04100112 CITY OF CUPERTINO ? ".
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDINGADDRESS: RESPONSIBLE ROOFING INC PERM(TN04100112
2332 REGNART RD
OWNER'S NAME: PERMIT ISSUE DATE
JOSEPH WALTER 2882 SPRING ST 10/15/2004
[ONE: SANITARY NO. CONTROL NO.
(650) 969-6151
ARCHITECflENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
,10 z LICENSED CONTRACTOR'S DECLARATION
d affirm that I am ffcun5ed under provisions of chaplet 9(commencing Job Description
with Section 7(M)of Division 3.f do Business and Professions Code,end my license is
menu tome and reel. 2 d E�2QOF�W�COMP. & FIBERGLASS CAP'
i Liccnsc Class = q Lic.N L
o
Data O Contmcmr
tt A CHITECTS DECLARATION
8 u Iund.raand my Plans shall Muscdmpublierarmts
;Qy Licensed Professional
-a OWNER-BUILDER DECLARATION 2004
<P (hereby affirm OW 1 om exempt fru.the Contractor's License Law I'n
AF I
OO following reason.(Section 703 1.5,Business and Pofessions Code:Any city sor county
m which requires a permit m m Construct,alter,improve,demolish, repos shins $33545
t-zi pnonn its issuance.also requires the applicant foramhpermit to flcasi I m
z< that he is licensed pursuant.the provisions of the Contractor's License pt loor Area Valuation
�hG (cam meninx with Section 70k)of Division 3 of the B usiness and Probe
w. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit subject.,Ne applicant to a civil penally of
rot mmc than live hundred della,,($500). be Occupancy Type
❑La sownerof the property, r is employcea withwagesss ale(Sole compensation,
will do fie work,ands: structureisnmintended
censor offered for sale(SO.9044,Business
and Professions Code:iThemproves
ves Contractor's License Law docs or apply to an owner of Required Inspections
propertywhobuilds improvesthereon,and who meant intended
work himselfor edthroush his
own employees,provided inorimprovement the such improvemc it are not intended mpleered foredo.own r,
builder the ave t e b renofng that a did of year of completion,the owner- -
hale.). will have the burden of proving del he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
constrect the project(Sec.9(114.Business and Professions Code:)The Contractors Li
conic law dues nor apply to an owner of property who builds or improves Iranian,and
who contracts for such projects with a tmoraam(s)licensed pursuant on the Contractor's
Liccnsc Law.
E]1 and exempt under Sec. .B&P C far this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby afind under penally of perjury one or the following decimations:
[have and will maintain a Curd Beam of Consent to self-maned for Worker's Compcm
,:tion,as provided for by Section 3700 of the Labor Code,for the performance of the -
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of no Labor Cod.,for the performance or the work for which this permit is issued.
My Worker's CompensaIIi�n�lnsumncc carrier and Policy number art:
Cartier.S �Lo )UReI Policy No.:7 x'37 W6 i
CERTIFICATE OF EXEM PITON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M mmpin.d if the permit is for one hundred dollars(3101)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as In become subject o the WmIec"'Compensation
Laws of California.Dat.
Applicant
NOTICE TO APPLICANT:It.alter making this Certificate of Exemption,you should
become subject to the Worker s Compensation previsions of the Labor Code,yen most
.J O forthwith comply with such provisions or this Permit shall.he deemed revoked.
'z" CONSTRUCf10N LENDING AGENCY
-F I hereby affirm that dere is a construction lending agency for the performance of
(.Y the work for which this permit is issued(Sec.3(197,Ci,C.)
W�Q Lender's Name
a,z Lender'sdeder's Address
U 1 certify that 1 have read this ci application and 5mm that the shove information g is
corrcn.l agree a comply with all city and county ordinances or and shire laws relating e
above-mentioned
hembyauthonp reprcscntatires of this city 10 enter upon the
4 about-(Wein gree to save for Inst an keep h
(11.)agree In save,indemnify and hick hay in an The City scenic
Cupertino against
UZ in
the granting Of this csmit. meginanyway:cove againstaaiOCiry
U Z A APPLICANT
of de UNDERSTANDS
Of this permit.
" APPLICEA��N/ET�UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC-! ULATION$.
a_„�G �� Z/ le Date Re-roofs f
Signature oTAppbcaHAZARDO Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore building occupant wore or handle hacmdous
and Sae(,
as defined by the Cupeninn Municipal Code,Chapmr 9.12,and the Health and Safcry
Cudc,Scnion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yu
Will theapplicant or future building equipment If a roof is installed without first obtaining an inspection,I agree to remove
.mit havardnua air contaminants use as defined by the Bay Arca Air Quality Management all new materials for inspection.
Y District? •
❑Yes [�Na
I have read the inanities materials requirements under Chapter b.95 ofthe Califor-
niaHeald&Safety Code,Sections 255!15.25533 and 25534.1 undersand the ifile building
doxis not currently have a Rnant,that it is my responsibility m nnd'y the Occupant of Ne /Y
requie?which must he met prior to issuance of a certificate or Occupancy. Signature of Applicant Date
�-,ap® G—/
Owner aw�riard age � '� SD� All roof coverings to be Class "B" or better
Community Development
' 10300 Torte Avenue
M �" Cupertino CA 95014
Its
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
ZZ332 nCiv� RSI Z
OWNER'S NAME: -My . Lkja j 1r G r PHONE # (40P, 25 _!Ss/o
GENERAL CONTRACTOR: 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 Res onslble 3
Septic Tank'
Sheet Metal
Sheet Rock
Tile
l Q.tGg/-Zg /a4-
Owner/Contractor SigWature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OFS
�'�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: .
Flat roofs must have a minimum of'/a" per foot slope and demonstrate
1. P P
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.
N
Homeowner's Name: y, wQ 1-}-
Job Site Address: 332 Q Cca K4; ,j,
Roofing Company Name: ISS(2JnSl b LP F-QCL-)G ,-r11C .
A plicant's Signature: li<< r"i Date: 9 2-01 J01-
\�I�1NDW
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
QE . REROOF ( � Z
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
-6 r
Building Address:
22332 � nCtv-t �d • f
Owner's Name: Phone#:
S C r- 00t) 25 - I
Contractor: Phone#: License#:
sib e RCdiro =nG• . 52-6496
Contact: Phone#: Cupertino Business License#:
Ed W-56 5(08-S9b3 16S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof u�uilt-Up roof
❑ Asphalt Shingles ®' Asphalt Shingles
Cr"Wood'Shakes ❑ Wood Shakes
❑--Wood Shingles ❑ Wood Shingles
❑/Other(Specify) TUvC In OY1 ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
CD"To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ffr
Job Description:—1 09 4 disVZs eKls -lrY1 5lia lce '4--WrC(vovn r PP " r`e-t.o
S iG CGS
Residential ComnYercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Deft. if
there are anrestrictions: E
Cost of Project: Type of Constru$4
ion: Occupancy group:
Qty.
A ca e 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
1,