04060186 CITY OF CUPERTINO ':>a � + »'�' �" " •. ,a> a•r..
BUILDING DIVISION PERMIT- G�O 'ITRACTC)R INk'URMATI(JN
v'.W' ,•�kt„ .��..+r,kf`r�.., s ~off* %:•.
'BUILDING ADDRESS: ABOVE ALL ROOFING PERMIT NOV.4060186
10265 RICHWOOD DR
OWNER'S NAME, PERMIT ISSUE DATE
KATHY BREWSTER 700 NORTHRUP ST
ONE: SANITARY NO. CONTROL NO.
(408) 292-4188
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
DC ELECT PLUMB MECH
O o LICENSED CONTRACTOR'S DECLARATION r Fl a
1 hereby slam tum 1 am licensed under provisions of Chapter v(commencing Job DeScriptii n 2004 n� with Section NA0)af D'so n 5ofdm Bminmeand Pm sslml Code,and my license is JUN 7 Z�0
in furl amlercen _ 9 �< qiI REROOF W�COMP. 4
te Contrac C I hal
ARCHnEGfS OBe RATIOI.A- N �—
? U I u.,.and my plans shall be used ss public mews BUILDING
;LLQ Licensed Professional BdY1�VJ
+0I OWNER-BUILDER DECLARATION
y
0 0 1 hereby affirm that 11. exempt from the Contmemoa :Any c law for the
yp0 filwhicwingmemo.eannit 1 RDL5,Busfmsand are.dimum Code:Anycity or county
+�$ which mquims a pmmio n rnnnrhe alter,Improve, permit to
ale music my tstructure
ammem $6250
k,zY poor ms Imenena,aru regtth,the for Cchpermiuoicurre nednammem
< (commelittnsM Sectio 7") fDiviomnfoKComncmhnimnsclaw(Co tend 5 Ft. Floor Area
'{5FFv P P P q• Valuation
6Ss (cat he Is ingwith ominate and of Divisiofr nftWeged exeand mpton.Any
Code)or
ill
that he 6 exempt IMmfrom and de beer far Ibe subjects
the cvemant to Any l violation of
.Section.1.0 7031.3 by nary applicant for s permit subject Ne Applicant m a civil penalty of p y Type
not mom Nen Ove hundred dolrrs(SSW). C OCCU anC
❑1.As morer of Ne property,or my employees with wages As doomic compensadmn,
will do the work,and the structure is not intended or offered for sale(Sec.TOM,Business
and Professions Code:The Con racmrs License Law doan Act apply To an owner of Required Inspections
prnpcnywho builds orimpro les thercon,and whodoeaauch work himself ortluough his
own employees,provided that such improvement are not intended moRered forsale.If,
however,the building or improvement is sold within one year of completion,the owner.
NI will have the Wrden of proving that he did not Wild m improve for purpose of
Mlc.).
❑I,a owner of the Property.am coclusivaly contracting with licenced convectors to
construct the denied(Sec,7744,Business and Prefosdom Code:)The Contractor's Li.
cense law does not apply On an owner of property who Wilde or improves daemon,and
who contract for such Project with a contractor(s)licensed pursuant to the Contractoes
License law.
❑Iameaemptundm Sce. ,Bh PCforthisremem
caner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afnrm under pamlty of perjury aro of the following declarations:
I,,",
1 have and will maintain aConifemc of Consemm aelf.ianon for Workers Camper.
ion,u provided for by Section]]W of the labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insurance.m rt uimd by Section
W ofthe labor Coda for the performance of the work for which this permiti Issued.
`mW;orks' m nasi sunnm�✓c/sarin and Policy number ate:
1 yfrVOF EXE.NPf10NpAl�M WORKERS-
VVV��- COMPENSATION INSURANCE
(nrsectlon need not be completed If the permit Is for one hundred dollars(SIM)
or lea)
1 certify Nat in the performance of the work for which this permit is issued,)shall not
employ any person in any mannas m to become subject o tho Workers'Compensatlon IT
Laws of California,Dat
Applicant
NOTICE TO APPLICANT:If.after making his CcniOcarc of Eacmpiion,you should
become subject to the Worker's Compensation previsions of the labor Cade,you must
.J,'Z forthwith comply with such prnvWnm or this permit shall W deemed revoked.
