05090073 CITY OF CUPERTINO ,,vend ' > ' ' I X
BUILDING mNc DlvlsloN PERMIT CC�NI2ACTQR L U21VIA1( 1
BUILDING ADDRESS: T D ROOFING P�A1R NO05090073
OWNER'S NAME: PERMIT ISSUE DATE
TONY GIOVANNONI 3540 MARGATE AVE. 09/12/2005
)NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ED
LOO LICENSED CONTRACTOR'S DECLARATION lob Description
i� 1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P
with Section 701(p)ofDivislan 3 of the Business and Professions Code.and my license is
r' y inmRfareeandeffefy 3e1 REROOF-T O 2 LAYERS WOOD S A f�y^y{ 1F,']t�' t`��,..
j Z� Licence Ctaaa Con g g�l-5 S q / ����Xe ly `yam^
;� D.m Contractor REPLACE W/LANDMARK TL COMP. U�ttt�B�� aaa
DOR
ARCHITECTS DECLARATION
e a�
y I untleraunJ my plan shall W used an public records
;t; Licensed Professional SEP 2-% 2005
y5OWNER-BUILDER DECLARATION
i I I bereM1y affirm
that I me exempt from the Convector's License Law for the ('
R OO following mason.(Section 7W 1.5,Business and professions Code:Any city or county
$� which requires a permit in cnnsuum.alley,lmprow:.dcmNtsh,ar repuir any nructum ' � •,
prior to its issuance,also requires the applicant for such permit to file a signed Ralement au
FF < that he is licensed pursuant to the provisions of the Contractor's License L w(chaPta9 Sq.Ft.Floor Area mValL t
C€� (commencing with Section 7000)at Division 3 of the Business and Profession Code)or
that he is exempt tWrefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the appliesm m a civil penalty of ApN Number OccupancyType
int mom than rive hundred dollars($50)). 36 214007 . 00
- YP
❑1,m owner of the pmpeny,m my employoea wit,wages u thehsom a mpenution,
will do the work,and theamacmm is notimmuded or offered reaam(See.7014,Business Required Inspections
and Prefradon Code:The Convector's Liana Law does rot apply m e ns an owner of q P
proper w ho bui Ids or im proves dmrcon,end who does mch work himself or ihmugh his
own employees,pmAded that such improvements am notintetiled ora0aed for sale.if,
however,the building or Improvement is mid within one year ofcampledon.the awoer-
builder .will have the burden of proving that W did not Wim or improve for purpose of
sale.).
❑1,an owner of the property,am exclusively contracting with licensed cunusumm m
construct the project(See.7064.Business and Professions Code:)The Commarm's Li-
ce..few doss not apply b an owmr of pmpeny.whe Wilds or improve Nemo.,and,
who conmeots for such projects with a com rsuam(s)licensed pursuant in the Conummrs
License Law.
❑I am exempt under Sec. .B k P C for this moan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I beroby arrive under penalty of perjury one of the following declension:
I have end will maintain a C"ficate of Consent in If-imam for Worker's Compehr
miles,m provided for by Section 3700 of tbe Labor Code,for me performance of the
wyg��k for which this permit is issued.
(y r have and will maintain Workers Compensation Insurance,m required by Section
3/D0 of the Labor Code,for the performance of the walk for which this permit is issued.
My WorkeInc mpensedon I mance ce ierand Policy numberam:
Cartier. C Policy No.: I S
CERTIFICA
OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE .
CIMS section seed nal ccomplet d Ifthe permit is fmamhundreddollam(g1(10)
or lean.)
I certify that in the performance of the work for which this permit is issued,l shall not '
employ anypersan in my manner an an a becomesubject to the Workers'Compensadon
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should '
become subject m the Workers Compenaetlon provisions of the Labor Code,you mum
`j, forthwith comply with such prevision or this permit hall be deemed rooked.
i O CONSTRUCTION LENDING AGENCY
't•s
4 I hereby air.that them in•construed.rending agency fm the performance of
a> the work for which this permit is issued(Sec.3097.Civ.C.) -
W Q Lenders Name
a z Lender'sAddmu
U Q 1 ceNfy,that I ham read this applicaion and Raw that the neve information is
ly correct.I agree to comply with all city and county ordinances and state laws minting to
C.) building convection,and hereby authorise mpmwnativcs of this city to corm upon tin:
W above-mentioned property for Inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
h.w y Iiebllitrea,judginents.Casa and expenses which may In any way secure against said City
in O
APPLICANT UNor theRranuNDSof Ihis AND WILL COMPLY WITH AL NON-POINT Issued by: - Date
SOURCE RECUL
u uo' i q I] ) 0% Re-roofs
Signature of App eanKordtaemr IDale
HAZARDOUS MATERIA Lh SOSURE Type of Roof
Will the applicammtown building uceupramet, ad].hannow.s material
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safely
Into
de,Section 255330)? All roofs shall be inspected prior to an roofing material bei. Installed.
Cl Yes N P P Y g $
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It It Mo..11Inamminaodc0ned by the Bay Area Air Quality Management all new materials for inspection.
en"?
❑Yes /
Ihava mad the hc, fioamateriW5533 me5534,lunder CMpmr Oatifthc Caldin t
HcaINAS ctyC e,Sectian25S113,25577 anJ23354.1understandNati(theWillinel notc lly a atenantNatItamymsponimlit m na'r'y the oceupant oftd. I, hi um m KIV,bmance.raCChermm fOcca cy. / Signature of Applicant Date
Owner or authorized agem Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
b ` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
,#UPER,TINO
Buildirig De artment
JOB ADDRESS: f PERMIT #
qA ,2 Se �� e �,� �e (�' �e I 00i09 oo � 3
OWNER'S NAME: T2-n. G' c\ � r) PHONE 4 0 S a S 9 1 S 6--Z
GENERAL CONTRACTOR D FAX#
I am not using any subcontractors: ZRIDA
ot % .�L o
Signature Date
Please check applicable subcontractors and complete the folloinformation:
60 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:M: 1
Sp
Owner/Contractor Si a Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�TINO 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.
7. 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.
� r
Homeowner's Name: 10 Y�N4 G o%la V)kn)-N i
lob Site Address: C1 12 S e_� k-"-I\ �, 2,1f �(
T_
Roofing Company Name: i V_(3
Applicant's Signature: Date: _9L1 , to
. Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
ai'CUP01NO PERMIT APPLICATION FORM
APN# 3 G ;l 14 CD O Date:
gl , a. I o5
Building Address:
Owner's Name: Pone#:
G ; o \Jc�,, ,no „ i
Contractor: Phone#: License#:
T D c 4 ,3g 89 .2 88 % 4 SSc=t l
Conrract: I It Phone#: Cupertino Business License#:
9-:> 2 / JJ civ i � Cy u,9 6 4 6
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof Built-Up roof
Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ 'Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
/hof To be Removed ❑ Provide Mfgr. Installation Specs.
40�1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
61 Job Description:
nI
x -n, oJe 1c.yeJS Woock SI1cvL-;LLS 7vf � C�. vJ
Residential Commercial ❑ c%„ cvr T L
Fire Zone: Yes ❑ NoConfirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Constru tion: Occupancy group:
SOO y,p _ roo
Qty. if
Applic,ible 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