04070185 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CCINTItACTQR I'NTCJILMt T ON
BUILDING ADDRESS: DONE RIGHT INC h PERMITNO04070185
10314 MALM DR
OWNER'S NAME: FERMITISSUEDATE
CATHY ROFFEHO 1129 LONG FT7.T.T.OW AITR 2004
NE: SANITARY NO. CONTROL NO.
(408) 377-8777
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUOMB MEOCH
Loo LICENSED CONTRACTOR'S DECLARATION IObeDSSCrlption
1 beteby afftrm that 1 am licensed under provisions M Chapter 9(commencing _
with Se5tion 7011117 fOiviaion Sof NC Bus send Pr cuinna ode,and m�yy llcenmis
ay in nnroeayde r . d REROOF W/COMP.
Lienor L » A
�—p Oa¢ Comncmr a U
e RCNITECTSD ATION
U as/my plans shell W used as Public mcnrJs py,�} 1 e ppb
OWNER-BUILDER DECLARATION 74
®��
S I hereby affirm Nat I am exempt from the Convectors License Law for the q
p 0 following mason.(Section 7031!,Business and Professions Code:Any city m county (o'9
X$ which requires a pcmit to crostrw:L altar,improve,demolish,or repair any structure
to °' 'poor to its issuance,also requires the applicant forsuch Permit to file a signed sutament
FSC that he is licensed pursuant mthe pmvisions.(the Cmuracwr'sLicense Law(Chapter 9 Sq. Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of thc Business and Professions Code)or
$ Nal he is exempt therefrom and the bats for On alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of $i_%UiMer 0 0 Occupancy Type
not mom than five hundred ddbux(5500).
❑I,as owner ofthe property.or my employees with wage as their sale compensation,
will do thework,end Neawmum is mol intended or onemd f.,,k(Sec 7W.Busness
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
propeny who builds or improves thereon,and who does such work him set f or through his
own employees,provided that such improvements arc not intanded oroffered for We.If.
however.the building or improvement is sold within one year o(completion,the owner.
builder will have the Wrden of proving that he did not build or improv:for purpose of
rale.).
❑1,as owner of the property,am exclusively contracting with licensed convacmos to
contact the project(Sec.7006,Business and Profesaiona Code:)The Conmewr's U.
cause Law does not apply to an owner of property who Wilda or improve thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Connector's
License Law.
❑l ren exempt undo Sac. ,B k P C froths;meson
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby afl under penalty of Perjury,one of the following declarations:
1 have and will maintain a CertiRcam of Consent to self-inure for WorkcrsComber.
1c,
ion,as provided for by Section]700.f the labor Code.for the performance of the
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,a roquired by Secdon
W of the Labor Corte,for to performance of the work for which this permit is Wand.
wo ri o en don unttey carie Pot cy NOand Y number '��/� j
ERTIFI ATEfOF�EXEMPTION FROMW S'
COMPENSATION INSURANCE
(This section need not W completed ifthe permit is for onehundred dollars($100) '
or lea.)
1 certify Not in Ne perfortnonce of the work for which this permit is issued,I shall not
employ any parson in any manner an as to become subject to the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,alter making this Ccnifteam of Exemption,you should
become subject in the worker's Compensation previsions of the labor Code,you must
.,z forthwith comply with such provisions or this Permit shall be doomed revoked.
„zy ""' CONSTRUCTION LENDING AGENCY
[—i Ihereby offiom Nat there isoconabrction lendingagarey for to performance of
the work for which Nu permit is issued(Sec.3097.Co.Q
14 Lender's Name
7. Lender's Address •/gip'
V I certify that I have read this application and state that the above information is
U. t~ cored.)agree to comply with all city and county ordinances and state laws mixing to
OtJ building consmcti.n.and hereby amhorim reprnsenmtives of Nis city w enter upon the
r LV above-mcmioncd property for imeoccuon purposes
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
„Fy h liabilities,judgmcru.coss and expenses which may in any way accrue against se id City
V Z m consequence of the gra r7g of this permit.
r.r APPLICANT NDS AND WILL COMPLY¢LL�N-POINT Issued by: Date
SOURC ONS. /�(
Re-roofs
Ylipsoafe ofApPhc HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or fuwm building occupant stare or handle havudaus material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
'agililCole,Section 25532(a)?
,as
—/ All roofs shall be inspected prior to any roofing material being installed. '
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil Woot dme;reit contaminants as defined by the Be,Area Air Quality Management all new materials fo ' spection.
District?
❑Yes
shave read the hmatdws ryaterialsrequimmenu under Chapter6.95 of the Califrry
OrInected
cd 505.25533 urm! 5130.I unJersund thmifthe Willingvmntl au Natitismyresponsibility m notily hthem horw mience.f.Ce"i ice or Si tore ofA licant Date
� pg PP agent z Date All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
UPERTINO
Building De ment
JOB ADDRESS: � PERMIT #
OWNER'S NAME: (�
WPHONE
GENERAL CONTRACTOR: FAX #
1 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 �/f
Septic Tank
Sheet Metal
Sheet Rock
Tile
r/Contractor Signature ate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
�UPEkTINO
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 cove stated policy on re-roofing.
Homeowner's Name: L`C / /
Job Site Address:
Roofing Company Name:
A plicanYs Signature: Date:
\�I/�VN[XJ� Ili
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF b J
CUPERTINO PERMIT APPLICATION FORM
APN# 6 ^�
/
Date:
Building Address: 3/
Owner's Name: Phone
a wfa - `
3,2 lC
Contractor: Phone#:
L ✓ M377License
#: �1�16
Contact: CJl Phone#: Z - Cupertino Business License#:
h
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Z�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 TeV Off Policy: 12-1 _
Job Description: t�D i i s ) /� Q I /cl / "L.1
Residential P,- Commercial E] 7 V AJ c��C/
Fire Zone: Yes ❑ NoZ Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: / Type of Construction: Occupancy group:
Qty. i
Appli6aWe 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