Z OECONSTRUCTION LENDING AGENCY
I hereby affirm Nat Nem is a construction lending agency for the performance of
the work for which this permit Is issued(Sec.NN?,Civ.C.)
14 QLendcrs Name
It. Lenders Addrem
V Q I OAI Nn 1 have led this application and sok,Net On move information is
[tat F tunnel.I agree to comply with all city and county collimates and soon laws mining to
QU Wlch j,mmwetion,and hereby authorim roprcsenttivm of this city to rotor upon the
W a WvcmcnuonW Propertycosts
for inspection
ex a recs purposes
,a'a agree to save,indemnify and keep Wanless Ne City of Cupertino agai mtmceentice dgmctb costs and On Offla"s which ley in any way¢cmc ageimt mid CiryiAoPPLIIeCATWOfth _WANDStAND WILL COMPLY WITH ALL NON POINT Issued by: Date *-
(We)
SOURCE ATIONS.
6 ZZ-a
Re-roofs
gnemre of ApplicanUCanlnnor Dere
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF
Will the applicant ale future Wilding tatomm.h re arhandlc hmudous metrial
m de0ned by the Cupertino Municipal Cones,Chapter 9.12,and the Health and Safety -
ode.gecoon 25552(a)?
❑Yesa All roofs shall be inspected prior to any roofing material being installed.
Will Lou applicant at future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wrardm$air eomomimn s Outlined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑Nu
Ihar mid the WklyccharzNtmam 5505, requirements and 35 underChapterdcomo that fire
the Wilding
.is Heald&SafnyCodc ccuom25,it I,mynmd255Ja.l to mound le oce.e Wilding �� -� f
doesno"....currcn y a octan that it is my rmpomihility m nouly Nc mcupant of Nc \ O
�remcn hich a aroissuanccofa CcniOcatof Occup. o d
z yatureofApplicant Date
�;
Ow�icr Lir awhorizcJ egret new All roof coverings to be Clas B or better '
Community Development
s 10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDWS: �O RMIT 004(%O`%-16 0 t (%O`%-16
OWNER'S N ( 1er(#talip 0'6a/--d PHONRiffj `7?_Z.- CS-VL/
GENERAL CONTRACTO • FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
1 1• Linoleum/ Wood
(� Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing d ViWa
Septic Tank
Sheet Metal
Sheet Rock
Tile
zz )
S/ O v� try/Contractor Signature Y Date
MM�
Community Development Department
Building Division
` City of Cupertino
Ls,�w 10300 Torre Avenue
Telephone: (408) 777-3228
CITY Of Fax: (408)777-3333
OUPEkTINO
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 po icy on re-roofing.
Homeowner's Name: U (QAAS /riQ✓lU �q t/, �Q
Job Site Address: ,1.1vo5 CV\k&60rrJ, or II
Roofing Company Name: r-ym261 V 1- v, �y1 .
A plicant's Signature: Date:�/v y
• Greg teal
Building Official
Revised 1/30/03
Primed on Recycled Paper
1�
' CITY OF CUPERTINO
00
CM'GF
CUPERTINO PERMIT APPLICATION FORM
APN #
]Building
ress:Owner' e: Pho #:ContracLwJ ano aVaf Y(A JL
n, 11 hone #: ' �/ ( � Licen e #:-7�/ 1
U UwS U(j 2Z_
1 g /-1 `� S S-
Contact: Phon #: Cupertino Business License #:
� �t uU8 ZqZ- (-1) kY
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A!r Asphalt Shingles
.B' 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: e
Job Description:
T 6W h Wn 11 lr a Q I Vik-edl l w, s•)
Residential .F Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: ,- ZSR Type of Construction: Occupancy group:
QtY -�
A i b e Fee ID Fee Description Fee Grou
BPERMFEE Bld Permit Fees BUILDING
BENERGY
Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
?4�
2-- 7, 7"