❑ Provide Mfgr. Installation Specs.
II Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1
–
Cf
Residential
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Det. if
LJ
there are any restrictions:
�y (90Type
Cost of Project:/()J
of Construction: Occupancy group:
Qty. if
PPP. C Tnun
A licable Pee LU
BPERMFEE
BENERGY
BSEISMICRE
BSEISMICOM
BPLANCHK
BUSLIC
BldLy Permit Fees
Energv
Seismic Fee Res
Seismic Commercial
Plan Check Fee
Business License
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING