04080260 CITY OF CUPERTINO a^,/��..
BUILDING DIVISION PERMIT CON ,bR I4� ge�t" - '-.
BUILDINGADDRESS: ALPINE RESIDENTIAL CONSTRU It T6"04080260
In ,11111nall
W NER'S NAME: PERMIT ISUEDATE
1
GURCAN & S
ONE:
SANITARY NO. CONTROL NO.
408 858-4
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
G E UMB MECH
t�
200 LICENSED COMAACIOR'SDECLARATIONJobDescrip On
iY F 1 hemby affirm that 1 am licamad under provisions of Chapter 9(commencing -
!EI with Scaian 70110)uf Division3of Ne Businem and Profrssiunv Code andmyliemscis
e so L enforeeendeffec I REROOF NOV 9 2004
Mj{� License CI s Lic.M
Dam O Convector n
AR H17EOTS DECLARATIOI BUILDING[understood.,plans shell be used a public records
3LLU
Licensed Professional
5O� OWNER-BUILDER DECLARATION
I hemby e0irm Nat 1 am1. exempt from the Conmctoh License taw for the
y p 0 which ng reaon.Permit
i 7113.rust, dues and Professions Code:Any city nr county
+� which its e a a permit pi cure.dica alma improve,de Permit
t or repair any structure
prior no its examen,.I.requimetW appliam for such permiuo file asigned smmmcm -
< thetheis licensed p.mount mthepaviswm;ofthe Commcmw(Chapter 9 Sq.Ft. Floor Area Valuation
Law
els z❑a (commencing wish Section 70110)of Division 3 of the Business and Professions Code)or
3..
that he is exempt Ihcmfrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty of 3 M NSffiMvr0 0 Occupancy Type
nut more Nan five hundred della.(5500).
I,as owner of the property,army employees with wages as their sale compensation,
will do the work.and the nature is not immnded oronered forsake(Sec.7W,Business
and Profealoa Code:The Contractors License law don not apply m an owner of Required Inspections
property who build,ar improves t her a m.and who d.,s.,h work himself or through his
awn employes,provided that such improvements are mmintended or offered forsem,if,
however.the building or improvement is sold within one year of completion,the owuer-
Wilder will have one burden of proving that W did not Wild or improw for purpose of
sale.).
Q 1,as Owner of she property,am exclusively contracting with licensed mnvacmme to
construct the project(Sec.7044,Business and ProfOrnmo Code:)The Commoners Li.
area law does not apply m an owner of property who Wilds or improws shemon,and
who concocts for such projects with a contractor(s)licensed pursuant m dm Conmetoe'a
LI ense law.
1 am ezem t�n,,tle^r Sec. B"P,C to'this
...a
nor "'"" `� QA Dam '-+ �/
WORKER'S COMPENSATION DECLARATION
I hereby aRtm under penalty of perjury one of Om following declarations:
1 hew and will m urnsin aCenifinot ofommm,m self-inure for WmkersCmilam.
adon,a provided for by Section 3700 of the Lothar Code,for the performance of the
wmk for which Nis permil is issued.
1 haw and will maintain Worker's Compensation Insurance,a required by Section
1700 of the Labor Colo.for the pedorman..f she work for which this permit is issued.
My Workers Compensation]...am Cartier end Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed ifft permit is foronchundred dallars(SIM)
or loss.)
1 canary Not in Ne performance of the work for which this permit is issued,I shall not
employ any person in any manneran as to become subject to the Workeri Componeation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Cenifiesm of Exemption,you should
become subject to the Workers Compensation previsions of the Labor Code,you must
OZ forthwith comply with such provisions or this permit shall be deemed revoked.
„z„O CONSTRUCTION LENDING AGENCY
[--, I hereby affirm Nat there is a ronsueation lending agency far the performance of
the work for which Nu permit is iawd(Sec.3099,Civ.C.)
QIandcrs Name
D z Lcnder'a Address
U Q 1 certify that I Mw mad this application and sum that the be.information is
Ill, F correct.I agree to comply with all city and County ordinances and slam laws Riesling to
0U building convection,and hereby auNmire representatives or this city to enter upon dm
Uabove-mentioned property for inspection purposes.
Vj F gy (We)agree On ave,indemnify and keep hamlea the City of Cupertino against
h liabilities,judgments.costs and expenses which may in any way accrue against aid City
to consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ^
SOURCE REG ATIONS. 3/ Re-roofs
Sig,mturc of App,a.VComuacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wail the eppliant or future building occupontsmm a handle harandous mamdal
dolined by use Cupertino Municipal Cade,Chapmr 9.@,and the Health and Safety
SmUm s53z(.)1All roofs shall be inspected prior to any roofing material being installed.'
❑Ya Na
If a roof is installed without first obtaining an inspection,I agree to remove
WIII the applicant or future building aupant use equipment or devices which
emit hazardous air contaminants a defined by she Bay Arca Air Quality Management all new materials for inspection. `
Demo,'
❑Yes No / /l
IhavercadC has dom25 rialarequircments under Chepmdb atifthc Califon �l �/
dies HcoNASntly ha a amant. hat It is
rte d].5534.1 in notify thacupam of the
ng
data not currently haw a tenant the It u my rcsponsihility m notify dm occupant of the
rcuiremenuwhich Tustbemel rinuiumance.fa Cervantaof Occas a. Signature of Applicant Date
y1/ All roof coverings to be Class"B" or better
Owner m sushorimd agent Oats_r
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: ! � '� IrI PERMIT # D,+ 08,C) 2 60
OWNER'S NAME: M r Ail rs L- PHONE # 9'5 g- y^ b
GENERAL CONTRACTOR t ne Codd s/1 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 Signature Date
Community Development Department
Building Division
r City of Cupertino
10300 Tone Avenue
CITY OF Telephone: (408)777-3228
U��_ '�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
1 t'he above stated policy on re-roofing.
Homeowner's Name: AAr- I f&
Job Site Address: /040 M o U eun lamer'
Roofing Company Name: A-12l/\-P `QondJYu^4&i `
A plicant's Signature: Date:
CIV `1NDCJ�
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper .
CITY OF CUPERTINO
SaCOREROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# � / � � s-' Date:
Building Address: /040 Nov aLm be_r n ��
Owner's Name: M r Anal ,l)C4 r Y A ra J( Phone#:9 7 3 0576
Contractor-G P #. 5 6 License#:
e6� 3, 146' 13
, 4S /3
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )f Asphalt Shingles
1< 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: P epla A N eoc,I �
`3� Woo S'� w.Vk
Residential X Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project Type of Construction: Occupancy group:
$2,000 .
Qty. if
Applicable 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